Bronchiolitis Obliterans Organizing Pneumonia: BOOP
The characteristic of organizing pneumonia is the appearance of granulized tissue in the distal bronchioles. BOOP can be classified by 1) its cause 2) the cause is undetermined 3) its cryptogenic organizing pneumonia (idiopathic type). About one-half of all cases of BOOP are idiopathic. BOOP on x-ray can also be confused with chronic eosiniphillic pneumonia (CEP). The difference between the two is that BOOP has consolidation in the lower lobes of the lung and CEP consolidation is found in the upper lobes. The definitive diagnosis of BOOP comes down to tissue biopsy.
Conditions that cause BOOP are radiation therapy, infections, drugs/toxins, connective tissue disease, immuno-supressed states, and miscellaneous conditions. The radiation therapy causes BOOP when there is a cancer in the bronchi or breast cancer and the ipsilateral lung develops BOOP. The only common type of infection that causes BOOP is pseudomonas aeruginosa. The other types are coxiella burnetili, mycoplasma, pneumocystis carinii, influenza A, measles, HIV, Chlamydia, plasmodium and parvovirus B19. When BOOP occurs in conjunction with drugs/toxins the common drug causes are minocin, cephalasporins, acebutolol, sulfasalazine, macrodantin, cordarone, tegretol, Dilantin, and betapace. The toxins include L-tryptophan ingestion, sauropus androgynous vegetable poisoning, gold, paint aerosols, nylon flock worker’s and silo filler’s disease, free-base cocaine, and smoke inhalation. Connective tissue diseases include rheumatoid arthritis, ankylosing spondylitis, ulcerative colitis, Crohn disease, systemic lupus, biliary cirrhosis and thyroiditis. The immuno suppressed causes are commonly due to organ transplantation, cancer, ARDS and AIDS. One of the miscellaneous causes of BOOP is menstrual and pregnancy related.
Clinically, BOOP affects ages 40-70 but has been reported in children. The course commonly follows a flu-like symptoms, illness lasting 1-4months with persistent non productive cough, dyspnea on exertion, low grade pyrexia, malaise and weight loss. BOOP can be assumed over pneumonia when there is no response to antibiotics, there are lung crepitations, and PFT will show a restrictive pattern with decreased DLCO and exercise related hypoxemia. Chest x-ray is a good indicator but CT scan is more concise. The only treatment for BOOP are steroids and all other therapies are supportive (i.e. Oxygen, ventilator).
Bronchoscopy is a common procedure when BOOP is suspected. When a biopsy is taken there is usually an increase in the normal amount of lymphs 20-40%, eosinophils 5%, neutrophils 10% and macrophages present.
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
Most of the time, it is from smoking. The tissue in the lungs will become inflame and produce mucous because of exposure to these chemicals. Theophylline and ß2 agonist will act to relax and dilate the airways and allow more oxygen to enter. They will also decrease the lungs sensitivity so that they do not react so much to inhaled chemicals.
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
Most patients may begin with symptoms of a runny nose, cold or sinusitis that continue to persist longer than normal upper respiratory infections and fail to respond to therapeutic measures. Even though, not all patients experience all of the symptoms, the severity of the disease is different for each patient. Other symptoms can include: arthritic joint pain, blood in urine, cough (with or without presence of blood), fever, inflammation of the ear with hearing problems, inflammation of the eye with vision problems, lack of energy, loss of appetite, nasal membrane ulcerations and crusting, night sweats, numbness of limbs, pleuritis (inflammation of the lining of the lung), rash and/or skin sores, saddle-nose deformity, weakness, fatigue, and weight
As you are aware, Lauris has been aware of exertional dyspnoea for at least seven years and this has progressed over time. She is now reaching a point that walking any more than 20-30m will induce symptoms. She is also limited by back and left hip pain relating to arthritis. Lauris reports no chest pain, chronic cough or wheeze, but does report occasional orthopnoea and paroxysmal nocturnal dyspnoea. Aside from pneumonia at the age of 21, she has not experienced any significant chest infections and I note is up to date with both the Fluvax and Pneumovax.
In addition to an endoscopy, a biopsy may be recommended. During a biopsy, a small piece of tissue is removed from an inflamed area. This piece of tissue is then examined in pathology in order to determine whether either disease is present or not.
The causes of pleurisy are different. Often the problem arises as a result of a disease that affects the lungs, such as tuberculosis, pneumonia or lung cancer. Other times the disturbance is due to the action of an infectious agent or to the penetration of an irritating substance. It can also happen that, through the bloodstream or lymphatic, are transported in the
A chest x-ray is used occasionally to detect lung damage in TB patients. What is the radiologist looking for in the x-ray?
Diagnosis include a pulmonary function test, a test which helps measure the lungs ability to exchange oxygen and carbon dioxide. This type of test is performed with a special machine called spirometry (Mayo Clinic, 2011). A spirometry determines how well the lungs intake, hold, and utilize the air and can even detect the severity of lung disease and determine whether the disease has decreased airflow or a disruption of airflow has occurred. Another device used is a peak flow monitor (PFM). A device that measures the speed at which an individual can blow air out of lungs (Mayo Clinic, 2011). A doctor can diagnose a patient with symptoms that correspond to emphysema, such as a cough that doesn’t go away, coughing up a large sum of mucus, shor...
Tuberculosis is transmitted from person to person through airborne droplets, when a person that is infected with TB coughs, sneezes, talks, and/or sings letting tiny droplet to be released into the air(Bare, Smeltzer, Hinkle, and Cheever, 2008). TB cannot be spread through touching inanimate objects, food, or drinks (Bare et al. 2008). The person must be in the same area an affected individual is in and inspirate the droplets to be affected. Once the bacillus is inspired into the lungs, the bacilli start to multiply causing lung inflammation also known as nonspecific pneumontis (Huether et al. 2008). To cause an immune response the bacilli will travel through lymphatic system and become lodged in the lymph nodes (Huether et al. 2008). Lung inflammation causes the activation of the alveolar macrophages and neutrophils (Huether et al. 2008). Granulomas, new tissue masses of live and dead bacilli, are surrounded by macrophages, which form a protective wall. They then transform into a fibrous tissue mass, the central portion is called a ghon tubercle (Bare et al. 2008). The bacterial then necrotic, forming a cheesy mass, this mass may become calcified and form a collagenous scar (Bare et al. 2008). At this point, the bacteria becomes dormant and there is no further progression of the active disease. The disease can become active again by re-infection or activation of the dormant bacteria (Bare et al. 2008).
Person, A. & Mintz, M., (2006), Anatomy and Physiology of the Respiratory Tract, Disorders of the Respiratory Tract, pp. 11-17, New Jersey: Human Press Inc.
Primary tuberculosis is the initial infection of the host, usually being mild and asymptomatic. A healthy person recently infected with the mycobacterium may exhibit flu-like symptoms and has no reason to suspect tuberculosis. Left untreated, the bacilli infect and multiply within pulmonary alveolar macrophages, migrating to the hilar lymph nodes. An immune response is exhibited by the T-helper cells, and inflammation develops at multiple sites. A person may test positive in the tuberculin skin test at this point, and a chest x-ray may shows opacities in the lungs.
According to the Boores (1977) Disease is defined as; "A type of internal state which is either an impairment ...
disease is coughing, rapid breathing, discharge from the nose and eyes, swelling near the neck