Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Veterans Affairs Medical Center, Nashville, TN, USA.
EBioMedicine. 2023 Sep;95:104760. doi: 10.1016/j.ebiom.2023.104760. Epub 2023 Aug 18.
Patients diagnosed with environmental/occupational bronchiolitis obliterans (BO) over the last 2 decades often present with an indolent evolution of respiratory symptoms without a history of high-level, acute exposure to airborne toxins. Exertional dyspnea is the most common symptom and standard clinical and radiographic evaluation can be non-diagnostic. Lung biopsies often reveal pathological abnormalities affecting all distal lung compartments. These modern cases of BO typically exhibit the constrictive bronchiolitis phenotype of small airway remodeling, along with lymphocytic inflammation. In addition, hypertensive-type remodeling of intrapulmonary vasculature, diffuse fibroelastosis of alveolar tissue, and fibrous thickening of visceral pleura are frequently present. The diagnosis of environmental/occupational BO should be considered in patients who present with subacute onset of exertional dyspnea and a history compatible with prolonged or recurrent exposure to environmental toxins. Important areas for future studies include development of less invasive diagnostic approaches and testing of novel agents for disease prevention and treatment.
在过去的 20 年中，被诊断为环境/职业性细支气管炎闭塞症（BO）的患者常表现为呼吸症状缓慢进展，无高水平、急性暴露于空气传播毒素的病史。运动性呼吸困难是最常见的症状，标准的临床和影像学评估可能无法确诊。肺活检常显示影响所有远端肺区的病理异常。这些现代 BO 病例通常表现出小气道重塑的缩窄性细支气管炎表型，伴有淋巴细胞炎症。此外，肺血管的高血压样重塑、肺泡组织弥漫性弹性纤维增生和内脏胸膜纤维性增厚也经常存在。对于出现亚急性运动性呼吸困难且有长期或反复接触环境毒素史的患者，应考虑诊断环境/职业性 BO。未来研究的重要领域包括开发侵入性较小的诊断方法和测试新型药物以预防和治疗疾病。
