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      Plastic Bronchitis in an Adult with Asthma

      , M.D., Ph.D. , 1 , , M.D. 1 , , M.D., Ph.D. 2 , , M.D., Ph.D. 3

      Tuberculosis and Respiratory Diseases

      The Korean Academy of Tuberculosis and Respiratory Diseases

      Bronchitis, Etiology, Asthma, Adult

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          Abstract

          Plastic bronchitis is a rare disease characterized by marked airway obstruction, via the formation of large gelatinous or rigid airway cast. In Korea, there were a few case reports with plastic bronchitis not in adults, but in children. So we report a case of an adult who was diagnosed as plastic bronchitis with eosinophilic casts, with no history of atopic and cardiac disease.

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          Most cited references 16

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          Bronchial casts in children: a proposed classification based on nine cases and a review of the literature.

          Bronchial casts are characterized by the formation of obstructive airway plugs that may be large enough to fill the branching pattern of an entire lung. The condition is rare but can occur at any age. Casts may be secondary to underlying diseases such as asthma and cystic fibrosis, but there are often no predisposing factors. There is no accepted classification system for bronchial casts; but only a confusion of descriptive terms such as mucoid impaction, fibrinous bronchitis, and pseudomembranous bronchitis. Based on a review of nine well-documented cases and the available literature, we have separated bronchial casts 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 only in children with congenital cyanotic heart disease. Acute mortality was high in both groups. Survivors of Type 1 casts seem to be well controlled with inhaled steroids. Optimal therapy for patients with Type 2 casts is not clear; the prognosis probably depends on underlying cardiac status. We hope that this simple classification will provide a framework for further study of this obscure condition.
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            Plastic bronchitis in children: a case series and review of the medical literature.

            Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts. We reviewed our experience and the literature to determine whether mortality rates are determined by underlying disease or cast type. We present 3 children with obstructive bronchial casts. One 3-year-old patient with Noonan's syndrome developed respiratory failure following surgery for tetralogy of Fallot requiring support with extracorporeal membrane oxygenation (ECMO) the first such case. There were 42 cases in the literature of children with plastic bronchitis. Casts may be divided into two types. Type I casts are inflammatory, consisting mainly of fibrin with cellular infiltrates, and occur in inflammatory diseases of the lung. Type II, or acellular casts, consist mainly of mucin with a few cells, and usually occur following surgery for congenital cardiac defects. Patients categorized by underlying disease included 31% with asthma or allergic disease, 40% with underlying cardiac defects, and 29% with other diseases. Mortality was 16%, but increased to 29% in patients with cardiac defects. Deaths occurred as long as 1 year after surgical repair for underlying defects. There were no deaths in patients with asthma. Life-threatening events were statistically higher in patients with cardiac defects (41%) than in those with asthma (0%, P = 0.02). Higher mortality in patients with type II casts compared to type I casts did not reach statistical significance (28% vs. 6%; P = 0.06). In conclusion, patients presenting with plastic bronchitis are at high risk for serious complications, especially with underlying cardiac disease. Copyright 2002 Wiley-Liss, Inc.
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              Plastic bronchitis: new insights and a classification scheme.

              Plastic bronchitis is a rare disease in which there is the formation of large gelatinous or rigid branching airway casts. The history of the disease is reviewed and a classification system is proposed based on our current understanding. This system classifies plastic bronchitis by clinical disease association and cast histology. A summary of the medical literature is included together with guidelines for treatment. The evidence for these treatment decisions is reviewed.
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                Author and article information

                Journal
                Tuberc Respir Dis (Seoul)
                Tuberc Respir Dis (Seoul)
                TRD
                Tuberculosis and Respiratory Diseases
                The Korean Academy of Tuberculosis and Respiratory Diseases
                1738-3536
                2005-6184
                August 2012
                31 August 2012
                : 73
                : 2
                : 122-126
                10.4046/trd.2012.73.2.122
                3492376
                23166545
                Copyright©2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

                It is identical to the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/)

                Categories
                Case Report

                Respiratory medicine

                etiology, asthma, bronchitis, adult

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