BRONCHIOLITIS OBLITERANS SYNDROME is usually occurs below 2 years of age. Children are usually affected. The disease is caused by respiratory syncitial viruses, other viruses and mycoplasma pneumonae. There are five types:
Toxic fume bronchiolitis
It occurs 1-3 weeks after exposure to toxic fumes. Chest X-ray shows “Ground glass” opacity.
Post infectious bronchiolitis
This occurs in association with mycoplasmal or viral lung infection in adults. Radiological finding is extremely variable.This type is also seen in cases of rheumatoid arthritis, polymyositis, dermatomyositis, heart lung transplantation or bone marrow transplantation.
Bronchiolitis obliterans with organising pneumonia (BOOP)
This occurs in both males and females in the age group 50-70 years. Dry cough, dyspnoea, severe weight loss are common, Chest examination reveals creps with wheeze. X-ray shows bilateral patchy ground glass opacity sometimes solitary pneumonia like shadow. Lung function test reveals restrictive dysfunction. Lung biopsy is required for a confirmed diagnosis. Steroids are useful for treatment but a long duration is required.
Respiratory bronchiolitis
This occurs in young with history of cigarette smoking. Clinical features are akin to Idiopathic pulmonary fibrosis. Open lung biopsy is required for its diagnosis.
Diffuse panbronchiolitis
This is commonly seen in Japan. Men are commonly affected. Dyspnoea, cough, sputum, creps, rhonchi are usually present. Lung function test shows obstructive features. Chest X-ray shows nodular shadows with hyperinflation of alveoli. Open lung biopsy is required for a confirmed diagnosis. Treatment includes antibiotics, bronchodilators and steroids. Prognosis is poor.

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