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Bronchiolitis obliterans organizing pneumonia.

G R Epler, T V Colby, T C McLoud

    The New England Journal of Medicine
    |January 17, 1985
    PubMed
    Summary
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    Idiopathic bronchiolitis obliterans with organizing pneumonia often presents with flu-like symptoms and patchy lung opacities. Corticosteroids show significant recovery in most patients, distinguishing it from irreversible obstructive lung disease.

    Area of Science:

    • Pulmonology
    • Pathology
    • Radiology

    Background:

    • Bronchiolitis obliterans (BO) can present with organizing pneumonia (BOOP).
    • Idiopathic BOOP lacks identifiable causes or associated diseases.
    • Understanding its distinct clinical and histological features is crucial.

    Purpose of the Study:

    • To characterize the clinical, radiographic, and physiologic features of idiopathic BOOP.
    • To evaluate the therapeutic response to corticosteroids.
    • To differentiate idiopathic BOOP from other interstitial lung diseases.

    Main Methods:

    • Retrospective analysis of 94 patients with bronchiolitis obliterans.
    • Histopathological examination of lung biopsies.
    • Clinical, radiographic, and pulmonary function tests.

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  • Follow-up assessment of treatment response.

    • Main Results:

    • 50 patients had idiopathic BOOP with patchy organizing pneumonia.
    • Common symptoms included cough and flu-like illness; crackles were heard in 68%.
    • Radiographs showed patchy densities (81%), physiological tests revealed restriction (72%) and impaired diffusion (86%).
    • Corticosteroid treatment led to complete recovery in 65% of patients; two died from progressive disease.
    • Obstruction was noted only in smokers.

    Conclusions:

    • Idiopathic BOOP is a distinct clinicopathologic entity with a generally benign course.
    • Histological differentiation is vital due to favorable response to corticosteroids.
    • It is often misdiagnosed as idiopathic pulmonary fibrosis.