panbronchiolitis%20-%20diffuse
PANBRONCHIOLITIS - DIFFUSE
Diffuse panbronchiolitis is an inflammatory disease affecting the respiratory bronchioles.
It causes progressive suppurative and obstructive respiratory disease.
This is an idiopathic disease which is primarily found in Japan, Korea and China.
Predisposition to the disease may be genetically-related but environmental factors should also be considered.
Failure to treat diffuse panbronchiolitis can lead to development of bronchiectasis, progressive failure and death.

Differential Diagnosis

  • Bronchiectasis
  • Bronchiolitis (infectious)
  • Chronic bronchitis
  • Cystic fibrosis
  • Hypogammaglobulinemia
  • Primary ciliary dyskinesia
  • Allergic bronchopulmonary aspergillosis (ABPA)
  • Obliterative bronchiolitis
  • Sarcoidosis
  • Mycobacterium Avium complex pulmonary infection
  • Churg-Strauss syndrome
  • Wegener’s granulomatosis

Diagnosis

Diagnostic Criteria for DPB by Ministry of Health & Welfare of Japan

  • Diagnosis of diffuse panbronchiolitis (DPB) is definite if the first 3 & at least 2 of the last 3 criteria are present
    • Presence of persistent cough, sputum production & dyspnea on exertion
    • History of chronic paranasal sinusitis
    • Chest X-ray (CXR) shows bilateral diffuse small nodular shadows, or chest computed tomography (CT) scan w/ centrilobular micronodules
    • Presence of coarse crackles, occasional rhonchi, wheezes or squawk on physical exam
    • FEV1/FVC <70% & PaO2 <80 mmHg
    • Cold haemmaglutinin titre ≥64

Physical Examination

  • Crackles, wheezing on chest exam

Laboratory Tests

Pulmonary Functions Tests

  • Spirometry, lung volume determination
    • May show significant obstructive defect w/ or w/o superimposed restriction
    • Significantly limited airways resistant to bronchodilators
    • FEV1/FVC <70%, vital capacity (VC) <80%, residual volume (RV) >150%
    • Hypoxemia may be present in blood gas analysis
  • P. aeruginosa infection, reduced pulmonary diffusing capacity, progression of hypoxemic state & subsequent hypercapnia seen in advanced stages of diffuse panbronchiolitis (DPB)

Imaging

  • Chest X-ray (CXR)
    • May show pulmonary hyperinflation & diffuse bilateral small nodular shadows
    • Findings of bronchiectasis (ring-shaped/tram-line shadows) may be seen in advanced disease
  • High-resolution computerized tomography (HRCT)
    • Bilateral & symmetric centrilobular nodules forming a “tree-in-bud” pattern,
    • Bronchiolectasis
    • Mosaic air trapping on lung periphery
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Jairia Dela Cruz, 02 Mar 2017
The placement of personalized inhaler technique reminder labels on dry-powder asthma inhalers may improve the retention of inhaler technique skills after training and potentially extend the benefit of the training onto asthma outcomes, according to a study.
Audrey Abella, 08 Feb 2018
Better clinical efficacy was observed among cancer patients with postoperative hospital-acquired pneumonia (HAP) who received prolonged infusion of the mixed preparation of the broad-spectrum β-lactamase inhibitor tazobactam and β-lactam antibiotic piperacillin (TZP) compared with those who received the traditional regimen, according to a study.

Stephen Padilla, 02 Mar 2017
Use of vitamin D supplementation prevents acute respiratory tract infection, with individuals who are very deficient in vitamin D and those not receiving additional bolus doses benefitting the most, a recent study has found.
18 Feb 2018
Plasma brain natriuretic peptide (BNP) threshold of 340 pg/mL appears to strongly predict survival up to 5 years in patients with pulmonary arterial hypertension, a study suggests.