Background: Bronchiolitis obliteans organizing pneumonia (BOOP) is characterized clinically by a subacute or chronic respiratory illness. The purpose of this study was to describe clinical and radiologic features of Idiopathic (cryptogenic) bronchiolitis obliterans organizing pneumonia.Materials and Methods: We retrospectively reviewed 11 patients with biopsy proven BOOP at Masih Daneshvari Hospital, for whom well documented clinical and radiographic data were available. The final diagnosis of BOOP was validated if the followings were present:1) Negative sputum or bronchoalveolar lavage (BAL) analysis for Mycobacterium tuberculosis 2) Open lung biopsy (OLB) or trans-bronchial lung biopsy (TBLB) findings characteristic of BOOP 3) Negative findings for systemic disorders or associated primary pulmonary lesions such as cancer 4) Prompt response to steroid therapy.Results: The mean age of patients with BOOP in this case series was 46.3±24.6 yrs.(range 32-70); the male/female ratio was 7/4. The clinical pattern in BOOP presentation was more similar to classic sub-acute infectious process: dyspnea in 9 patients (81.8%), fever in 5 (45.4%), and cough in 6 (54.5%). The symptoms were usually mild. Physical examination showed sparse crackles in 5 patients (45.4%) and wheezing in 7 (63.6%). The most frequent radiologic patterns were ground glass appearances (63.6%) and diffuse infiltration associated with reticular pattern (27.2%). In 6 patients chest images showed bilateral distribution. The clinical and radiological manifestation of BOOP in our patients did not differ from other reports. Conclusion: BOOP cases may present a distinct entity like pneumonia. Physicians in charge of these patients were all surprised of BOOP diagnosis by tissue examination. Trans- bronchial lung biopsy specimens along with strongly suggestive clinical and radiologic findings in many cases were adequate for making the diagnosis. We suggest that the diagnosis of BOOP must be considered in any immunocompetent patient with pneumonia with poor or no response to antibiotic therapy.

Objective: An appropriate treatment of acute viral bronchiolitis can reduce the symptoms, hospitalization duration and exorbitant costs which is imposed on the families and insurance organizations. This study was conducted to determine the efficacy of epinephrine in comparison with salbutamol in the treatment of the disease.Methods: Forty infants aged one month to 2 years with acute bronchiolitis in Amin and Al-Zahra hospitals, during 2008, were enrolled in this study. The participants were randomized in two treatment groups to receive epinephrine 0.1 ml/kg or salbutamol 0.15 mg/kg. Three doses of each medication were prescribed at intervals of 20 minutes and continued every 10 minutes after the third dose. The patients in both groups were monitored and rated by RDAI, number of the hospitalized days in the hospital, level of oxygen saturation and vital signs.Findings: Mean hospitalization duration was 3.3±1.1 and 3±0.9 in the patients receiving salbutamol and epinephrine, respectively (P=0.03). There was a significant difference in assessing RDAI index between the two groups (P=0.03). There were no differences in SPO2, PR, or RR variables in the studied intervals in both groups (P>0.05).Conclusion: Regarding the effect of epinephrine on reduction of hospitalization duration and the RDAI index in patients with acute bronchiolitis, it seems that using epinephrine instead of salbutamol could be more effective in the management of the disease.

Background- Bronchiolitis is one of the common respiratory infections of infancy and is most commonly caused by respiratory syncytial virus (RSV). This study was conducted to find the incidence of myocarditis and cardiac dysrrhythmia in RSV bronchiolitis.Methods- During the winter and spring of 1999-2001, infants admitted with bronchiolitis to our department were studied. ECG was taken at time of admission and discharge. After RSV was determined as the etiologic agent by IFA, 50 infants were chosen for the study.Results- There were ECG changes in 19 cases, but persistent changes fitting criteria of myocarditis were present in three cases. Statistically and in comparison with the control group, the incidence of myocarditis in RSV bronchiolitis was not significant (p= 0.0546).Conclusion- The findings of this study show that while ECG is beneficial in bronchiolitis, persistent specific changes can be helpful in the diagnosis of clinical and subclinical myocarditis

Background: Some histopathologic patterns of bronchiolar disease may be relatively unique to a specific clinical entity, such as respiratory bronchiolitis caused by cigarette smoking and toxic fumes i.e. sulfur mustard (SM).The aim of this study was to determine the trend of pulmonary function indices in SM-exposed patients with the diagnosis of bronchiolitis obliterans.Materials and Methods: In this retrospective cohort study, 407 cases were evaluated. Patients were divided into 4 groups according to the time period from performing PFT: 1-3, 4-6, 7-10 and more than 10 years. The amounts of these changes amongst four PFT interval groups were compared by analysis of variance test. In addition, we used linear regression analysis to create a linear model of changes for each PFT index.Results: The following equations imply a correlation between decrease in PFT indices and interval between the two tests plus index value of baseline PFT. 1: (FVC %)= -2.23 - (0.76 T)-(0.23 FVC1 %), 2: (FEV1%)= -1.43 - (0.95 T)-(0.10 FEV11 %), 3: (PEF %)= -0.91 - (1.07 T)-(0.14 PEF1 %).Conclusion: Better understanding of the nature of bronchiolitis obliterans, helps improve the treatment of this disease. Our study suggests a pattern of decline in pulmonary function indices directly proportional to the percentage of each index in the baseline PFT which was apparent during a 10-year observation period.

I read with great interest the article by Heydarian et al.The authors had conducted a clinical trial and found that zinc supplementation did not benefit clinical manifestations of acute bronchiolitis. The study is well described, but there are few points that need comment.The authors described that bottles of drug and placebo were similar in size and shape. However, it is well known that, the most important factor in zinc trials have been problem in blinding due to bad taste of zinc salts. There is also no description of the adverse events in the study (even in the zinc group), which is really surprising. So, author’s description of double-blinding might have been compromised, with resultant affection of the findings of the study. The authors also excluded children with pneumonia. But, how did they exclude children with viral pneumonia (as both are difficult to distinguish clinically and radiologically)? This is an important question, as it has been found that zinc might not be effective in viral pneumonia. It is also not clear, whether the person responsible for the administration of the intervention and evaluation of clinical signs of bronchiolitis is same or different. Because, if both have been done by the same person, then it might have also affected blinding and resultant data collection. These factors question the validity of the result.

Objective: Bronchiolitis is a common lower respiratory tract infection in the first year of life. In this disease upper respiratory tract infection is associated with nasal congestion, respiratory distress and hypoxia. We studied the effect of phenylephrine drops as a decongestant in treatment of light and moderately severe cases of acute bronchiolitis.Methods: This is a double blind randomized trial involving 100 children aged 4 weeks to 12 months. The patients were divided into two groups, the first group received 0.1 ml phenylephrine 0.5% and the second group 0.1 ml sodium chloride (NaCl) 0.9% as placebo in both nostrils. Respiratory rate, heart rate, O2 saturation, dyspnea, retractions and wheezing were assessed before and 30 minutes after medication.Findings: After medication, O2 saturation and respiratory muscles retractions in the phenylephrine group were significantly better than those of the placebo group (P=0.004 and P=0.002, respectively). In the phenylephrine group, O2 saturation, retractions and wheezing were also significantly better before than those after medication (P=0.003 and P<0.0001 respectively). In the placebo group no significant difference before and after intervention was observed.Conclusion: Phenylephrine as a topical decongestant is an inexpensive, easily available and suitable means in the treatment of mild to moderately severe bronchiolitis.