Understanding Plastic Bronchitis: Symptoms, Causes, and Treatment

• Definition of Plastic Bronchitis

  Plastic bronchitis is a rare respiratory condition in which abnormal and thickened bronchial secretions are formed in the airway leading to blockages that can further lead to severe breathing difficulties. The condition can affect people of any age but is seen commonly affecting children with underlying medical conditions such as congenital heart disease, and pulmonary hypertension. Plastic bronchitis can also occur as a complication of certain surgical procedures such as surgery of heart and lung transplantation. ⁽¹⁾
  
  

• Importance of Understanding Plastic bronchitis

  It is important to understand plastic bronchitis as it’s a rare and life-threatening respiratory condition and can have serious complications. Understanding the cause and symptoms can be helpful in diagnosing and managing the condition. This can be helpful in improving the outcome for the patient.

  Also, it can be helpful in increasing public awareness of the disease. This can help in recognizing the symptoms and getting treated at the earliest.

The exact cause of plastic bronchitis is not known. ⁽²⁾ However, there are a few medical conditions that are associated with developing plastic bronchitis. Some of the causes and risk factors of plastic bronchitis include:

• Congenital Heart Disease: Children with congenital heart disease have a higher risk of developing plastic bronchitis, which may be due to the abnormal flow of blood into the lungs. Plastic bronchitis is seen occurring in 4-14% of people undergoing the Fontan procedure, a procedure in which the blood flow from the lower body is redirected to the lungs to treat congenital heart disease. ⁽³⁾
• Pulmonary Hypertension: This condition is characterized by high pressure in the lungs, which increases the risk of plastic bronchitis.
• Lymphatic Abnormalities: Problems in the lymphatic system can disrupt the normal flow of lymph fluid which may lead to abnormal secretions.
• Lung Transplantation: Complications in lung transplantation can lead to damage to the lymphatic system during the surgery.
• Infection: Infections including viral and bacterial pneumonia can lead to inflammation and obstruction of the airways, which increases the risk of developing plastic bronchitis.
• Inflammatory conditions: Inflammatory conditions including asthma or cystic fibrosis can increase the risk of developing plastic bronchitis.
• Familial predisposition: There are more chances of developing plastic bronchitis if the condition runs in family.

The symptoms of plastic bronchitis may vary depending on the severity of the condition. It depends on the size of the cast and its location in the airway. Sometimes the cast may cover only a small segment of bronchi while in others it may fill the entire airway.

• Coughing: Coughing is the main symptom of plastic bronchitis. Sometimes people may even cough up casts as they become large. People may have a persistent cough which may be dry or productive.
• Shortness of Breath: There may be difficulty in breathing that may lead to shortness of breath, wheezing, or chest tightness.
• Chest Pain: The person with plastic bronchitis may experience chest discomfort especially when breathing deeply or coughing.
• Fatigue: If the condition is prolonged there may be fatigue and weakness.
• Fever: In some, there may be fever or other signs of infection including chills and sweat.
• Cyanosis: Due to lack of oxygen the skin may turn blue or purple.

Seeking medical attention is important if any of the above symptoms are experienced.

Plastic bronchitis may not have a definitive diagnosis. The doctor may diagnose plastic bronchitis on the basis of the symptoms of a person, physical examination, and imaging reports such as CT scan and x-ray. ⁽⁴⁾ The imaging reports may be helpful in showing complications including a partially collapsed lung. Bronchoscopy can also be helpful in confirming the diagnosis of plastic bronchitis. It shows the presence of the cast.

Medication is given for managing the condition. Bronchodilators and corticosteroids may be given to open up the airway and reduce inflammation. ⁽³⁾ Antibiotics may be prescribed to decrease the formation of the cast and treat the underlying infection. Mucolytics are given to thin the mucus, making it easier for the person to cough the cast out of the lungs.

The procedures involved in the treatment of plastic bronchitis include:

• Bronchial Artery Embolization: It is a minimally invasive procedure that involves inserting the catheter into bronchial arteries that supply blood to the lungs. Tiny particles are injected to block blood flow to the abnormal vessels that supply mucus-producing glands in the airway. This helps in reducing mucus plugs and improves breathing.
• Lymphatic Embolization: It involves injecting small particles into the lymphatic vessels in the lungs. This reduces the flow of lymphatic fluid and reduces the formation of mucus plugs.
• Surgical Removal: In severe cases of plastic bronchitis, surgical removal of mucus plugs may be necessary. The surgical procedure is known as surgical cast removal and bronchial cast resection.

To prevent or manage plastic bronchitis, a combination of the following strategies can be used:

• Lifestyle Changes: The lifestyle changes include quitting smoking, avoiding environmental triggers, introducing exercise and physical activity, and eating a healthy diet. These can be helpful in reducing lung irritation, removing inflammation, and improving breathing. Stress management techniques such as yoga and meditation can be helpful in improving the symptoms of plastic bronchitis.
• Follow-up Care: It is an essential part of the management of plastic bronchitis. It is important for the evaluation of symptoms, medication management, and monitoring of complications. Lung function testing can be performed to evaluate lung function and assess the effect of treatment.
• Support Groups: Education and support should be provided to the patient and their family and friends to help them manage the condition.

• Long-Term Outlook: The outlook for plastic bronchitis may depend on the location of the casts. There may be asphyxiation if the cast blocks the main airway. The mortality may range from 6-60%. ⁽¹⁾
• Possible complication: The complication of plastic bronchitis may include recurrent infection, respiratory failure, pneumothorax, and cardiac complications. If left untreated, plastic bronchitis may even lead to death.

• Ongoing Studies and Research: The ongoing studies focus on the goal of understanding and improving the condition and determining effective treatment. Researchers are exploring the genetic and molecular factors that may be contributing to the development of plastic bronchitis. The goal is to identify potential targets for new treatments. ⁽⁵⁾

  New medical therapies are being developed to improve management. Researchers are also focusing on the safety and effectiveness of surgical and interventional procedures such as lymphatic embolization and bronchial artery embolization in the treatment of plastic bronchitis.

  Researchers are also working towards a better understanding of the epidemiology of plastic bronchitis including its incidence, prevalence, and risk factors to improve diagnosis and treatment.

• Potential for New Treatment and Intervention: Some of the potential areas for new treatment and intervention include the following.

  Pharmacological Therapies: New drugs are being developed that would target specific molecular pathways involved in the disease, thereby providing more effective treatment. ⁽⁵⁾

  Immunomodulatory Therapies: Researchers are also investigating the use of immunomodulatory therapies to target the immune system and reduce inflammation.

  Gene Therapies: Advance gene therapies may provide long-term relief from plastic bronchitis by correcting the gene mutation

  Stem Cell Therapies: Stem cell therapies are being explored as a potential treatment for plastic bronchitis.

Plastic bronchitis involves the formation of a rubbery cast containing mucus, which can lead to respiratory distress.

It is a rare condition but is found to occur more in children, especially those undergone heart surgery.

Plastic bronchitis can be treated by medication and removal of the cast. It is important to speak with a healthcare professional if any of the related symptoms. The doctor may investigate the symptoms carry out the required test and detect the underlying condition and treat it.

Early diagnosis and treatment can effectively improve the symptoms of Plastic bronchitis and thereby the quality of life.