Chest
Volume 110, Issue 5, November 1996, Pages 1289-1293
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Miscellaneous: Clinical Investigations
Importance of Diffuse Aspiration Bronchiolitis Caused by Chronic Occult Aspiration in the Elderly

https://doi.org/10.1378/chest.110.5.1289Get rights and content

Diffuse aspiration bronchiolitis (DAB) is a new term that we proposed to define a clinical entity that is characterized by a chronic inflammation of bronchioles caused by recurrent aspiration of foreign particles. In the present study, a total of 4, 880 consecutive autopsies were reviewed and we found 31 patients with DAB (0.64%). To investigate the clinicopathologic features of DAB, the 23 patients with DAB (age, 81.2±6.2 years [mean±SD]), from whom clinical information was available, had their features compared to those of 40 randomly selected patients with aspiration pneumonia (age, 81.9±8.3 years [mean±SD]). Oropharyngeal dysphagia was observed in half of the patients with DAB, and two thirds of patients with DAB were bedridden. The onset of DAB was more insidious than aspiration pneumonia, and in half of the patients with DAB episodes of aspiration were unrecognized. Neurologic disorders (52.2%) and dementia (47.8%) were common associated diseases. Most patients with DAB showed signs of bronchorrhea, bronchospasm, and dyspnea. The macroscopic appearance of the cut surface of DAB lung showed diffusely scattered miliary yellowish nodules that resembled those of diffuse panbronchiolitis (DPB). Histologic findings of DAB were characterized by localization of chronic mural inflammation with foreign body reaction in bronchioles. Recurrence of small amounts of aspiration might play a role in the pathogenesis of DAB. In view of possible therapeutic intervention, we emphasized the importance of recognizing this entity and differentiating DAB from pulmonary diseases associated with bronchospasm in the elderly, in particular, late-onset asthma and DPB.

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MATERIALS AND METHODS

A retrospective study was performed on 3,253 consecutive autopsy cases at Tokyo Metropolitan Geriatrics Center Hospital (TGH) between November 1985 and December 1992 and on 1, 627 consecutive autopsy cases at the Tokyo University Hospital (TUH) between March 1986 and June 1991. Pathologists examined autopsy cases macroscopically and histologically for characteristics of DAB. Histologic examination was performed on one or two tissue samples in each lobe of both right and left lungs (apical

RESULTS

Aspiration pneumonia (APN) was found in 6.7% of all autopsy cases from the TGH and in 1.0% of all autopsy cases from the TUH. DAB was found in 0.6% and 0.7% of all autopsy cases (age, 81.2±6.2 years [n=20] and 62.6±10.4 years [n=11] [mean±SD]) from the TGH and TUH, respectively. The incidence of DAB in a total of 4, 880 autopsy cases was 0.64% (total, n=31: male, n=21; female, n=10). The distribution of the age of onset of DAB was as follows: age 40 to 49 years, 2 patients; age 50 to 59 years,

DISCUSSION

Aspiration of gastric contents containing food particles can cause varied lesions in the lung. Thus, the term “aspiration pulmonary disease” has been applied to a variety of pulmonary conditions with diverse manifestations. Aspiration pulmonary disease, including aspiration pneumonia, Mendelson's syndrome, and aspiration bronchiolitis, follows the inhalation of gastric contents or infected material from the oropharyngeal region. 4 Chronic aspiration has been reported as a cause of obliterative

ACKNOWLEDGMENTS

We thank Drs. K. Ohtubo and I. Ezaki for their valuable support in pathologic examination, Drs. H. Katayama and C-Y. Shu for their assistance, and T. Hamada for his statistical advice. We also thank Drs. S. Hayashi and T. Nagase for their helpful review.

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