Home
|
Inbox
|
Search
|
View Abstract
Successful Treatment of Deployment-Related Constrictive Bronchiolitis with Azithromycin
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6081 - Successful Treatment of Deployment-Related Constrictive Bronchiolitis with Azithromycin
Author Block: E. Papierniak1, Y. Samra2; 1Pulmonary, Critical Care, and Sleep Medicine, US Department of Veterans Affairs, Gainesville, FL, United States, 2Pulmonary, critical care and sleep medicine, Orlando, FL, United States.
Introduction: Constrictive Bronchiolitis related to inhalational exposures (e.g., “burn pits”) has been previously described in US military veterans deployed to Iraq and Afghanistan. No effective therapy has been reported to-date. We present a case of a patient who has shown both subjective and objective improvement following long-term treatment with azithromycin.
Case Report: A 44-year-old Caucasian male presented to our Veteran’s Affairs clinic with progressive dyspnea on exertion, worsening over the span of 8 years. Previously a triathlete, he now required 3 liters of oxygen with exertion. The patient had never smoked or used illicit drugs and had no family history of lung disease. Physical exam was noteworthy for an athletic build but was otherwise unremarkable with clear lung fields. Initial pulmonary function testing was at the lower limits of normal for age. Six-minute walk (6MW) distance was reduced at 298 meters. Routine labs and comprehensive rheumatologic work-up was negative. Chest radiography, including high-resolution chest CT, was unrevealing, as were a shunt study, echocardiogram with bubble, right heart catheterization and ventilation-perfusion scan.
Constrictive bronchiolitis was suspected due to unexplained hypoxia and a significant occupational history of military deployment to the Middle East with multiple inhalational exposures, including “burn pits.” He was referred for thoracoscopic lung biopsy. The case was reviewed at the Defense Health Agency’s Joint Pathology Center in Maryland and the diagnosis of constrictive bronchiolitis was confirmed.
The patient continued to decline, and based on it’s use with other diseases of the small airways, we initiated treatment with thrice-weekly azithromycin. After 18 months of therapy, there has been sustained symptomatic improvement and 6MW has increased by 128m. Notably, he was briefly lost to follow-up and was off treatment for approximately 6-8 weeks, during which time he experienced both a functional decline and a reduction in his FEV1. After re-starting azithromycin he again experienced both subjective and objective improvement, supporting a true therapeutic effect. As a result, we have subsequently begun treatment in two additional patients and are awaiting follow up data.
Discussion: Deployment-related constrictive bronchiolitis is a rare disease of the small airways with subtle manifestations than can be challenging to diagnose, with no known effective therapy. We present the first report to our knowledge of successful treatment with azithromycin, a macrolide antibiotic with immunomodulatory properties and known efficacy in the management of other pulmonary conditions, including diseases of the small airways. This promising result bears further investigation.
Author Block: E. Papierniak1, Y. Samra2; 1Pulmonary, Critical Care, and Sleep Medicine, US Department of Veterans Affairs, Gainesville, FL, United States, 2Pulmonary, critical care and sleep medicine, Orlando, FL, United States.
Introduction: Constrictive Bronchiolitis related to inhalational exposures (e.g., “burn pits”) has been previously described in US military veterans deployed to Iraq and Afghanistan. No effective therapy has been reported to-date. We present a case of a patient who has shown both subjective and objective improvement following long-term treatment with azithromycin.
Case Report: A 44-year-old Caucasian male presented to our Veteran’s Affairs clinic with progressive dyspnea on exertion, worsening over the span of 8 years. Previously a triathlete, he now required 3 liters of oxygen with exertion. The patient had never smoked or used illicit drugs and had no family history of lung disease. Physical exam was noteworthy for an athletic build but was otherwise unremarkable with clear lung fields. Initial pulmonary function testing was at the lower limits of normal for age. Six-minute walk (6MW) distance was reduced at 298 meters. Routine labs and comprehensive rheumatologic work-up was negative. Chest radiography, including high-resolution chest CT, was unrevealing, as were a shunt study, echocardiogram with bubble, right heart catheterization and ventilation-perfusion scan.
Constrictive bronchiolitis was suspected due to unexplained hypoxia and a significant occupational history of military deployment to the Middle East with multiple inhalational exposures, including “burn pits.” He was referred for thoracoscopic lung biopsy. The case was reviewed at the Defense Health Agency’s Joint Pathology Center in Maryland and the diagnosis of constrictive bronchiolitis was confirmed.
The patient continued to decline, and based on it’s use with other diseases of the small airways, we initiated treatment with thrice-weekly azithromycin. After 18 months of therapy, there has been sustained symptomatic improvement and 6MW has increased by 128m. Notably, he was briefly lost to follow-up and was off treatment for approximately 6-8 weeks, during which time he experienced both a functional decline and a reduction in his FEV1. After re-starting azithromycin he again experienced both subjective and objective improvement, supporting a true therapeutic effect. As a result, we have subsequently begun treatment in two additional patients and are awaiting follow up data.
Discussion: Deployment-related constrictive bronchiolitis is a rare disease of the small airways with subtle manifestations than can be challenging to diagnose, with no known effective therapy. We present the first report to our knowledge of successful treatment with azithromycin, a macrolide antibiotic with immunomodulatory properties and known efficacy in the management of other pulmonary conditions, including diseases of the small airways. This promising result bears further investigation.
|
Home
|
Inbox
|
Search
|