THE DIAGNOSIS AND MANAGEMENT OF PLASTIC BRONCHITIS: A SYSTEMATIC LITERATURE REVIEW

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Plastic bronchitis is an extremely rare respiratory disease in which patients suffer from dyspnea, chronic cough, congested lungs, tenacious mucus and frequent mucus plug expectoration. The pathophysiology of plastic bronchitis is poorly understood, and diagnosing this disease is often greatly delayed or missed entirely. Most known cases are found in the pediatric population following congenital cardiac surgery, making the diagnosis and treatment of plastic bronchitis in adults even more challenging. This research study is the largest review of plastic bronchitis cases performed to date, and seeks to better understand the symptoms adults with plastic bronchitis suffer from, propose criteria for earlier bronchoscopic investigation and diagnosis, and provide a literary review of successful treatment options. METHODS: Online database search (PubMed, Web of Science, Embase and Scopus) using term “adult plastic bronchitis” was performed. Studies from 1966 till current year were reviewed. Cases were filtered for relevance based upon adult age, English language and a clinical plastic bronchitis diagnosis. Patient demographics and relevant clinical history were analyzed. Successful treatment methods were also investigated and explored to arrive at the most commonly beneficial management options for patients with plastic bronchitis. RESULTS: A total of 71 adult cases of plastic bronchitis were found after a comprehensive search of literature. Of these only 38 had sufficient information and a credible diagnose of plastic bronchitis. The following are the common clinical findings: symptoms of mucus cast/plug expectoration (25/37, 68%), chronic cough (25/38, 68%), exam findings of wheezing (9/12, 75%), decreased breath sounds (4/12, 33%), non-specific opacity on chest x-ray or CT (28/31, 90%), abnormal lymphatic flow on lymphangiography (12/31, 39%), mucus casts/plugs found on bronchoscopy (23/29, 79%), and mucus analysis indicating fibrinous mucus (14/24, 58%). Treatments that most effectively relieved symptoms were the following: Lymphatic intervention (10/11, 91%), bronchoscopy (9/27, 33%), oral steroids (5/18, 28%), and multimodal medical treatment (7/35, 20%). CONCLUSIONS: This study provides physicians caring for patients presenting with unusual respiratory symptoms helpful criteria for earlier diagnosis of plastic bronchitis, and suggests potential treatment options for this rare disease. CLINICAL IMPLICATIONS: This study provides physicians caring for patients presenting with unusual respiratory symptoms helpful criteria for earlier diagnosis of plastic bronchitis, and suggests potential treatment options for this rare disease. DISCLOSURES: No relevant relationships by Alex Aram, source=Web Response No relevant relationships by Bhavinkumar Dalal, source=Web Response