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Chronic bronchitis is a key phenotype of chronic obstructive pulmonary disease (COPD), characterized by airway-centered inflammation and mucus overproduction. It develops from long-term exposure to harmful particles or gases, most commonly cigarette smoke, which triggers a persistent inflammatory response.Cellular and Structural ChangesInflammation initially affects the large bronchi and later the smaller airways, with infiltration by immune cells, including neutrophils, macrophages, and...
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Emphysema, a major phenotype of chronic obstructive pulmonary disease (COPD), is characterized by irreversible destruction of alveolar walls and permanent enlargement of distal airspaces. Unlike chronic bronchitis, which primarily affects the airways, emphysema predominantly involves the lung parenchyma, where structural damage leads to airflow limitation.PathophysiologyIt most commonly results from prolonged exposure to cigarette smoke and other toxic gases, particularly cigarette smoke.
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Chronic bronchiolitis in ankylosing spondylitis.

D Marquette1, E Diot, A de Muret

  • 1CHRU Tours, Hôpital Bretonneau, Service de Pneumologie et Explorations Fonctionnelles Respiratoires; Inserm U 1100, Faculté de Médecine, Université François Rabelais, Tours, France. s.marchandadam@univ-tours.fr.

Sarcoidosis, Vasculitis, and Diffuse Lung Diseases : Official Journal of WASOG
|November 29, 2013
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Summary

Severe chronic bronchiolitis is a newly described complication in ankylosing spondylitis (AS). This condition presents with progressive dyspnea and obstructive lung defects, with macrolide treatment showing promise for follicular bronchiolitis.

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Area of Science:

  • Pulmonology
  • Rheumatology
  • Pathology

Background:

  • Ankylosing spondylitis (AS) commonly presents with pleuro-pulmonary manifestations, primarily asymptomatic apical lung fibrosis.
  • Severe bronchiolitis, a known complication in other spondyloarthropathies, has not been previously documented in AS patients.

Purpose of the Study:

  • To report and characterize severe chronic bronchiolitis in two patients with ankylosing spondylitis.
  • To investigate the clinical, radiological, and pathological features of this rare complication.

Main Methods:

  • Case report of two ankylosing spondylitis patients with severe respiratory symptoms.
  • Clinical evaluation including pulmonary function tests and high-resolution computed tomography (HRCT) scans.
  • Histopathological examination of lung biopsies.

Main Results:

  • Both patients exhibited progressive dyspnea (stage III-IV) and non-reversible obstructive ventilatory defects.
  • CT scans revealed air trapping with mosaic attenuation and ground-glass opacities during expiration.
  • Lung biopsy confirmed severe follicular bronchiolitis in one patient; constrictive bronchiolitis was suspected in the other.
  • Only the patient with follicular bronchiolitis showed improvement with low-dose macrolide therapy.

Conclusions:

  • Severe chronic bronchiolitis represents a potentially underrecognized pulmonary complication of ankylosing spondylitis.
  • Follicular bronchiolitis may be a treatable subtype, responding to macrolides.
  • Further research is needed to elucidate the pathogenesis and optimal management of bronchiolitis in AS.