Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium.
Respiration. 2012;84(1):75-9. doi: 10.1159/000339404. Epub 2012 Jun 29.
A 67-year-old never-smoker was diagnosed with diffuse panbronchiolitis (DPB) and was started on 250 mg azithromycin twice weekly. Over a 16-month observation period, lung function was assessed monthly, including a dedicated small airways test, the multiple breath nitrogen washout (MBW) with indices S(cond) and S(acin) of ventilation heterogeneity at the level of the conductive and acinar air spaces, respectively. Baseline measurements indicated moderate airway obstruction, air trapping and considerable dysfunction of the small airways around the acinar entrance. Treatment resulted in excellent symptomatic improvement paralleled by marked improvements in FEV(1), FVC, RV/TLC, S(cond) and S(acin); by contrast, there were no consistent changes in FEF(75) or TL(CO). While improvements were such that S(cond) fell within normal limits after 5 months, S(acin) remained abnormal even after 16 months of treatment. This suggests a distinct acinar structural abnormality in DPB that cannot be reversed by azithromycin.
一位 67 岁从不吸烟的患者被诊断为弥漫性泛细支气管炎（DPB），并开始每周服用 250 毫克阿奇霉素两次。在 16 个月的观察期内，每月评估肺功能，包括专门的小气道测试、多呼吸氮冲洗（MBW），以及分别在传导和腺泡气腔水平上通气异质性的 S(cond)和 S(acin)指数。基线测量表明存在中度气道阻塞、空气潴留和围绕腺泡入口的小气道明显功能障碍。治疗导致症状显著改善，FEV(1)、FVC、RV/TLC、S(cond)和 S(acin)均显著改善；相比之下，FEF(75)或 TL(CO)没有一致的变化。虽然改善如此之大，以至于 S(cond)在 5 个月后恢复正常范围，但 S(acin)即使在 16 个月的治疗后仍保持异常。这表明 DPB 存在明显的腺泡结构异常，阿奇霉素无法逆转。
