Drugs of choice in diffuse pan bronchioltis is
(Erythromycin): (1489-1490 - H18th edition)Low dose erythromycin is the D.O.C. in the treatment of diffuse panbronchiolitis.Macrolides have to be taken orally for an extended period of time -2-3 yrs.M.O.A - ImmunomodulationThe antibiotic effects of marolides are not involved in their beneficial effects toward reducing inflammation in DPB. They are especially effective at inhibiting the proliferation of neutrophils, by diminishing the ability of interleukin 8 and leukotriene B4 to attract them. They also reduce lymphocyte activity and obstructive mucus and water secretions in airways.Diffuse panbronchiolitis (DPB) is an idiopathic progressive inflammatory obstructive lung diseaseIt tends to present in middle aged (~ 30-60 year old) adults, often non smokers. There is a high prevalence rate in males with a M:F ratio of ~ 2:1.PathologyDiffuse panbronchiolitis is characterized by centrilobularperibronchiolar infiltrates of acute and chronic inflammatory cells, which occur principally at the level of the respiratory bronchioles. There can be bronchiolar dilatation and intra-luminal inflammatory exudates.Radiographic featuresPlain filmNon specific and may show bilateral, diffuse, small nodular shadows with pulmonary hyper inflation.HRCT ChestA periphero-basilar predilection may be present. Features are generally non specific and include:* Centrilobular opacities with branching lines (tree-in-bud pattern)* Bronchiolectasis* Expiratory air trapping
Erythromycin
Tetracyclines
Predsnilone
Cyclophosphamide
Respiratory