Obliterating bronchiolitis

Sclerosis of bronchioles, which leads to their narrowing and obliteration. Causes: connective tissue diseases (especially RA), infections (viral, mycoplasma), inhalation of toxic substances, drugs (gold preparations, penicillamine), ulcerative colitis, condition after lung, heart, or bone marrow transplantation (bronchiolitis obliterans syndrome - BOS - bronchiolitis obliterans syndrome).

Symptoms of: cough, progressive dyspnea, crepitation in the lower parts of the lungs. The disease usually progresses and the cause of death is respiratory failure.

Auxiliary examinations: spirometry - irreversible obstruction. DLCO is usually reduced. The thoracic thoracic gland in 1/3 of the cases does not reveal any changes, sometimes - signs of emphysema, rarely - bronchiectasis. HRCT: a picture of mosaic perfusion, bronchiectasis, a typical symptom of an air trap on exhalation.

The diagnosis is: based on the results of a histological examination of lung biopsy.

Treatment of HA with BOS is ineffective; can increase the dose of immunosuppressors (effectiveness is questionable) with the prevalence of inflammation? consider the need to prescribe azithromycin 250 mg every other day. When RA? etanercept in combination with methotrexate.