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Occupational causes of constrictive bronchiolitis

Kreiss, Kathleen

Current Opinion in Allergy & Clinical Immunology: April 2013 - Volume 13 - Issue 2 - p 167–172
doi: 10.1097/ACI.0b013e32835e0282
OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli

Purpose of review: New literature from 2009 to 2012 regarding occupational constrictive bronchiolitis challenges textbook descriptions of this disease, formerly thought to be limited to fixed airflow limitation arising in the wake of accidental overexposure to noxious chemicals. Indolent evolution of dyspnea without a recognized hazardous exposure is a more common presentation.

Recent findings: Biopsy-confirmed case series of constrictive bronchiolitis from US soldiers, Iranian survivors of sulfur mustard gassing, hospital-based studies, and flavoring-related cases document that indolent constrictive bronchiolitis cases can have normal spirometry or either restrictive or obstructive abnormalities. High-resolution computerized tomography studies can be normal or reflect air-trapping and mosaic attenuation on expiratory films. Thus, in the absence of noninvasive abnormalities, the diagnosis in dyspneic patients may require thoracoscopic biopsy in settings in which exposure risk has not been recognized. Many workers with occupational constrictive bronchiolitis stabilize with cessation of exposures causing bronchiolar epithelial necrosis.

Summary: Clinicians need a high index of suspicion for constrictive bronchiolitis in young patients with rapidly progressing exertional dyspnea, regardless of spirometric and radiologic findings. Identification of novel causes and exposure-response relations for known causes are needed to provide guidance for protecting workers at risk for this largely irreversible lung disease.

Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA

Correspondence to Kathleen Kreiss, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, 1095 Willowdale Road, M/S H2800, Morgantown, WV 26505, USA. Tel: +1 304 285 5800; fax: +1 304 285 5280; e-mail: KKreiss@cdc.gov

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.