Bronchiolitis obliterans cause - natural, alternative treatment - supplements herbs vitamins and review of published trials
June 10 2016

Bronchiolitis obliterans is a rare and life-threatening lung disease. It is a type of respiratory infection in which there is an inflammation of the lungs at the level of the bronchioles. Childhood constrictive bronchiolitis obliterans is characterized clinically by the persistence of obstructive respiratory symptoms following a prolonged episode of a lower respiratory viral infection.

Natural treatment of bronchiolitis obliterans
Very few herbal medicine studies have been done to find out what natural products may be helpful.

N-acetylcysteine improves the clinical conditions of mustard gas-exposed patients with normal pulmonary function test.
Basic & Clinical Pharmacology & Toxicology. 2008; Ghanei M, Shohrati M, Jafari M, Ghaderi S, Alaeddini F. Research Center of Chemical Injuries, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Administration of N-Acetylcysteine may be effective in diseases caused by oxidative-antioxidative imbalance. We aimed to determine the effect administration for 4 months of N-acetylcysteine (1200 mg daily) on sulfur mustard-induced bronchiolitis obliterans in patients with normal pulmonary function test. In a double-blind clinical trial, 144 patients with bronchiolitis obliterans due to sulfur mustard and bronchiolitis obliterans syndrome class 0, randomly entered to group 1 N-acetylcysteine) and group 2 placebo. The changes in dyspnea, wake-up dyspnea, cough and sputum were measured after 4 months. Dyspnea, wake-up dyspnea, and cough improved after 4 months of N-acetylcysteine administration compared to the control group. N-acetylcysteine reduced sputum from 76% of cases before the trial to 9%  of cases after the trial. Spirometric components were significantly improved in N-acetylcysteine group compared to the placebo group:. A 4-month trial with 1200 mg oral N-acetylcysteine per day can be used for treating bronchitis, but is also effective in treating bronchiolitis. It also prevents sulfur mustard-induced oxidative stress, and can be used in the treatment of sulfur mustard-induced pulmonary disease.

Inhal Toxicol. 2014. The role of N-acetylcysteine in the management of acute and chronic pulmonary complications of sulfur mustard: a literature review. Sulfur mustard exposure, as the most widely used chemical weapon, can lead to acute and long-term pulmonary complications via various pathways, such as triggering an imbalance between the oxidant and antioxidant system. Currently, there is no validated antidote, chemoprophylaxis and curative modality for pulmonary toxicities secondary to sulfur mustard exposure. The aim of this literature review is to collect available experimental and clinical data on the efficacy of N-acetylcysteine (NAC), as a prominent antioxidant agent, in the prevention and/or treatment of sulfur mustard-induced acute and chronic pulmonary toxicities. A literature search was performed by the relevant keywords like "N-acetyl cysteine", "Sulfur mustard" and "Lung injury" in databases such as Scopus, Medline, Embase and ISI Web of Knowledge. No time limitation was considered. Nineteen articles were selected for review. A number of in vitro and experimental studies concluded that oral, intravenous, intraperitoneal and intra-tracheal administration of NAC is effective in the management of sulfur mustard-induced acute lung injury, in a time-dependent manner, via direct scavenging, inhibition of oxidative stress, inflammatory responses and apoptosis. In addition, oral NAC alone (1200 or 1800 mg/day for 4 months) or at a dose 600 mg/day for 6 months in combination with clarithromycin (500 mg/day) have led to improvements of clinical and paraclinical pulmonary parameters of patients with bronchiolitis obliterans due to sulfur mustard, through undetermined mechanisms. Despite limitations of relevant experimental and clinical studies, NAC can be considered as a candidate agent for prevention and/or treatment of sulfur mustard-induced acute lung injuries, as well as its long-term pulmonary toxicities, especially bronchiolitis obliterans.

Q. Would taking more than 1,000 mg of NAC be safe for long term use in those with bronchiolitis obliterans?
   A. NAC is a safe supplement, but if lower dosages, such as 500 mg, work, then it may be best to use the lower dosages.

Role of antioxidants?
Lung transplantation: does oxidative stress contribute to the development of bronchiolitis obliterans syndrome?
Transplant Rev (Orlando). 2009; Madill J, Aghdassi E, Hartman-Craven B, Gutierrez C, Chow CW, Allard J; University Health Network. University of Toronto, Lung Transplant Program, University Health Network, Toronto, ON, Canada.
Lung transplantation is the ultimate treatment of end-stage lung disease. After transplantation, the 1-year survival rate is 80%. However, 5-year survival rates drop to 50% due to bronchiolitis obliterans syndrome (BOS). Ischemia / reperfusion injury, infections, and acute rejection are major risk factors contributing to the development of BOS. These risk factors are also associated with increased oxidative stress. Oxidative stress is a condition whereby prooxidants overwhelm the antioxidant defense system and may contribute to the pathogenesis of BOS by inducing more tissue injury and inflammation. This article reviews the current state of knowledge on oxidative stress in lung transplantation and BOS.

Bronchiolitis obliterans cause
Bronchiolitis obliterans syndrome usually occurs after infection of the lower airways. Bronchiolitis obliterans is known to be caused by exposure to noxious gases in occupational settings and has been described in workers in the microwave-popcorn industry who were exposed to artificial butter-flavoring chemicals, including diacetyl. Workers at factories that make food flavorings are at risk of  bronchiolitis obliterans. Diacetyl, which produces a butter flavor, is the main suspect although other flavorings may play a role. Safe occupational exposure levels for diacetyl and many other flavoring chemicals have not been established.
   In children with post infectious bronchiolitis obliterans, adenoviruses are the most common cause. Bronchiolitis obliterans can be associated with Stevens-Johnson syndrome.

Diacetyl as cause of bronchiolitis obliterans
People who work in factories producing diacetyl, a chemical used in food flavoring, are at increased risk for developing bronchiolitis obliterans syndrome. Bronchiolitis obliterans syndrome has also been called popcorn worker's lung. Dr. Frits G. B. G. J. van Rooy, of Utrecht University, the Netherlands, and colleagues examined the risk of bronchiolitis obliterans syndrome in chemical workers producing diacetyl, with exposure to less complex mixtures of chemicals. Dr. Frits G. B. G. J. van Rooy and colleagues identified 200 workers who had potentially been exposed to diacetyl between 1960 and 2003. Of these individuals, 10 had died. Of the remaining 196 individuals, 175 consented to the study. Three cases consistent with bronchiolitis obliterans syndrome were identified in the highest exposure group of 102 process operators. Two of these subjects were life-long smokers. Their symptoms had started an average of 5 years after employment at the diacetyl plant. Other exposures included acetoin, diacetyl, acetaldehyde, and acetic acid. Diacetyl exposures were in the range previously reported to be associated with airway blockage in the microwave popcorn industry. American Journal of Respiratory and Critical Care Medicine, September 2007.

Role of cytokines
Analysis of cytokine pattern in exhaled breath condensate of lung transplant recipients with bronchiolitis obliterans syndrome.
Inflamm Res. 2010; Antus B, Barta I, Czebe K, Horvath I. Department of Pathophysiology, National Koranyi Institute for TB and Pulmonology, Budapest, Hungary.
Exhaled breath condensate (EBC) analysis is a promising method for investigating airway pathology. In this pilot study we tested the cytokine pattern of EBC of lung transplant patients with and without clinical evidence of bronchiolitis obliterans syndrome (BOS). MATERIALS AND METHODS: Breath condensates collected from eight BOS patients and eight stable BOS-free lung transplant recipients in three consecutive visits were pooled in order to increase protein concentration and were then used for antibody microarray analysis detecting 120 cytokines simultaneously. Nine cytokines exhibited more than twofold increase and four exhibited more than twofold decrease in BOS patients as compared to stable subjects. We conclude that inflammatory cytokines are present in EBC of lung transplant recipients, however the potential benefit of detecting the EBC proteome warrants further studies.

Bronchiolitis obliterans symptoms
Vague symptoms include cough and shortness of breath, that steadily worsen.