title: Clinical Manifestations of Respiratory Bronchiolitis as an Incidental Finding in Surgical Lung Biopsies: A Retrospective Analysis of a Large Austrian Registry.
abstract: BACKGROUND
  While respiratory bronchiolitis (RB) is a frequent histopathological finding in smoker's lungs, RB-associated interstitial lung disease (RB-ILD) remains a rare disease.
  
  
  OBJECTIVE
  We analyzed how the histological finding of RB was associated with clinical information in a series of 684 consecutive surgical lung biopsies.
  
  
  METHODS
  Retrospective analysis with delineation of clinical manifestations, smoking habits, pulmonary function test, and blood gas analysis in patients with RB in surgical lung biopsy. In 240 of these biopsies, RB was diagnosed, and in 146 of these cases a full clinical dataset was available.
  
  
  RESULTS
  The final diagnosis of these 146 patients was consistent with RB-ILD (n = 18), pulmonary Langerhans cell histiocytosis (n = 7), various ILD (n = 9), spontaneous pneumothorax (n = 43), traumatic pneumothorax (n = 5), lung cancer (n = 41), various benign lung tumors (n = 8), and chronic pulmonary effusion (n = 15). Smoking history was positive in 93% of patients, 72% revealed centrilobular emphysema in their biopsy, and 58% described dyspnea as the main symptom. Amongst these diagnoses there were significant differences in age and smoking habits, but only small distinctions in pulmonary function test and blood gas analysis. Out of the patients with RB-ILD, 17% developed lung cancer in the later course.
  
  
  CONCLUSIONS
  RB is strongly related to smoking, emphysema, and dyspnea and frequently associated with lung cancer. RB-ILD is a rare disease that may represent a considerable risk for lung cancer. Pulmonary function testing and blood gas analysis do not differ between RB-associated diseases. The finding of RB should prompt further diagnostic workup, and in case of RB-ILD, entail regular screening for lung cancer.
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Scheidl
authors.forename: Marlene
authors.initials: M
authors.lastname: Kusej
authors.forename: Holger
authors.initials: H
authors.lastname: Flick
authors.forename: Elvira
authors.initials: E
authors.lastname: Stacher
authors.forename: Veronika
authors.initials: V
authors.lastname: Matzi
authors.forename: Gabor
authors.initials: G
authors.lastname: Kovacs
authors.forename: Helmut H
authors.initials: HH
authors.lastname: Popper
authors.forename: Ulrich
authors.initials: U
authors.lastname: Costabel
authors.forename: Horst
authors.initials: H
authors.lastname: Olschewski
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D001784:Blood Gas Analysis; D001988:Bronchiolitis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D004417:Dyspnea / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D033162:Incidental Findings; D008168:Lung / Q000473:pathology* / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D016676:Macrophages, Alveolar / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D012042:Registries; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D055815:Young Adult