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Plastic Bronchitis with asthma 입니다.
인용 저널을 첨부하였습니다.
Tuberc Respir Dis (Seoul). 2012 August; 73(2): 122–126.
Published online 2012 August 31. doi: 10.4046/trd.2012.73.2.122
Plastic Bronchitis in an Adult with Asthma
Eun Jin Kim, M.D., Ph.D.,1 Jung Eun Park, M.D.,1 Dong Hoon Kim, M.D., Ph.D.,2 and Jaehee Lee, M.D., Ph.D.
Plastic bronchitis has been called by different names over the years. It has been referred to as Hoffman's bronchitis, cast bronchitis, pseudomembranous bronchitis or fibrinous bronchitis
classified it into two well-defined groups: type 1 (inflammatory), consisting of casts composed mainly of fibrin with a dense eosinophilic inflammatory infiltrate; and type 2 (acellular), consisting of casts composed mainly of mucin with little or no cellular infiltrate and occurring in children with congenital cyanotic heart disease.
The prevalence of plastic bronchitis is unknown, but rare.
The clinical presentation has productive cough, dyspnea, pleuritic chest pain, fever and wheezing. Radiographic evaluation reveals the site of the bronchial cast impaction, demonstrating atelectasis or infiltrates. Hyperinflation is often evident on the contralateral side
The CT scan allows visualization of impacted casts within the major airways. The diagnosis is usually confirmed by bronchoscopy, demonstrating airway obstruction from bronchial casts
Asthma and atopic disease are the next most common reported association with plastic bronchitis after congenital heart disease. Madsen et al.
The mortality has been estimated at 6~50% for 'inflammatory' casts
The treatment of plastic bronchitis is represented by endoscopic extraction of the casts. Complete extraction is always a very delicate procedure that often needs fragmentation and several successive bronchoscopy
Treatment has historically included bronchodilators, inhaled and oral corticosteroids, mucolytic agents, airway clearance therapy and antibiotics. Other therapeutic options have included inhaled heparin, urokinase, tissue plasminogen activator, dornase alfa and oral macrolide antibiotics as mucoregulatory therapy
In patients with asthma or atopic disease and type I cast, therapy should be directed toward treating underlying inflammation. Oral and inhaled corticosteroids, macrolide antibiotics are known to be both immunomodulatory and mucoregulatory drugs and Anti-fibrin therapies can be used if fibrin is present.
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