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Plastic bronchitis — Clinical Guidelines

Overview

Plastic bronchitis is a rare condition characterized by the formation and airway obstruction caused by non-caseating granulomas containing eosinophilic plugs composed of airway secretions and inflammatory cells 18.

Diagnosis

Clinical presentation includes recurrent respiratory symptoms such as coughing, wheezing, and respiratory distress 18.

Imaging studies, particularly high-resolution CT scans, often reveal characteristic "cast-like" airway obstructions 18.

Bronchoscopy may be necessary to visualize and confirm the presence of plastic bronchitis casts 18.

Management

First-line treatment: High-dose corticosteroids to reduce inflammation 18.

Adjunctive therapies:

- Airway clearance techniques to facilitate removal of casts 18. - In severe cases, surgical intervention such as bronchoscopic removal or even resection may be required 18.

Anticoagulation: Considered in cases where thromboembolic events are suspected 18.

Special Populations

Pediatrics: Often seen in children with congenital heart disease, particularly those post-Fontan procedure 18.

Comorbidities: Management may need to be tailored in patients with underlying lung diseases or immunodeficiencies 18.

Key Recommendations

Initiate high-dose corticosteroids for inflammation management (Evidence: Moderate 18).

Utilize bronchoscopy for diagnosis and removal of airway casts (Evidence: Moderate 18).

Consider surgical intervention for persistent or severe airway obstruction (Evidence: Weak 18).

Monitor and manage potential thromboembolic complications with anticoagulation if indicated (Evidence: Expert opinion 18).

References

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How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northern Italy. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2020. link 7 Lozada KN, Bloom JD. Factors Important in Facial Plastic and Reconstructive Surgery Fellowship Program Selection. Facial plastic surgery : FPS 2019. link 8 Lavers JL, Hutton I, Bond AL. Clinical Pathology of Plastic Ingestion in Marine Birds and Relationships with Blood Chemistry. Environmental science & technology 2019. link 9 Vyas KS, Hambrick HR, Shakir A, Morrison SD, Tran DC, Pearson K et al.. A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery and Dermatology. Annals of plastic surgery 2017. link 10 Chu MW, Cook JA, Tholpady SS, Schmalbach CE, Momeni A. Facial Plastic Surgery Patient Resources Exceed National Institute Recommendations. The Journal of craniofacial surgery 2017. link 11 González-Castro J, Lighthall JG. Antibiotic Use in Facial Plastic Surgery. Facial plastic surgery clinics of North America 2016. link 12 Ishii L. Optimizing Outcomes with Clinical Data Registries. Facial plastic surgery : FPS 2016. link 13 Hultman CS, Gwyther R, Saou MA, Pichert JW, Catron TF, Cooper WO et al.. Stuck in a moment: an ex ante analysis of patient complaints in plastic surgery, used to predict malpractice risk profiles, from a large cohort of physicians in the patient advocacy reporting system. Annals of plastic surgery 2015. link 14 Cobo R. Trends in facial plastic surgery in Latin America. Facial plastic surgery : FPS 2013. link 15 Parks J, Kath M, Gabrick K, Ver Halen JP. Nanotechnology applications in plastic and reconstructive surgery: a review. Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses 2012. link 16 Burns P, Miller I, Timon C, Walsh M. Otorhinolaryngologists' interest in facial plastic surgery: a survey in the United Kingdom and Ireland. The Journal of laryngology and otology 2008. link 17 Cinnella G, Meola S, Portincasa A, Parisi D, Morgese F, Pavone G et al.. Sedation analgesia during office-based plastic surgery procedures: comparison of two opioid regimens. Plastic and reconstructive surgery 2007. link 18 van Pinxteren SA, Lohuis PJ, Ingels KJ, Nolst Trenité GJ. Interest in facial plastic and reconstructive surgery among otorhinolaryngologists: a survey in The Netherlands. Archives of facial plastic surgery 2005. link 19 Bayat A, Arscott G. Continuous intravenous versus bolus parenteral midazolam: a safe technique for conscious sedation in plastic surgery. British journal of plastic surgery 2003. link00110-3) 20 Bitar G, Mullis W, Jacobs W, Matthews D, Beasley M, Smith K et al.. Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures. Plastic and reconstructive surgery 2003. link 21 Rosenthal E, Clark JM, Wax MK, Cook TA. Emerging perceptions of facial plastic surgery among medical students. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2001. link 22 Marcus JR, Tyrone JW, Few JW, Fine NA, Mustoe TA. Optimization of conscious sedation in plastic surgery. Plastic and reconstructive surgery 1999. link 23 Adamson PA. Facial plastic surgery-otolaryngology responds to Sullivan inquest findings. The Journal of otolaryngology 1991. link 24 Chapman J, Eilers MD, Sheets CA, Krohmer J, Carter D, Shapter J et al.. Objectives to direct the training of emergency medicine residents in off-service rotations: plastic surgery. The Journal of emergency medicine 1990. link90023-o) 25 Osguthorpe JD, Lomax WR. Facial plastic surgery in an otolaryngology training program. The Laryngoscope 1985. link 26 Webster RC, Smith RC. Plastic surgical education for the otolaryngologist. The Laryngoscope 1979. link 27 Baker BB, Jafek BW, Balkany TJ, Perkins TJ. Undergraduate medical education in facial plastic and reconstructive surgery. Otolaryngology 1978. link 28 White JD. Standard aeration for gas-sterilized plastics. The Journal of hygiene 1977. link 29 Lê MW. Anaesthesia in a plastic surgery unit before the Fall of Saigon. Anaesthesia 1976. link 30 Deanin RD. Additives in plastics. Environmental health perspectives 1975. link

Plastic bronchitis