Post-Breast Cancer Radiotherapy Bronchiolitis Obliterans Organizing Pneumonia.

BACKGROUND: Radiotherapy for breast cancer has been implicated in the development of bronchiolitis obliterans organizing pneumonia (BOOP). Patients may be asymptomatic or may have pulmonary and constitutional symptoms that are moderate or severe. Postradiotherapy BOOP usually develops during the 12 months after completion of radiotherapy and is characterized by ground-glass opacities in the radiation-exposed lung and frequently in the non-irradiated lung. METHODS: An updated literature search and review was performed to update the systematic review we conducted in 2014. Ten new publications were identified: 2 Japanese epidemiological studies, 1 Japanese case series study, 6 case reports, and 1 review article. RESULTS: The incidence of postradiotherapy BOOP was 1.4% in both Japanese epidemiological studies. Risk factors included increasing age, cigarette smoking, and increasing central lung distance. The case reports included 7 women who had breast cancer postradiation BOOP and 1 woman who had an ataxia telangiectasia mutated (ATM) gene mutation, which may increase radiation sensitivity. CONCLUSION: Postradiotherapy BOOP in women with breast cancer occurs at a rate of 1.0-3.0% and may occur in women with immune system dysfunction and genetic mutations.

Systematic review of postradiotherapy bronchiolitis obliterans organizing pneumonia in women with breast cancer.

BACKGROUND: Radiation therapy for breast cancer has been implicated in the development of bronchiolitis obliterans organizing pneumonia (BOOP). This inflammatory lung disorder was first noted in 1983, and there have been numerous reports of BOOP occurring in women who have had radiation therapy for breast cancer since 1995. This study was undertaken to perform a systematic review of postradiotherapy BOOP to determine the occurrence, presentation, treatment, and outcome. MATERIALS AND METHODS: A systematic literature review was conducted according to the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses report. RESULTS: The literature search yielded 10 Japanese epidemiological reports with 129 women, 4 case series reports with 36 women, and 24 case reports with 34 women. Common symptoms included fever, cough, and shortness of breath. Most patients received corticosteroid therapy, and duration of treatment ranged from 6 months to 1 year, although some patients received steroids for longer than 1 year because of relapse, which occurred in approximately one half of patients. No deaths have been reported. CONCLUSION: BOOP is a rare but significant complication from radiation therapy for breast cancer. Chest radiographic studies for women who report new respiratory symptoms during the postradiation period can be beneficial for early diagnosis and for guiding appropriate management.

Post-breast cancer radiotherapy bronchiolitis obliterans organizing pneumonia.

Post-radiotherapy bronchiolitis obliterans organizing pneumonia may occur in as many as 2.3% of women receiving radiation therapy for breast cancer. Cough and fever are common symptoms, and a quarter of these women have no symptoms. Latency period is usually within 6 months after completion of therapy but may be as long as 1 year. Pulmonary function is normal or will show slight decreases in vital capacity and diffusing capacity. Chest computed tomography studies show ground-glass opacities with air bronchograms within and outside the radiation field, and there are often peripheral triangular-shaped infiltrates. Management consists of close monitoring of women who have no symptoms or minimal symptoms, and a short-course of corticosteroid therapy for women who have symptoms and extensive bronchiolitis obliterans organizing pneumonia. The prognosis is excellent; there have been no deaths reported.

Bronchiolitis obliterans organizing pneumonia, 25 years: a variety of causes, but what are the treatment options?

Bronchiolitis obliterans organizing pneumonia is an inflammatory lung disease involving the distal bronchioles, respiratory bronchioles, bronchiolar ducts and alveoli. Its cause is generally unknown, but there are several known causes and associated systemic diseases. The clinical features include cough, shortness of breath and bilateral crackles. The vital capacity is slightly decreased, and the diffusing capacity is moderately to severely decreased. The high-resolution chest CT scan shows bilateral ground-glass opacities with air bronchograms and triangular, pleura-based opacities. Corticosteroid therapy is the best treatment option. The outcome of patients suffering from bronchiolitis obliterans organizing pneumonia is good, as up to 80% of individuals will be cured.

Diagnosis and treatment of constrictive bronchiolitis.

Constrictive bronchiolitis is a bronchiolar airway disease that surrounds the lumen with fibrotic concentric narrowing and obliteration. The mosaic pattern seen on the expiratory high-resolution chest CT scan is diagnostic in an individual with shortness of breath, early inspiratory crackles, and irreversible airflow obstruction. Swyer-James-MacLeod syndrome is no longer considered a congenital disorder but as constrictive bronchiolitis detected in young adults who had infectious pneumonia during infancy. For lung transplant recipients, tacrolimus continues to be an important immune suppression medication, extracorporeal photopheresis may improve the decline of pulmonary function, and azithromycin may be effective in some lung transplant recipients for treatment of bronchiolitis obliterans syndrome for prevention of constrictive bronchiolitis.

Bronquiolitis constrictiva: ¿qué conocemos acerca de esta enfermedad fibrosante de las vías aéreas?

OBJETIVOS: 1. Identificar la bronquiolitis constrictiva como una enfermedad fibrosante a diferencia de la bronquiolitis proliferativa, una condición inflamatoria de las vías aéreas. 2. Describir las causas de la bronquiolitis constrictiva y su asociación a enfermedades sistémicas. 3. Identificar los hallazgos clínicos, radiológicos y fisiológicos de la bronquiolitis constrictiva. 4. Conocer y entender el manejo y tratamiento de la bronquiolitis constrictiva. 5. Describir la evolución clínica de la bronquiolitos constrictiva. La bronquiolitis constrictiva es una enfermedad respiratoria que afecta las pequeñas vías aéreas y es importante reconocerla debido a su naturaleza fibrosante e irreversible. Los términos utilizados en el mundo para describir esta condicion son variables. En esta revisión, el término Bronquiolitis obliterans constrictiva (BOC) será usado para describir este síndrome que se presenta como una condicion fibrótica de las pequeñas vías aéreas. Patología generalmente utiliza el término bronquiolitis constrictiva y lo usará independientemente si hay o no obliteración total de las vías aéreas; clínicamente la enfermedad se manifiesta, especialmente, cuando hay obliteración de las pequeñas vías aéreas.

Constrictive bronchiolitis obliterans: the fibrotic airway disorder.

Constrictive bronchiolitis obliterans is an important respiratory illness because of its underlying irreversible fibrotic process, and is defined as concentric fibrosis in the bronchiolar submucosal layer with continual external circular scarring. The fibrotic and destructive nature of this lesion is the defining characteristic. Although patchy, the airway may become slit-like or obliterated from this fibrotic process, resulting in bronchiolitis obliterans. Constrictive bronchiolitis is limited to the bronchioles and does not extend into the alveoli. The clinical features of constrictive bronchiolitis consist of a chest radiograph that is often normal, early inspiratory crackles and irreversible airflow obstruction by pulmonary function testing. Chest CT scans show a mosaic pattern, air trapping by the expiratory film, bronchiolectasis and thickened small airway walls. Although idiopathic constrictive bronchiolitis is rare, the lesion is common among lung-transplant recipients. The lesion also occurs from certain types of toxic fumes, some of the connective tissue diseases, specific types of medications and post respiratory infection. Unusual exposures have also been described as a cause of constrictive bronchiolitis, such as consumption of the leafy vegetable Sauropus androgynus in far eastern Asia and from inhaling diacetyl, the ketone butter flavoring used in microwave popcorn production. Empirical treatment consists of corticosteroid and immunosuppressive agents. Antifibrotic agents may be successful in the future. This is generally a nonsteroid-responsive lesion and for disabling disease, lung transplantation can be a successful option.

Drug-induced bronchiolitis obliterans organizing pneumonia.

Several medications have been associated with the development of the BOOP lesion. Often, symptoms include nonproductive cough and shortness of breath with bilateral crackles by examination. Occasionally, there is fever and rash, and, rarely, eosinophilia. The chest radiograph usually shows bilateral patchy infiltrates. In rare situations, the outcome is fatal, although cessation of the medication or treatment with corticosteroid therapy results in resolution of symptoms and radiographic abnormalities for most patients.