Plastic Bronchitis

Plastic bronchitis is a rare condition characterized by the formation and expectoration of long, branching casts of the bronchial tubes. Primarily a pediatric problem, plastic bronchitis is usually associated with some type of underlying pulmonary disease including bronchiectasis, cystic fibrosis, bronchial asthma, and allergic bronchopulmonary aspergillosis. Symptoms include violent coughing, wheezing, and episodes of severe dyspnea.

Pathologic examination demonstrates that the bronchial casts diagnostic of plastic bronchitis are composed of layers of mucus thickened by evaporation or absorption of fluid and the breakdown products of inflammatory cells.

During bronchoscopic examination, the tracheobronchial tree frequently is found to be filled with white, cheesy material too soft to grasp and remove with forceps but too thick to suction. During episodes of severe distress, patients have been known to cough out a complete cast of the tracheobronchial tree.

  • In plastic bronchitis, inability to clear mucus casts from the lungs results in pulmonary complications including impaired gas exchange, chronic or persistent infection, atelectasis, and permanent tissue damage.

  • Mucus hypersecretion, which occurs as a response to inflammation secondary to infection and epithelial tissue damage, further exacerbates the incidence of mucus plugging and cast formation.

  • Retained secretions provide a culture medium for bacterial pathogens. Consequent infections produce still more mucus, initiating a vicious cycle of mucus obstruction, recurrent bouts of pneumonia, bacterial colonization, and, finally, respiratory failure.

In addition to therapeutic interventions to treat underlying pulmonary disease, patients with plastic bronchitis require aggressive bronchial hygiene, including daily Airway Clearance Therapy. Such therapy is recognized as an essential component in managing and minimizing the obstruction, infection, and inflammation which contribute significantly to medical care costs, morbidity, and mortality in afflicted individuals.

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Sources

Park JY, Elshami AA, Kang DS, Jung TH. Plastic bronchitis. Eur Respir J 1996; 9(3): 612-614. Cairns-Bazarian AM, Conway EE Jr, Yankelowitz S. Plastic bronchitis: an unusual cause of respiratory distress in children. Pediatr Emerg Care 1992; 8(6): 335-337. Jett JR, Tazelaar HD, Keim LW, Ingrassia TS. Plastic bronchitis: an old disease revisited. Mayo Clinic Proc 1991; 66(3): 305-311.

Liston Sl, Porto D, Siegel LG. Plastic bronchitis. Laryngoscope 1986; 96(12): 1347-1351.

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