Plastic Bronchitis: A Management Challenge

Eberlein, Michael; Drummond, M. Bradley; Haponik, Edward F.

doi:10.1097/maj.0b013e318068b60e

Cited by 81 publications

(96 citation statements)

References 38 publications

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“…or by bronchosopic or chest computed tomography findings of casts within airways (5,6). Mortality from plastic bronchitis occurs due to respiratory failure related to central airway obstruction, and is more severe in those with underlying cardiac abnormalities (mortality rate of 44-60%) (11,24,25).…”

Section: Clinical Relevancementioning

confidence: 99%

“…Although occasionally seen in adults (4,5), plastic bronchitis not due to chemical inhalation is a disorder affecting mostly children. It can develop after Fontan surgery for congenital cyanotic heart diseases (6-12), or after various bronchopulmonary diseases, such as asthma (13,14), cystic fibrosis (15,16), acute chest syndrome, or sickle cell disease (17), viral lower respiratory tract infections, including H1N1 (18), neoplasms, such as lymphoma (19), chemical or thermal inhalation injuries (5,(20)(21)(22), or idiopathic causes (23). Presenting symptoms include wheezing, coughing, expectoration of rubbery casts, chest pain, hypoxemia, and/or frank respiratory distress (11,24).…”

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confidence: 99%

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Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Veress

Hendry‐Hofer²,

Loader³

et al. 2013

Am J Respir Cell Mol Biol

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Sulfur mustard (SM) inhalation causes the rare but life-threatening disorder of plastic bronchitis, characterized by bronchial cast formation, resulting in severe airway obstruction that can lead to respiratory failure and death. Mortality in those requiring intubation is greater than 80%. To date, no antidote exists for SM toxicity. In addition, therapies for plastic bronchitis are solely anecdotal, due to lack of systematic research available to assess drug efficacy in improving mortality and/or morbidity. Adult rats exposed to SM analog were treated with intratracheal tissue plasminogen activator (tPA) (0.15-0.7 mg/kg, 5.5 and 6.5 h), compared with controls (no treatment, isoflurane, and placebo). Respiratory distress and pulse oximetry were assessed (for 12 or 48 h), and arterial blood gases were obtained at study termination (12 h). Microdissection of fixed lungs was done to assess airway obstruction by casts. Optimal intratracheal tPA treatment (0.7 mg/kg) completely eliminated mortality (0% at 48 h), and greatly improved morbidity in this nearly uniformly fatal disease model (90-100% mortality at 48 h). tPA normalized plastic bronchitis-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress (i.e., clinical scores) while decreasing airway fibrin casts. Intratracheal tPA diminished airwayobstructive fibrin-containing casts while improving clinical respiratory distress, pulmonary gas exchange, tissue oxygenation, and oxygen utilization in our model of severe chemically induced plastic bronchitis. Most importantly, mortality, which was associated with hypoxemia and clinical respiratory distress, was eliminated.Keywords: plastic bronchitis; tissue plasminogen activator; airway obstruction; sulfur mustard; fibrin Sulfur mustard (bis(2-chloroethyl)sulfide; SM) is a vesicant and chemical weapon used in warfare during much of the twentieth century, and which remains in the stockpiles of multiple nations today (Syria, Iran, North Korea, Libya, the United States, and possibly others). SM exposure affects the eyes, skin, upper airways, and lungs. After a brief latent period, respiratory failure and death can develop within 12 to 48 hours. Despite a century of study, the mechanisms responsible for SM's toxic effects remain unsolved, and clinically effective rescue therapies or antidotes are not available.Initial reports of human SM inhalation toxicity in the early 1900s described the presence of airway-obstructive necrotic debris/ mucosa, or "pseudomembranes," in the large airways of victims, and these were more recently confirmed in the victims of the IranIraq war (1, 2). Such severe lesions have been reported to lead to respiratory compromise, with need for artificial ventilation, and death in 80% of those needing intubation (2). Furthermore, chronic conducting airway lesions, such as bronchiolitis obliterans, tracheal/bronchial stenosis, and chronic bronchitis, are commonly found in survivors of SM inhalation months to years after exposure (2, 3), whereas chronic alveolar or paren...

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Section: Clinical Relevancementioning

confidence: 99%

mentioning

confidence: 99%

Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Veress

Hendry‐Hofer²,

Loader³

et al. 2013

Am J Respir Cell Mol Biol

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“…The true prevalence of bronchial cast is unknown, because it is difficult to differentiate bronchial cast from mucus plug in children with asthma [2]. However, there are a few reports on bronchial cast in children without underlying diseases [3,5,6]. …”

Section: Discussionmentioning

confidence: 99%

“…Bronchial cast is an unusual condition that can be a life-threatening emergency if mechanical obstruction of major airways occurs [6]. Although bronchial cast can occur at all ages, many of the reported cases were in children, especially as a complication of corrective surgery for congenital heart defects [7].…”

Section: Discussionmentioning

confidence: 99%

“…However, these classifications are not appropriate in all cases. There have been a few reports on bronchial cast in children without underlying diseases [3,5,6]. We report the case of a 12-year-old girl who expectorated a bronchial cast following hemoptysis, secondary to an aortopulmonary collateral artery (APC), in the absence of a lung or systemic disease.…”

Section: Introductionmentioning

confidence: 99%

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Bronchial Cast in a Child with Hemoptysis

Jin¹,

Sol²,

Lee³

et al. 2017

J Pulm Respir Med

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Eosinophilic lung disease with plastic bronchitis and bronchiectasis in an adolescent male

Hussain

Kherallah

2018

Clinical Case Reports

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Key Clinical MessageAny case of unresolving chronic pneumonia with expectoration of thick mucoid plugs should have high index of suspicion for plastic/cast bronchitis, requiring early flexible bronchoscopy with lavage and histopathologic evaluation. Associated presence of idiopathic chronic eosinophilic pneumonia is unusual and could be considered as a cause for atypical plastic bronchitis complicated by bronchiectasis.

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Plastic Bronchitis: A Management Challenge

Cited by 81 publications

References 38 publications

Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Bronchial Cast in a Child with Hemoptysis

Eosinophilic lung disease with plastic bronchitis and bronchiectasis in an adolescent male

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