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Diffuse panbronchiolitis (DPB) is a disease of adults characterized by chronic inflammation of the respiratory bronchioles and the infiltration of chronic inflammatory cells. The clinical efficacy of erythromycin therapy has been demonstrated in DPB patients, but the mechanism of action of this drug is unknown. We investigated the localization of neutrophils in lung biopsy specimens, as well as the cell population and elastolytic-like and chemotactic activity of bronchoalveolar lavage (BAL) fluid, before and after treatment with erythromycin or ampicillin in 11 DPB patients (six biopsy-proven and five clinically diagnosed) and one follicular bronchiolitis patient. These bronchiolitis patients had a high percentage of neutrophil and a high neutrophil-derived elastolytic-like activity in BAL fluid compared with chronic bronchitis patients and normal control subjects. The number of neutrophils and the neutrophil-derived elastolytic-like activity in BAL fluid decreased significantly after treatment with erythromycin along with a significant improvement in pulmonary function studies, although there was no significant change in the chemotactic activity of BAL fluid. No significant reduction in BAL fluid neutrophilia was found in the ampicillin-treated patients. These results suggest an important role for the neutrophil in the pathogenesis or development of bronchiolitis, and also suggest that erythromycin may be useful for the treatment of bronchiolitis through its direct action upon host phagocytic cells.

Although mycoplasmal airway infection frequently exacerbates bronchial asthma, the cause of the initial onset of asthma remains unclear at present. In this report, we describe a patient in whom a previous acute mycoplasmal respiratory infection led to an initial onset of bronchial asthma. One month after the onset of the illness, cough and wheezing appeared. Pulmonary function studies revealed an airway obstructive dysfunction. Oral administration of bronchodilators resulted in a marked improvement of the asthmatic symptoms. An airway hyperresponsiveness to methacholine was demonstrated even 2 yrs after the initial onset of the illness, and IgE antibody specific to Mycoplasma pneumoniae was detected in the serum by use of enzyme-linked immunosorbent assay. An immediate skin test for M. pneumoniae was positive in addition to multiple positive skin tests. A bronchial inhalation challenge test with M. pneumoniae antigen also yielded a positive result. We conclude that the effects of mycoplasmal respiratory infections on the airway are multifactorial and involve a complex interplay of airway inflammation and IgE-mediated hypersensitivity.

Acute post-ESD bleeding and delayed post-ESD bleeding were associated with different clinical characteristics. Antithrombotic therapy is a risk factor for post-ESD bleeding in both the acute and delayed phases.

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