Bronchiolitis Obliterans Organizing Pneumonia (BOOP) – Causes, Signs, Symptoms, Treatment

Discovered by Dr. Gary Epler, BOOP is rare lung condition marked by inflammation of the bronchioles, alveoli and surrounding tissue in the lungs.

BOOP is also known as cryptogenic organizing pneumonia (COP) where bronchioles and alveoli gets infected and plugged with connective tissue.

The clinical features show the results similar to that of infectious pneumonia. Even radiological imaging bears resemblance with pneumonia. The diagnosis of BOOP is done if patient does not response to multiple antibiotics and there are negative results for blood and sputum cultures.

 Causes of BOOP

BOOP may be triggered by infections from variety of agents including bacteria, viruses and parasites, drugs, or toxic fumes.

                    Pre-existing chronic inflammatory disease such as Rheumatoid arthritis, lupus, scleroderma, etc.

                    Side effect of certain medicinal drugs such as amiodarone

Signs and symptoms of BOOP

BOOP/COP may not produce any signs or symptoms in some cases. However, a persistent non productive cough and shortness of breath are the two most common symptoms in people who have BOOP.

Other Symptoms may include the following.

   

                    Dyspnoea

                    Mild resting hypoxemia

                    Symptoms of influenza

                    Exertion resulting in shortness of breath

                    febrile illness

                    Extensive crackles

Diagnosis of BOOP

As discussed briefly in the opening paragraphs, the clinical features and radiological imaging

of BOOP are similar to that of infectious pneumonia.  Before a patient visit the doctor, he/she already had the symptoms for less than two months.

Some patients can be diagnosed by presence of various symptoms like cough, fever, illness, fatigue, and reduction in weight.

                    The clinical examination of BOOP patient shows widespread crackles and some patients may also have clubbing.

                    The laboratory results are not specific with absence of any explicit abnormalities on routine physical examination or lab tests.

                    Doctors can detect the presence of crackling sounds with a stethoscope.

                    Pulmonary function tests determine the presence of below normal level of air in the lungs and less amount of oxygen in the blood at rest and exercise.

                    Plain chest radiography reveal about lung volumes to detect presence of any abnormal structures.

                    Chest x-ray shows features similar to that of extensive pneumonia. The widespread white patches with both lungs appear to migrate from one region of the lung to another with progress of the disease.

                    Computed Tomography (CT) is a confirmatory diagnostic test for BOOP that does away with need to conduct any other additional tests.

                    Lung biopsy by using a bronchoscope is also recommended by doctors to confirm the presence of BOOP.

Treatment of BOOP

The treatment for BOOP involves corticosteroid therapy where patient is administered with gradual variation in doses over a period of 24 weeks. It results in consistent outcome without any reduction in the corticosteroid exposure.

Patient is administered with high dosage of 50 mg per day in the beginning and it eventually reduces to zero over a period of six-month to one-year. Commonly used steroids are prednisolone and prednisone.

Care has to taken to avoid stopping steroid treatment rapidly as it may cause disease to return.

Doctors recommend other drugs along with steroids to take care of the side effects of the steroid.