Clinical and radiological manifestations of inhaled bronchiolitis in the process of dynamic observation

Inhaled bronchiolitis develops from exposure to gases, vapors, acids, fumes and other substances and is characterized by a progressive course. Therapy of inhaled bronchiolitis is not fully presented to date. The results of long — term follow-up of 11 patients with chronic inhaled bronchiolitis from exposure to harmful factors (3 men, 8 women 49.2±2.1 years), 18% — smokers were analyzed. A comprehensive functional study of external respiration and lung diffusion capacity (LDC) and high-resolution computed tomography (HRCT) were performed before and after 1.7±0.4 years of treatment. The diagnosis was made using a 2.6±1.2 years after the appearance of the first symptoms of bronchiolitis. Eight patients received nebulizer therapy with budesonide 1000 mcg per day for two weeks in combination with inhaled glucocorticosteroids, long-acting beta2-agonists and long-acting anticholinergic drugs in ultradisperse forms via dosed inhalers. Three patients took bronchodilators according to their needs.

Against the background of therapy, all patients showed stabilization of the course of the disease. Prior to treatment, HRCT revealed a mosaic of the pulmonary pattern (75%; 6/8), centriacinar foci and bronchioloectases — the pattern “tree in the buds” (50%; 4/8), “air traps” (80%; 4/5). After therapy, positive CT dynamics was determined in the form of a decrease in the uneven density of lung tissue and the disappearance of the “tree in the buds” pattern in 5 patients (62%). In three patients who did not follow the recommendations, CT changes remained: the mosaic of the lung pattern and “air traps” were detected in 67% (2/3) of cases, the pattern “tree in the buds” — in one patient 33% (1/3). Indicators of external respiration changed according to the obstructive type. After treatment, there was a tendency to reduce hyperinflation-residual lung volume (RLV) decreased by 40.7%, although it remained elevated in 66.7% (4/6) patients. LDC increased by 6.6% and normalized in 2 patients.

Conclusions. For the diagnosis of inhalation bronchiolitis is recommended to body plethysmography, LDC test and HRCT. Long-term triple therapy leads to stabilization of the course of the disease, reduction of hyperinflation, reduction of CT signs of bronchiolitis. To control the course of bronchiolitis, it is advisable to monitor the RLV and LDC, HRCT picture with the study on inhalation and exhalation.

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