Distinct characteristics of bronchiolar disorders related to occupational and environmental exposures

Details

• Personal Author:
  Cummings, Kristin J. ; Kreiss, Kathleen
• Description:
  Rationale: Bronchiolar disorders encompass a spectrum of diseases involving the small airways (<2 mm in diameter). Pathology may be limited to the bronchioles or also involve other components of the respiratory tract, including the alveoli. Etiologies include infection, immunologic mechanisms, and inhalational exposures; many cases are categorized as idiopathic. We sought to determine whether bronchiolar disorders related to occupational and environmental exposures could be distinguished from other causes on the basis of clinical, functional, and radiographic findings and clinical course. Methods: We searched PubMed for articles on bronchiolar disorders using the following terms: "bronchiolitis," "cellular bronchiolitis," "bronchiolitis obliterans," "obliterative bronchiolitis," "constrictive bronchiolitis," "proliferative bronchiolitis," "bronchiolitis obliterans organizing pneumonia (BOOP)," and "organizing pneumonia." We also consulted textbook chapters on bronchiolar disorders and the reference lists of identified information sources. Case reports, case series, and epidemiologic investigations were included. Although hypersensitivity pneumonitis often has bronchiolar involvement, we considered it to be a separate entity and excluded it from our review. Results: We included 146 information sources, the majority of which were original reports in peer-reviewed journals. A wide range of gaseous, volatile, and particulate exposures has been reported to result in bronchiolar disorders, including diacetyl, methyl isocyanate, nitrous oxide, nylon flock, sulfur mustard, textile dye, World Trade Center dusts, and humidifier disinfectant. The symptoms of exposure-related bronchiolar disorders are generally non-specific respiratory complaints: dyspnea, particularly with exertion; cough; and in some cases, wheeze. Reported functional abnormalities include obstruction and restriction with or without impaired diffusing capacity. HRCT findings include centrilobular nodules, ground glass opacification, and mosaic attenuation. However, recent histopathologic series have demonstrated bronchiolar disease in the face of normal lung function and/or normal imaging. Biopsy has demonstrated classic features of known histopathologic entities with some exposures and novel patterns with others, and highlighted a spectrum of responses to a particular exposure in some series. Exposure-related bronchiolar disorders including BOOP appear to be less responsive than their non-exposure-related counterparts to therapies like steroids. However, exposure cessation has been found to halt progression of disease and, for some exposures, leads to recovery. Conclusions: Clusters of bronchiolar disorders in workplaces and communities have identified new etiologies, drawn attention to indolent disease that may otherwise have been categorized as idiopathic, and expanded the spectrum of histopathologic responses to an exposure. Cessation of exposure is the most important therapeutic measure and may result in improved outcomes compared to bronchiolar disorders unrelated to exposures. [Description provided by NIOSH]
• Subjects:
  Asthma Environmental Exposure Epidemiology Immune System Lung Lung Diseases Occupational Exposure Occupational Health Pathology Radiography Respiratory System Respiratory Tract Diseases Safety Steroids

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• Keywords:
  Airway Obstruction Airway Resistance Alveolar Cells Biopsy Bronchial Asthma Bronchiolitis Case Reports Clinical Pathology Environmental Exposure Etiology Histopathology Immune System Infectious Agents Information Retrieval Systems Information Systems Inhalation Lung Disorders Occupational Exposure Pneumonia Pneumonitis Pulmonary System Disorders Radiographic Analysis Respiratory Diseases Respiratory Function Respiratory System Disorders

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• ISSN:
  1073-449X
• Document Type:
  Text
• Genre:
  Abstract or Summary
• Place as Subject:
  OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  191
• NIOSHTIC Number:
  nn:20048531
• Citation:
  Am J Respir Crit Care Med 2015 May; 191(Abstract Issue):A4660
• Contact Point Address:
  K. J. Cummings, NIOSH/CDC, Morgantown, WV
• Email:
  cvx5@cdc.gov
• Federal Fiscal Year:
  2015
• Peer Reviewed:
  False
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Abstract Issue
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:e6663201061fe9d931b95395026f8b52c541f5a9ae9300d735b6e8c3cf69da44f7c8161a09ab7b452c3a26d0f9b1e7b913e16d8fd785faa66cd494c090d42b69
• Download URL:
  https://stacks.cdc.gov/view/cdc/203271/cdc_203271_DS1.pdf
• File Type:
  [PDF - 17.26 KB ]