Chest
Volume 107, Issue 1, January 1995, Pages 120-125
Journal home page for Chest

Clinical Investigations: Imaging: Articles
Reversible Airway Lesions in Diffuse Panbronchiolitis: Detection by High-Resolution Computed Tomography

https://doi.org/10.1378/chest.107.1.120Get rights and content

The clinical effectiveness of erythromycin for patients with diffuse panbronchiolitis (DPB) was previously recognized. However, it remains unknown what kind of airway lesions change with the clinical effectiveness induced by erythromycin. We performed the present study to clarify this unknown. We devised a method for scoring findings on high-resolution computed tomography (HRCT) to aid in the objective evaluation of the airway lesions in patients with DPB. The 18 patients with DPB were treated with oral erythromycin, 600 mg/d. All patients were evaluated by pulmonary function tests and HRCT before and after 3 months of therapy. Characteristic HRCT findings in patients with DPB pretherapy were small nodules, airway ectasia, periairway thickening, and mucus plugging. After erythromycin therapy, there was significant reduction in scores for the extent of small nodular opacities, the severity of periairway thickening, and the extent of mucus plugging with a corresponding significant improvement in results of the pulmonary function test parameters. The present study demonstrated reversible airway lesions in patients with DPB in response to erythromycin therapy.

Section snippets

Subjects and Study Design

We evaluated 18 patients with DPB, 10 men and 8 women, aged 18 to 69 years (average, 47.0±3.4 years). All patients had been diagnosed as having DPB according to criteria of the Ministry of Health and Welfare of Japan.7 The histologic diagnosis of DPB was confirmed in 14 patients by transbronchial or open lung biopsy specimen. None of the patients showed an increase in FEV1 greater than 15% after the inhalation of a bronchodilator.

All patients were evaluated by pulmonary function tests,

Pulmonary Function Tests

Pretherapy spirometric tests showed a restrictive ventilatory defect in seven cases, an obstructive defect in one case, a combined defect in four cases, and nearly normal ventilation in six cases. Blood gas analysis revealed hypoxemia in all cases (PaO2, 54.9 to 84.5; mean, 70.8±1.7 mm Hg). The FVC, FEV1, and PaO2 all increased significantly after erythromycin therapy: FVC, 2.35±0.25 to 2.83±0.28 L, p<0.01; FEV1, 1.68±0.20 to 2.01±0.24 L, p<0.01; PaO2 70.8±1.7 to 82.4±3.0 mm Hg, p<0.01 (Table 2

Discussion

The identification of specific and more clinically relevant pathologic changes in pulmonary diseases has been made possible by CT and especially by HRCT.9, 11, 12, 13 The usefulness of HRCT in the evaluation of both the location and severity of the lesions is well documented in patients with DPB.6 However, this approach had not been used for objective evaluation. We therefore attempted to score the HRCT findings clinically relevant to the pathologic findings in patients with DPB to objectively

References (22)

  • GrenierP et al.

    Bronchiectasis: assessment by thin section CT

    Radiology

    (1986)
  • Cited by (39)

    • Imaging of Small Airways Disease and Chronic Obstructive Pulmonary Disease

      2008, Clinics in Chest Medicine
      Citation Excerpt :

      CT may help monitor the course of patients who have diffuse panbronchiolitis. On serial evaluation in untreated patients [37], centrilobular nodules progress, with development of bronchiolectasis and bronchiectasis; conversely, in patients treated with erythromycin, the nodules decrease in size and number, though areas of decreased attenuation may persist (see Fig. 11) [37,38]. Bronchiolectasis also improves on treatment, but bronchiectasis does not change significantly [39].

    • Centrilobular nodules correlate with air trapping in diffuse panbronchiolitis during erythromycin therapy

      2001, Chest
      Citation Excerpt :

      In our study, significant improvements were found in centrilobular nodules, peripheral bronchiolar wall thickness, and peripheral bronchiolectasis. Ichikawa et al9 demonstrated the reversibility of airway lesions on CT in response to erythromycin therapy. They reported a significant reduction in the extent of centrilobular nodules, the periairway thickening, and the extent of mucus plugging in conjunction with an improvement of the pulmonary function tests.

    • Diffuse panbronchiolitis - Pathophysiology and treatment mechanisms

      2001, International Journal of Antimicrobial Agents
    View all citing articles on Scopus
    View full text