1 / 30

Bronchiolitis Obliterans Organizing Pneumonia

Bronchiolitis Obliterans Organizing Pneumonia. History. 68 y female admitted to H6 X smoker 4y 40 pack Unresolving respiratory symptoms since Jan/04  Cough , SOB, Fever. History. SOBE on minimal exertion Cough with minimal sputum Fever low grade & occasional night sweating

kuniko
Download Presentation

Bronchiolitis Obliterans Organizing Pneumonia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bronchiolitis Obliterans Organizing Pneumonia

  2. History • 68 y female admitted to H6 • X smoker 4y 40 pack • Unresolving respiratory symptoms since Jan/04  Cough , SOB, Fever

  3. History • SOBE on minimal exertion • Cough with minimal sputum • Fever low grade & occasional night sweating • SR: wt loss 10 lb , bilateral lower costal pain • No orthopnea , PND ,wheeze

  4. History • NO GI , Renal , CTD symptoms • PMH: HTN & Hypothyroidism • Rx: HCTZ , L Thyroxine • PSH& FH –ve

  5. History • Office job , • No travel & No pets • Had received multiple Abx without significant improvement

  6. Examinations • Afebrile RR 18 Sat95% • BP 130/70 HR 90 • No clubbing , LN , Skin rash • Chest : tender lower ribs minimal crackles & wheeze bilateral • CVS : S1+S2+0 • Abd & LL N

  7. Investigation • WBC 12 Poly 10.8 Lymph0.7 • Hb 99 MCV N Coagulation N • BUN , Creat , Lytes & LFT  N • UA & microscopy N

  8. Investigation • ESR 99 • ABG PH 7.46 PAO2 66 Sat 93% PCO2 38 HCO3 26.8 • CXR & CT Chest • PFT

  9. Investigation • BAL  -ve cultures & cytology • ANA , Anti DNA , RF & ANCA -ve • Bone Scan single non specific uptake focus ?fracture • Open Lung Bx RML & RLL

  10. Open Lung Bx  BOOP

  11. BOOP • Multiple etiologies • Extensive proliferation of granulation tissue in the small airways • Inflammation of the surrounding alveoli • Incidence 6 /100,000 hospital admission

  12. BOOP • Equal male : female 5th-6th decades • Smoking is not a risk factor • Mimicker of CAP • Symptoms , Signs , Radiological & Laboratory findings are not specific • Good response to steroids

  13. Etiologies • Idiopathic • Post Infectious Atypical ,Viral ,PCP, Malaria • Drug Abx, Chemo , Gold ,Amiodarone • CTD SLE , Rheumatoid ,PM , Sjogren

  14. Etiologies • Organ transplantation BMT ,Renal , Lung • Radiotherapy • Autoimmune diseases PBS , IBD ,Thyroditis • Environmental textile printing dye

  15. ?Steroid Response • Higher vasculrization Higher levels of VEGF vascular endothelial growth factor & its receptors in BOOP > UIP J Pathology Feb 2002 • Higher Apoptotic Activity Higher apoptotic activity index in BOOP > UIP Similar levels of apoptosis regulating proteins Lung 1999

  16. Relapse Predictors • Retrospective study • GERM “O”P Registry 1100 cases by 1999 • Looking for relapse characteristics & possible predictors • Inclusion criteria 1) Bx diagnosis 2)Compatible clinical & radiological picture 3)Absence of etiology 4) Treatment with steroid Am Jr Respir Crit Care Med vol 162 2000

  17. Study Population • 19931997 48 / 92 cases were included • 65% Female 35% Male • Mean Age 61y • 71% Non smoker

  18. Study Population • Symptoms duration prior to Dx 13weeks • Dx was made by surgical Bx 69% Transbronchial Bx 31% • Follow up 35 months

  19. Relapse Predictors • 42% had no relapse NR • 31% experience single relapse • 27% experience >1 relapse MR • Time of relapse 6 months from initial episode • Highest probability of relapse in the first year

  20. Relapse Predictors • 68% were still on prednisone at time of relapse • Mean dose at relapse time 12 mg • Statistical significant predictors NR Vs MR Delay between symptoms & diagnosis Elevated GGT , Alk Phos & ALT • NO difference in Age, Gender , Smoking , PFT or BAL or steroid dose

  21. Outcomes • No significance difference NR Vs MR clinical , radiological & PFT at last follow up • 5 y survival 95% 2 Mortality  PE & rupture AAA • Steroid Side effects were similar NR Vs MR

  22. Will Low Dose Steroid Do the Job • 12/28 MR treated with <20 mg prednisone • 16/28 MR >20 • Similar relapse number & clinical course • Slower radiological improvement in Low dose • More steroid side effects in High dose

More Related