Table of ContentsView AllTable of ContentsWhat It IsSymptomsCausesDiagnosisWhat Are the Treatments for Bronchiolitis Obliterans?Prognosis
Table of ContentsView All
View All
Table of Contents
What It Is
Symptoms
Causes
Diagnosis
What Are the Treatments for Bronchiolitis Obliterans?
Prognosis
Also known as obliterative bronchiolitis and “popcorn lung,” it causes symptoms similar to those ofchronic obstructive pulmonary disease (COPD)orasthma, such as coughing and shortness of breath. Diagnostic tests can help distinguish these illnesses from each other. While there is no cure, there are treatments that can help manage the effects.
This article discusses bronchiolitis obliterans and its causes and treatment. It also addresses symptoms and prognosis.
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What Is Bronchiolitis Obliterans?
Why Is It Called “Popcorn Lung?“Bronchiolitis obliterans earned the nickname “popcorn lung” after an outbreak affected a group of people who worked in a popcorn production plant. The cause was traced to inhalation of diacetyl, a chemical that was used togive microwave popcorn its buttery flavor.
Why Is It Called “Popcorn Lung?”
Bronchiolitis obliterans earned the nickname “popcorn lung” after an outbreak affected a group of people who worked in a popcorn production plant. The cause was traced to inhalation of diacetyl, a chemical that was used togive microwave popcorn its buttery flavor.
What Are the Symptoms of Bronchiolitis Obliterans?
Generally, bronchiolitis obliterans is a disease that affects adults, but it can affect children and adolescents too. The effects generally develop over the course of a few weeks or months and may cause significant distress in your day-to-day life.
The most common symptoms of bronchiolitis obliterans include:
Because bronchiolitis obliterans affects breathing, you are likely to experience exercise intolerance with this condition. You may feel extremely short of breath and exhausted after moderate physical exertion.
Complications
If you have bronchiolitis obliterans, you are at an increased risk of developing lung infections, such aspneumoniaorbronchitis. With bronchiolitis obliterans, these infections may become severe and can make your baseline respiratory symptoms substantially worse than usual.
Bronchiolitis obliterans, like COPD, eventually leads to respiratory failure, which is a severely impaired ability to breathe enough air to supply the body with adequate oxygen. Eventually, this condition can lead to premature death.
Bronchiolitis Obliterans and Its Causes and Treatment
Associated Effects
Because bronchiolitis obliterans often develops in response to toxin exposure or as a transplant complication, you may experience other associated symptoms.
For example, toxin exposure can also cause problems such as a skin rash in addition to your respiratory impairment. A lung or bone marrow transplant may also be associated with complications of chemotherapy (such as loss of appetite and decreased immunity).
You may experience these problems along with bronchiolitis obliterans.
Causes of Bronchiolitis Obliterans
The most common triggers include:
About 10% of people who receive a bone marrow transplant from a donor develop bronchiolitis obliterans within five years of the transplant procedure, while approximately 50% of lung transplant recipients develop the condition within five years.
Bronchiolitis Obliterans and VapingMany researchers are concerned that the chemical diacetyl that peopleinhale during vapingmay cause bronchiolitis obliterans. Diacetyl, a flavor-enhancing chemical originally used to enhance the flavor of microwave popcorn was associated with early cases of the disease.
Bronchiolitis Obliterans and Vaping
Many researchers are concerned that the chemical diacetyl that peopleinhale during vapingmay cause bronchiolitis obliterans. Diacetyl, a flavor-enhancing chemical originally used to enhance the flavor of microwave popcorn was associated with early cases of the disease.
Scarring and Inflammation of the Bronchioles
Thebronchiolesare tiny tubes in the lungs that carry air. When air cannot pass through the bronchioles to thealveoli (air sacs), the body’s oxygen absorption becomes impaired.
Bronchioles can become damaged as a result of an infection, toxins, or inflammation. As they heal, the bronchioles may become permanently scarred. The thick scar tissue essentially “obliterates” the airway, blocking the bronchioles and preventing air from passing through. This where the name bronchiolitisobliteransstems from.
How Is Bronchiolitis Obliterans Diagnosed?
There are a number of causes of shortness of breath and wheezing—many of which are more common than bronchiolitis obliterans. Since the treatment of bronchiolitis obliterans is different than the treatment of other respiratory conditions, and symptoms of each can overlap, getting an accurate diagnosis is essential.
Your medical history will typically provide the biggest clue that you could have bronchiolitis obliterans. If you have had a lung or bone marrow transplant, or if you have been exposed to a toxin (especially industrial toxins), it is important that you tell your healthcare provider.
Your physical examination is an important part of your evaluation. Your healthcare provider will listen to your breathing sounds with a stethoscope and can detect sounds such as wheezing, which are indicative of lung disease.
Diagnostic Tests
You may need to have some diagnostic tests to help assess your respiratory function. These tests can assess the severity of your condition and help distinguish bronchiolitis obliterans from illnesses such as COPD, asthma, cancer, and heart disease.
While bronchiolitis obliterans is irreversible, there are treatments that can help prevent the progression of the disease and reduce your symptoms. If possible, be sure to avoid exposure to the precipitating toxin (if applicable) to avoid additional damage to your lungs.
It is important to be aware that bronchiolitis obliterans is expected to progress—even if you are no longer exposed to what caused it. It can be fatal if left untreated.
Medications, includingcorticosteroidsand other immunosuppressants, can reduce inflammation. This may help prevent further scarring and disease progression. This strategy may be considered regardless of the trigger that caused you to develop bronchiolitis obliterans.
When you have bronchiolitis obliterans, your lung function may decline slowly over time, so you may need to have some of your medical tests repeated as your healthcare team assesses your disease progression and the effectiveness of your treatment.
Symptomatic Treatment
Your healthcare provider may prescribe an inhaler for you to use. This can help alleviate your shortness of breath and wheezing. You may also be advised to use a cough suppressant if your cough is bothersome or interfering with your sleep or quality of life.
If you develop complications, such as pneumonia or bronchitis, you may need antimicrobial treatment, such as antibiotics or antifungal medications.
For late-stage bronchiolitis obliterans, you may need oxygen supplementation. Some people receive oxygen using a nasal cannula or a face mask. If you have advanced disease, mechanical ventilation may be necessary.
When to Consider Oxygen Therapy for COPD
Lung Transplant
In some instances, a lung transplant is considered. This is major surgery. Of course, if you developed bronchiolitis obliterans as a complication of a lung transplant, another transplant might be difficult to physically tolerate.
Bronchiolitis Obliterans Prognosis
Bronchiolitis obliterans can progress over a few weeks or months. While there is no cure, treatment can help manage the effects.
What is the life expectancy of someone with bronchiolitis obliterans syndrome?People with bronchiolitis obliterans have a lower life expectancy compared to the general population, however, life expectancy varies significantly depending on the cause of the condition, how early it is identified, and how it is treated. However, the median survival rate for early onset of BOS is 1.47 years and 2.51 years for late-onset disease.
What is the life expectancy of someone with bronchiolitis obliterans syndrome?
People with bronchiolitis obliterans have a lower life expectancy compared to the general population, however, life expectancy varies significantly depending on the cause of the condition, how early it is identified, and how it is treated. However, the median survival rate for early onset of BOS is 1.47 years and 2.51 years for late-onset disease.
Summary
Bronchiolitis obliterans is a rare condition of the small airways. People with this condition have scarring in the lungs that affects their ability to breathe. Bronchiolitis obliterans can have various causes, including infection, inhalation of a toxic substance, and lung or bone marrow transplant.
Bronchiolitis obliterans can be treated, but it can’t be cured. Since it is a progressive condition, it is important to identify the illness early so its progression can be slowed.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center.Bronchiolitis obliterans.Krishna R, Oliver T.Bronchiolitis Obliterans (Obliterative Bronchiolitis, Constrictive Bronchiolitis). Treasure Island, FL: StatPearls Publishing.Estenne M, Hertz MI.Bronchiolitis obliterans after human lung transplantation.Am J Respir Crit Care Med. 2002;166(4):440-4. doi:10.1164/rccm.200201-003PPAllen JG, Flanigan SS, Leblanc M, et al.Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes.Environ Health Perspect. 2016;124(6):733-9. doi:10.1289/ehp.1510185Copeland, C. Ashley Finland, Snyder, Laurie D. et. al.Survival After Bronchiolitis Obliterans Syndrome Among Bilateral Lung Transplant Recipients.Am J Respir Crit Care Med.2010 Sep 15; 182(6): 784–789. Published online 2010 May 27. doi: 10.1164/rccm.201002-0211OCAdditional ReadingBelachew N, Jerkic S, Michel F, Schubert R, Zielen S, Rosewich M.Lung Function, Lung Clearance Index und Bronchial Inflammation in Children and Adolescents with Bronchiolitis obliterans.Pneumologie. 2019 Jul;73(7):399-406. doi:10.1055/a-0853-0253.Bruguera-Àvila N, Sánchez-Martínez E, Garcia-Olivé I, Pérez-Ochoa JF, Martínez-Barenys C, Ruiz-Manzano J.Obliterating bronchiolitis in a patient treated with (D)-penicillamine. Arch Bronconeumol. 2013 Sep;49(9):411-2. doi:10.1016/j.arbres.2013.02.002.Kulkarni HS, Cherikh WS, Chambers DC, Garcia VC, Hachem RR, Kreisel D et al.Bronchiolitis obliterans syndrome-free survival after lung transplantation: An International Society for Heart and Lung Transplantation Thoracic Transplant Registry analysis.J Heart Lung Transplant. 2019 Jan;38(1):5-16. doi:10.1016/j.healun.2018.09.016.Seccombe EL, Ardern-Jones M, Walker W, Austin S, Taibjee S, Williams S, et al.Bronchiolitis obliterans as a long-term sequela of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.Clin Exp Dermatol. 2019 Mar 25. doi:10.1111/ced.13969.Williams KM.How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Blood. 2017 Jan 26;129(4):448-455. doi:10.1182/blood-2016-08-693507.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center.Bronchiolitis obliterans.Krishna R, Oliver T.Bronchiolitis Obliterans (Obliterative Bronchiolitis, Constrictive Bronchiolitis). Treasure Island, FL: StatPearls Publishing.Estenne M, Hertz MI.Bronchiolitis obliterans after human lung transplantation.Am J Respir Crit Care Med. 2002;166(4):440-4. doi:10.1164/rccm.200201-003PPAllen JG, Flanigan SS, Leblanc M, et al.Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes.Environ Health Perspect. 2016;124(6):733-9. doi:10.1289/ehp.1510185Copeland, C. Ashley Finland, Snyder, Laurie D. et. al.Survival After Bronchiolitis Obliterans Syndrome Among Bilateral Lung Transplant Recipients.Am J Respir Crit Care Med.2010 Sep 15; 182(6): 784–789. Published online 2010 May 27. doi: 10.1164/rccm.201002-0211OCAdditional ReadingBelachew N, Jerkic S, Michel F, Schubert R, Zielen S, Rosewich M.Lung Function, Lung Clearance Index und Bronchial Inflammation in Children and Adolescents with Bronchiolitis obliterans.Pneumologie. 2019 Jul;73(7):399-406. doi:10.1055/a-0853-0253.Bruguera-Àvila N, Sánchez-Martínez E, Garcia-Olivé I, Pérez-Ochoa JF, Martínez-Barenys C, Ruiz-Manzano J.Obliterating bronchiolitis in a patient treated with (D)-penicillamine. Arch Bronconeumol. 2013 Sep;49(9):411-2. doi:10.1016/j.arbres.2013.02.002.Kulkarni HS, Cherikh WS, Chambers DC, Garcia VC, Hachem RR, Kreisel D et al.Bronchiolitis obliterans syndrome-free survival after lung transplantation: An International Society for Heart and Lung Transplantation Thoracic Transplant Registry analysis.J Heart Lung Transplant. 2019 Jan;38(1):5-16. doi:10.1016/j.healun.2018.09.016.Seccombe EL, Ardern-Jones M, Walker W, Austin S, Taibjee S, Williams S, et al.Bronchiolitis obliterans as a long-term sequela of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.Clin Exp Dermatol. 2019 Mar 25. doi:10.1111/ced.13969.Williams KM.How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Blood. 2017 Jan 26;129(4):448-455. doi:10.1182/blood-2016-08-693507.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center.Bronchiolitis obliterans.Krishna R, Oliver T.Bronchiolitis Obliterans (Obliterative Bronchiolitis, Constrictive Bronchiolitis). Treasure Island, FL: StatPearls Publishing.Estenne M, Hertz MI.Bronchiolitis obliterans after human lung transplantation.Am J Respir Crit Care Med. 2002;166(4):440-4. doi:10.1164/rccm.200201-003PPAllen JG, Flanigan SS, Leblanc M, et al.Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes.Environ Health Perspect. 2016;124(6):733-9. doi:10.1289/ehp.1510185Copeland, C. Ashley Finland, Snyder, Laurie D. et. al.Survival After Bronchiolitis Obliterans Syndrome Among Bilateral Lung Transplant Recipients.Am J Respir Crit Care Med.2010 Sep 15; 182(6): 784–789. Published online 2010 May 27. doi: 10.1164/rccm.201002-0211OC
National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center.Bronchiolitis obliterans.
Krishna R, Oliver T.Bronchiolitis Obliterans (Obliterative Bronchiolitis, Constrictive Bronchiolitis). Treasure Island, FL: StatPearls Publishing.
Estenne M, Hertz MI.Bronchiolitis obliterans after human lung transplantation.Am J Respir Crit Care Med. 2002;166(4):440-4. doi:10.1164/rccm.200201-003PP
Allen JG, Flanigan SS, Leblanc M, et al.Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes.Environ Health Perspect. 2016;124(6):733-9. doi:10.1289/ehp.1510185
Copeland, C. Ashley Finland, Snyder, Laurie D. et. al.Survival After Bronchiolitis Obliterans Syndrome Among Bilateral Lung Transplant Recipients.Am J Respir Crit Care Med.2010 Sep 15; 182(6): 784–789. Published online 2010 May 27. doi: 10.1164/rccm.201002-0211OC
Belachew N, Jerkic S, Michel F, Schubert R, Zielen S, Rosewich M.Lung Function, Lung Clearance Index und Bronchial Inflammation in Children and Adolescents with Bronchiolitis obliterans.Pneumologie. 2019 Jul;73(7):399-406. doi:10.1055/a-0853-0253.Bruguera-Àvila N, Sánchez-Martínez E, Garcia-Olivé I, Pérez-Ochoa JF, Martínez-Barenys C, Ruiz-Manzano J.Obliterating bronchiolitis in a patient treated with (D)-penicillamine. Arch Bronconeumol. 2013 Sep;49(9):411-2. doi:10.1016/j.arbres.2013.02.002.Kulkarni HS, Cherikh WS, Chambers DC, Garcia VC, Hachem RR, Kreisel D et al.Bronchiolitis obliterans syndrome-free survival after lung transplantation: An International Society for Heart and Lung Transplantation Thoracic Transplant Registry analysis.J Heart Lung Transplant. 2019 Jan;38(1):5-16. doi:10.1016/j.healun.2018.09.016.Seccombe EL, Ardern-Jones M, Walker W, Austin S, Taibjee S, Williams S, et al.Bronchiolitis obliterans as a long-term sequela of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.Clin Exp Dermatol. 2019 Mar 25. doi:10.1111/ced.13969.Williams KM.How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Blood. 2017 Jan 26;129(4):448-455. doi:10.1182/blood-2016-08-693507.
Belachew N, Jerkic S, Michel F, Schubert R, Zielen S, Rosewich M.Lung Function, Lung Clearance Index und Bronchial Inflammation in Children and Adolescents with Bronchiolitis obliterans.Pneumologie. 2019 Jul;73(7):399-406. doi:10.1055/a-0853-0253.
Bruguera-Àvila N, Sánchez-Martínez E, Garcia-Olivé I, Pérez-Ochoa JF, Martínez-Barenys C, Ruiz-Manzano J.Obliterating bronchiolitis in a patient treated with (D)-penicillamine. Arch Bronconeumol. 2013 Sep;49(9):411-2. doi:10.1016/j.arbres.2013.02.002.
Kulkarni HS, Cherikh WS, Chambers DC, Garcia VC, Hachem RR, Kreisel D et al.Bronchiolitis obliterans syndrome-free survival after lung transplantation: An International Society for Heart and Lung Transplantation Thoracic Transplant Registry analysis.J Heart Lung Transplant. 2019 Jan;38(1):5-16. doi:10.1016/j.healun.2018.09.016.
Seccombe EL, Ardern-Jones M, Walker W, Austin S, Taibjee S, Williams S, et al.Bronchiolitis obliterans as a long-term sequela of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.Clin Exp Dermatol. 2019 Mar 25. doi:10.1111/ced.13969.
Williams KM.How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Blood. 2017 Jan 26;129(4):448-455. doi:10.1182/blood-2016-08-693507.
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