Management of plastic bronchitis with topical tissue-type plasminogen activator

Elizabeth Gibb; Robert Blount; Nancy Lewis; Dennis Nielson; Gwynne Church; Kirk Jones; Ngoc Ly

doi:10.1542/peds.2011-2883

Back

Management of plastic bronchitis with topical tissue-type plasminogen activator

Journal article

Peer reviewed

Management of plastic bronchitis with topical tissue-type plasminogen activator

Elizabeth Gibb, Robert Blount, Nancy Lewis, Dennis Nielson, Gwynne Church, Kirk Jones and Ngoc Ly

Pediatrics (Evanston), Vol.130(2), pp.e446-e450

08/2012

DOI: 10.1542/peds.2011-2883

PMID: 22802609

View Online

Abstract

Plastic bronchitis or cast bronchitis is a rare disease of unclear etiology characterized by formation of airway casts that can lead to life-threatening airway obstruction. There is currently limited data regarding optimal treatment of plastic bronchitis. Several therapies have been suggested, but recurrences are common and mortality remains high. We report the case of a 6-year-old boy with refractory eosinophilic bronchial casts, unresponsive to low-dose systemic corticosteroids, inhaled corticosteroids, azithromycin, and dornase alfa, who was treated successfully and safely with direct instillation of tissue-type plasminogen activator (tPA) to the obstructing casts during flexible bronchoscopy and inhaled tPA. Our case illustrates that the current therapy for plastic bronchitis remains inadequate. To our knowledge, this case is the first to show that direct instillation of tPA can be used safely for treatment of this disease. The use of tPA via direct administration into the airways during bronchoscopy and via a nebulizer appeared to be a safe and effective therapy for plastic bronchitis and should be considered early in the course of the disease to prevent complications of severe airway obstruction.

Respiratory Distress Syndrome, Adult - pathology

Instillation, Drug

Humans

Airway Obstruction - diagnosis

Male

Tomography, X-Ray Computed

Pulmonary Atelectasis - drug therapy

Bronchitis - diagnosis

Eosinophilia - pathology

Pulmonary Atelectasis - pathology

Pulmonary Atelectasis - diagnosis

Eosinophilia - drug therapy

Child

Eosinophilia - diagnosis

Asthma - diagnosis

Bronchoscopy

Tissue Plasminogen Activator - administration & dosage

Respiratory Distress Syndrome, Adult - drug therapy

Respiratory Distress Syndrome, Adult - diagnosis

Bronchitis - drug therapy

Asthma - complications

Airway Obstruction - pathology

Bronchitis - pathology

Airway Obstruction - drug therapy

Administration, Topical

Asthma - pathology

Details

Title: Subtitle: Management of plastic bronchitis with topical tissue-type plasminogen activator
Creators: Elizabeth Gibb - Division of Pulmonary Medicine, Department of Pediatrics, Benioff Children’s Hospital, University of California San Francisco, San Francisco, California 94143, USA. gibbe@peds.ucsf.edu
Robert Blount
Nancy Lewis
Dennis Nielson
Gwynne Church
Kirk Jones
Ngoc Ly
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.130(2), pp.e446-e450
DOI: 10.1542/peds.2011-2883
PMID: 22802609
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Publisher: American Academy of Pediatrics
Language: English
Date published: 08/2012
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Occupational and Environmental Health; Stead Family Department of Pediatrics; Internal Medicine
Record Identifier: 9984093500302771

Metrics

33 Record Views

35 Times Cited - Web of Science

See more details