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.

Pharmacotherapy

  • Macrolides should be started as soon as diagnosis is established

Macrolides

  • Eg Erythromycin,14 member-ringed macrolides (eg Clarithromycin, Roxithromycin), & the 15 member-ringed macrolide Azithromycin
  • Erythromycin is the 1st choice in treatment of diffuse panbronchiolitis (DPB)
    • Treatment duration is for at least 6 months
  • Other macrolides (Clarithromycin, Roxithromycin, Azithromycin) are used when Erythromycin is ineffective or not tolerated
  • Studies show better lung function (decreased dyspnea, opacities in HRCT) w/ Azithromycin use in patients w/ DPB

Actions:

  • Inhibit production of pro-inflammatory cytokines & formation of leukotriene B4
  • Block the formation of adhesion molecules required for migration of neutrophils

Effects:

  • Decreased inflammation of the airways, leading to improved pulmonary function & decreased infection
  • Erythromycin helps improve host defense & regulate bacterial activities
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