Bronchiolitis syndrome

Whyte RI, Rossi SJ, Mulligan MS, Florn R, Baker L, Gupta S, Martinez FJ, Lynch JP 3rd (1997) Mycophenolate mofetil for obliterative bronchiolitis syndrome after lung transplantation. Ann Thorac Surg 64 945-948... 

Akpinar-Elci, M., Travis, W., Lynch, D., and Kreiss, K. (2004). Bronchiolitis obliterans syndrome in popcorn plant workers. Eur. Respir. ]. 24, 298-302. 

Hepatotoxicity Penicillamine has been associated with a mild elevation of hepatic enzymes that usually returns to normal even with continuation of the drug. Autoimmune syndromes Autoimmune syndromes that may be caused by penicillamine include polymyositis, diffuse alveolitis and dermatomyositis, Goodpasture s syndrome, myasthenic syndrome, pemphigus, and obliterative bronchiolitis. 

The commonest form of lung damage is an interstitial alveolitis, although pneumonitis and bronchiolitis obhter-ans have also been reported, as have sohtary localized fibrotic lesions, non-cardiac pulmonary edema, pleural effusions, acute respiratory failure, acute pleuritic chest pain, and adult respiratory distress syndrome (SEDA-17, 220) (SEDA-18, 201) (66-68). Amiodarone has also been reported to cause impairment of lung function, even in patients who do not develop pneumonitis (69), and preexisting impairment of lung function may constitute a contraindication to amiodarone. 

Ger, L.P., Chiang, A.A., Lai, R.S., Chen, S.M. and Tseng, C.J. (1997) Association of Sauropus androgynus and bronchiolitis obliterans syndrome A hospital-based case-control study. Am. J. Epidemiol. 145, 842-849. 

Estimated annual excess cases of childhood illness and death attributable to parental smoking in the United States include low birth weight (46,000 cases, 2800 perinatal deaths), sudden infant death syndrome (2,000 deaths), RSV bronchiolitis (22,000 hospitalisations, 1,100 deaths), acute otitis media (3.4 million outpatient visits), otitis media with effusion (110,000 tympanostomies), asthma (1.8 million outpatient visits, 14 deaths), and fire-related injuries (10,000 outpatient visits, 590 hospitalisations, and 250 deaths). Parental smoking was found to be an important preventable cause of morbidity and mortality among American children it results in annual direct medical expenditures of USD 4.6 billion and loss of life costs of USD 8.2 billion [298(NC)]. 

Ribavirin is a synthetic guanosine analogue, with in vitro activity against a broad spectrum of DNA and RNA viruses, and retroviruses, including HIV. Ribavirin has been used for treatment of a variety of viral infections, including respiratory syncytial virus bronchiolitis and pneumonia, measles, influenza types A and B, Lassa fever, hemorrhagic fever with renal syndrome (Hantaviruses), hepatitis C, and HIV infection. It is used commonly now along with interferon alpha for treatment of hepatitis C infection. There is no known direct nephrotoxicity of ribavirin. 

Bronchiolitis obliterans, hypersensitivity pneumonitis, fibrosis, pulmonary—renal syndrome see NSAlDs... 

Belperio JA, Keane MP, Burdick MD, et al. Critical role for the chemokine MCP-1/CCR2 in the pathogenesis of bronchiolitis obliterans syndrome. J Clin Invest... 

CCR2 in the pathogenesis of bronchiolitis obliterans syndrome. J Clin Invest 2001 108 547-556. 

Heng D, Sharpies LD, McNeil K, Stewart S, Wreghitt T, WaUwork J. Bronchiolitis obliterans syndrome incidence, natural history, prognosis, and risk factors. J Heart Lung Transplant 1998 17 1255-1263. 

In a retrospective study, everolimus reversed tacrolimus-associated renal dysfunction in lung transplant recipients [38 ]. Eight of 55 patients were switched from high-dose tacrolimus maintenance therapy to everolimus (mean drug concentration 42 ng/1) in combination with low-dose tacrolimus (mean concentration 55 ng/1) and glucocorticoids. In patients with renal dysfunction before conversion to low-dose everolimus, serum creatinine returned to baseline 3 months after everolimus treatment and remained there for at least 2 year follow-up. In patients with bronchiolitis obliterans syndrome, there was maintenance of ventricular ejection fraction or a little improvement, which implies at least possibly prevention of progression. No patient had a rejection episode. There were no adverse events related to everolimus, but one patient stopped taking it after 1 year because of intolerance. 

Bronchiolitis obliterans syndrome is a leading cause of death beyond the first year after lung transplantation. Aerosolized tacrolimus has been successfully used in a 32-year-old female lung transplant patient to treat bronchiolitis obliterans syndrome [152" ]. 

Crestani B, Valeyre D, Roden S, et al. Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM 0 P). Am J Respir Crit Care Med 1998 158(6) 1929-1935. 

Sjogren syndrome (SS) is characterized by infiltration of CD4-positive lymphocytes into different organs, most notably the lacrimal and salivary glands. In the lung, the disease manifests as a prominent lymphoreticular infiltration in the tracheobronchial tree with follicular bronchiolitis, atrophy of glands, and fibrosis... 

Keane MP, Gomperts BN, Weigt S, et al. IL-13 is pivotal in the fibro-obliterative process of bronchiolitis obliterans syndrome. J Immunol 2007 178(1) 511-519. 

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