Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly
Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly
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DOI：
10.1378/chest.110.5.1289
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发表时间：
1996-11-01
期刊：
影响因子：
9.6
通讯作者：
Fukuchi, Y
中科院分区：
文献类型：
--
作者：
Matsuse, T;Oka, T;Fukuchi, Y
弥漫性吸入性细支气管炎（diffuseaspirationbronchiolitis，DAB）是我们提出的一个新术语，用于定义一种临床实体，其特征是由反复吸入异物颗粒引起的细支气管慢性炎症。为探讨DAB的临床病理特点，对23例DAB患者进行了病理组织学检查，（年龄，81.2 ± 6.2岁[平均值± SD]），与40例随机选择的吸入性肺炎患者相比，（年龄，81.9 +/- 8.3岁[平均值+/- SD]），在半数DAB患者中观察到口咽吞咽困难，三分之二的DAB患者卧床不起，DAB的发作比吸入性肺炎更隐蔽，52.2%的患者伴有神经系统疾病（52.2%）和痴呆（47.8%）。DAB患者多表现为支气管痉挛、支气管痉挛和呼吸困难。DAB肺切面肉眼可见弥漫性散在粟粒性淡黄色结节，与弥漫性泛细支气管炎（DPB）相似。DAB的组织学表现为局限性慢性附壁炎症伴细支气管异物反应。考虑到可能的治疗干预，我们强调了认识这一实体并将DAB与老年人支气管痉挛相关的肺部疾病（特别是晚发性哮喘和DPB）区分开来的重要性。
Diffuse aspiration bronchiolitis (DAB) is a new term that we proposed to define a clinical entity that is characterized by a chronic inflammation of bronchioles caused by recurrent aspiration of foreign particles, In the present study, a total of 4,880 consecutive autopsies were reviewed and we found 31 patients with DAB (0.64%). To investigate the clinicopathologic features of DAB, the 23 patients with DAB (age, 81.2 +/- 6.2 years [mean +/- SD]), from whom clinical information was available, had their features compared to those of 40 randomly selected patients with aspiration pneumonia (age, 81.9 +/- 8.3 years [mean +/- SD]), Oropharyngeal dysphagia was observed in half of the patients with DAB, and two thirds of patients with DAB were bedridden, The onset of DAB was more insidious than aspiration pneumonia, and in half of the patients with DAB episodes of aspiration were unrecognized, Neurologic disorders (52.2%) and dementia (47.8%) were common associated diseases, Most patients with DAB showed signs of bronchorrhea, bronchospasm, and dyspnea. The macroscopic appearance of the cut surface of DAB lung showed diffusely scattered miliary yellowish nodules that resembled those of diffuse panbronchiolitis (DPB), Histologic findings of DAB were characterized by localization of chronic mural inflammation with foreign body reaction in bronchioles, Recurrence of small amounts of aspiration might pla, a role in the pathogenesis of DAB. In view of possible therapeutic intervention, we emphasized the importance of recognizing this entity and differentiating DAB from pulmonary diseases associated with bronchospasm in the elderly, in particular, late-onset asthma and DPB.