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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma

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Published on: November 4, 2010

Occupational causes of constrictive bronchiolitis.

Kathleen Kreiss¹

¹Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA. KKreiss@cdc.gov

Current Opinion in Allergy and Clinical Immunology

|February 15, 2013

Summary

Occupational constrictive bronchiolitis often presents subtly, differing from textbook descriptions. Early diagnosis in young patients with exertional dyspnea is crucial, even with normal lung function tests.

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Area of Science:

Occupational Medicine
Pulmonary Medicine
Toxicology

Background:

Constrictive bronchiolitis was historically associated with acute chemical overexposure.
Recent literature (2009-2012) suggests a more indolent presentation without clear hazardous exposure is common.
This challenges traditional understanding and diagnostic approaches.

Purpose of the Study:

To review new literature on occupational constrictive bronchiolitis.
To highlight the evolving understanding of its presentation and diagnosis.
To emphasize the need for increased clinical suspicion.

Main Methods:

Review of recent literature (2009-2012) including case series and high-resolution computerized tomography (HRCT) studies.
Analysis of biopsy-confirmed cases from various cohorts (soldiers, chemical exposure survivors, hospital patients, flavoring industry workers).
Evaluation of diagnostic findings including spirometry and HRCT.

Main Results:

Indolent constrictive bronchiolitis can present with normal spirometry or restrictive/obstructive abnormalities.
HRCT may show normal findings, air-trapping, or mosaic attenuation.
Thoracoscopic biopsy may be necessary for diagnosis when exposure is unrecognized.
Cessation of exposure can lead to stabilization in many workers.

Conclusions:

A high index of suspicion for constrictive bronchiolitis is needed in young patients with exertional dyspnea, irrespective of initial test results.
Further research is required to identify new causes and exposure-response relationships.
Protecting at-risk workers necessitates improved understanding and guidance.