Bronchiolitis in Chronic Pigeon Breeder's Disease: Morphologic Evidence of a Spectrum of Small Airway Lesions in Hypersensitivity Pneumonitis Induced by Avian Antigens

doi:10.1378/chest.110.2.371

Chest

Volume 110, Issue 2, August 1996, Pages 371-377

https://doi.org/10.1378/chest.110.2.371 Get rights and content

We analyzed 36 open lung biopsy specimens from patients with chronic pigeon breeder's disease (PBD) to assess bronchiolar involvement and its relationship to the parenchymal pathologic abnormalities. Likewise, 21 biopsy specimens obtained from patients with usual interstitial pneumonia (UIP) were also examined. The bronchiolar abnormalities were scored by the method of Wright et al using a panel of photographs. In addition, the severity of lung fibrosis was evaluated in all samples and expressed as percentage in multiples of ten. A variable degree of epithelial cell metaplasia, bronchiolar inflammation and fibrosis, smooth muscle hypertrophy, extrinsic small airways narrowing, and intraluminal macrophages was observed in both diseases. Occasionally, hyperplasia of lymphoid follicles was also present. Bronchiolar changes were proportional in type and severity to the parenchymal damage. Spearman's nonparametric correlation between fibrosis in parenchyma and fibrosis in membranous bronchiole for the complete group (including patients with UIP and with PBD) showed a moderate but significant association (R=0.51; p<0.01). A significant association was also demonstrated when the score for bronchiolar fibrosis and inflammation was evaluated in relation to lung fibrosis divided in high degree (>50%) and low degree (<50%), respectively. In the case of patients with PBD, the correlation between bronchiolar and parenchymatous fibrosis was of 0.33 (p<0.05). In general, bronchiolar fibrosis was less severe and inflammation more severe in PBD lungs compared with patients with UIP. Fibrosis in membranous bronchioles correlated with increased mortality in the complete group of patients, but the impact on mortality disappeared after correcting for overall fibrosis in the biopsy sample. Our findings demonstrate that a spectrum of bronchiolar lesions is usually observed in chronic PBD lungs, although the predominant pattern is similar to that found in the surrounding parenchyma, suggesting that the damage occurs in parallel.

Section snippets

Study Population

This research was approved by the Institutional Ethical and Scientific Committees. The study included 57 consecutive open lung biopsy specimens, 36 from patients with PBD and 21 from patients with a histopathologic pattern of UIP. These patients are part of a cohort assembled from 1983 to 1987.¹ Our institute is a Tertiary Reference Center for pulmonary diseases in the Mexico City metropolitan area, receiving the overall spectrum of PBD. In general, biopsy specimens are taken from most patients

RESULTS

Table 1 shows some demographic and clinical characteristics of the patients studied. As previously demonstrated,¹ chronic PBD produced severe lung damage, although the degree of lung fibrosis and the clinico-functional deterioration were worse in patients with IPF and UIP+BE, which resulted in higher mortality.

In all PBD lung samples, variable degrees of bronchiolar inflammation and fibrosis were observed. Small numbers of intraluminal macrophages and epithelial cell metaplasia were often

DISCUSSION

The peripheral airway abnormalities in ILDs are often underrecognized because the predominant pathologic changes occur within the alveolar region producing a restrictive pulmonary function disorder, which usually masks the presence of bronchiolar disease.

In this study, a variety of pathologic abnormalities were found in membranous and respiratory bronchioles of patients with PBD and UIP. Concerning PBD, the most prominent findings were mild to severe peribronchiolar inflammation, and slight to

ACKNOWLEDGMENTS

The authors thank Dr. Talmadge E. King, Jr, for his critical review of this manuscript, and Isabel Pérez Montfort who corrected the English version of the manuscript.

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Supported in part by a grant from CONACYT (F643-M9406).

A summary or this work was included in the chapter “Airflow obstruction and airway lesions in hypersensitivity pneumonitis: bronchiolitis.” Clin Chest Med 1993;14:699–714.

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Chest

Clinical Investigations: ImmunologyBronchiolitis in Chronic Pigeon Breeder's Disease: Morphologic Evidence of a Spectrum of Small Airway Lesions in Hypersensitivity Pneumonitis Induced by Avian Antigens

Section snippets

Study Population

RESULTS

DISCUSSION

ACKNOWLEDGMENTS

Clin Chest Med

Chest

Lancet

Chest

Mortality in Mexican patients with chronic pigeon breeders lung compared with those with usual interstitial pneumonia

Am Rev Respir Dis

Hypersensitivity pneumonitis: clinical manifestations, diagnosis, pathogenesis and therapeutic strategies

Semin Respir Med

Hypersensitivity pneumonitis: clinical approach and an integral concept about its pathogenesis: a Mexican point of view

Clinical and histologic spectrum of bronchiolitis obliterans, including bronchiolitis obliterans organizing pneumonia

Semin Respir Med

State of the art: diseases of the small airways

Am Rev Respir Dis

Small airways in idiopathic pulmonary fibrosis: comparison of morphologic and physiologic observations

J Clin Invest

Clinical Investigations: Immunology
Bronchiolitis in Chronic Pigeon Breeder's Disease: Morphologic Evidence of a Spectrum of Small Airway Lesions in Hypersensitivity Pneumonitis Induced by Avian Antigens