We describe the characteristic clinical and pathologic findings of three cases of constrictive bronchiolitis. All three patients were middle-aged women with chronic respiratory illness characterized by chronic cough, dyspnea, mild to severe obstructive pulmonary dysfunction, relatively normal chest radiographs with occasional peribronchial infiltration, and lack of response to bronchodilators or prednisolone. The patients also had medical diseases such as non-Hodgkin's lymphoma and hyperprolactinemia in case 1 and 3, respectively. None of the patients smoked cigarettes and had clinical evidence of recent viral lower respiratory tract infection. Histologic study by open lung biopsy revealed a spectrum of changes ranging from active cellular bronchiolitis to obliterative peribronchiolar fibrosis. The intervening interstitial and alveolar areas showed no remarkable lesion. Immunohistochemically, the bronchiolar or peribronchiolar inflammatory infiltrates mainly comprised of mixed T- and B-lymphocytes. It may be possible that the active form of constrictive bronchiolitis is initiated by attendant lymphocytic inflammation of the airways, which is followed by fibrous obliteration of bronchioles.
Adult ; Biopsy ; Bronchiolitis/immunology/*pathology ; Bronchoconstriction/*immunology ; Female ; Human ; Middle Age ; Pulmonary Fibrosis/immunology/pathology ; T-Lymphocytes/immunology

OBJECTIVETo investigate bronchial responsiveness to acetylcholine in allergic airway inflammation of SD rats.

METHODSSD rats were immunized and challenged by chicken ovalbumin (OVA). Airway responsiveness, acetylcholine (Ach) provocation concentration needed to increase baseline airway resistance by 200% (PC(200)) were measured.

RESULTSThe value of baseline airway resistance in asthma group was significantly higher than that in control group (2.282 +/- 0.128 vs 3.193 +/- 0.239; P < 0.01). After multiple ovalbumin exposures, airway responsiveness to intravenous injection of acetylcholine decreased significantly (-LogPC(200): 4.006 +/- 0.554 vs 2.059 +/- 0.262; P < 0.01). Bronchial alveolar lavage fluid (BALF) and lung tissue specimen analysis indicated that airway allergic inflammation was present.

CONCLUSIONSThe study demonstrates a dissociation between the bronchoconstrictor response and bronchial hyper-responsiveness and indicates that multiple ovalbumin exposures induces persistent bronchoconstriction with airway hypo-responsiveness despite airway allergic inflammation.

Acetylcholine ; pharmacology ; Airway Resistance ; Allergens ; immunology ; Animals ; Bronchi ; drug effects ; physiology ; Bronchial Hyperreactivity ; etiology ; Bronchoconstriction ; Lung ; pathology ; Male ; Ovalbumin ; immunology ; Rats ; Rats, Sprague-Dawley