BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA - A CLINICAL AND RADIOLOGICAL REVIEW

Background: The clinical presentation, course, and radiological spectr um of bronchiolitis obliterans organising pneumonia (POOP) is still be ing characterised to aid differentiation from other causes of organisi ng pneumonia. Aims: To define the clinical presentation, response to t herapy, and radiological spectrum of BOOP. Methods: Fifteen cases of B OOP were retrospectively reviewed. The clinical presenting features, t reatment and outcome of each patient were determined. Three independen t readers and chest X-rays (CXRs) were blinded. CXRs were scored by a semi-quantitative method. Modal scores were calculated for type and pr ofusion of opacification of each CXR. Results: The mean age of present ation was 64 years and the median duration of follow-up was 12.5 month s. Thirteen patients received corticosteroid therapy. Outcome was vari ed. One patient had progressive loss of lung function, five had persis ting symptoms with stable abnormal lung function, and nine were asympt omatic with near normal lung function. Five patients had a disease rel apse. Symptom length prior to presentation, duration and intensity of treatment were not associated with outcome (p = 0.23-0.9). Radiologica l opacities were alveolar in 73%, large localised infiltrates in 13%, nodular in 20% and mobile in 33% of CXR series. There was no relations hip between overall profusion, type of CXR opacities and patient outco me, treatment duration or treatment intensity (p = 0.42-1.0). Conclusi ons: The clinical spectrum of BOOP includes mild subacute, chronic pro gressive, and acute life threatening illness. Prognosis and response t o treatment is variable. The diversity of radiological findings and cl inical presentations should prompt consideration of the diagnosis in p atients with undiagnosed respiratory tract symptoms and persisting or varying radiological abnormalities.