Young chronic obstructive lung disease or constrictive bronchiolitis: difficulties in differential diagnosis in the context of hostilities

Анотація

Confirmation of the diagnosis of chronic obstructive pulmonary disease (COPD) in young patients is a difficult but important challenge for respiratory physicians, as it is the key to prescribing the correct therapy and has an important medical and social role. The term “young COPD” is used in the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2026 GOLD Report to refer to patients with COPD aged 20-50 years. The aim of the study was to describe the features of the diagnosis of young COPD and to systematize the latest data on the differential diagnosis with obliterative bronchiolitis. We conducted a literature search on the relevant topics and keywords in the scientific databases PubMed, Google Scholar, Scopus and Web of Science. After a detailed analysis, 53 literature sources were selected and evaluated, 90% of which were published over the past 5 years and contained the most up-to-date information. It has been established that genetic factors prevail over the influence of environmental factors in the development of COPD in young patients, among which the most common cause is congenital alpha-1 antitrypsin deficiency. However, there is a growing trend of airway damage as a result of smoking modern devices for nicotine and tobacco use, such as new generations of e-cigarettes and tobacco heating devices, which are especially popular among youth. The diagnosis of COPD in people younger than 50 years can be considered if the patient has not only persistent post-bronchodilator obstruction, but also presents a long history of smoking (≥10 pack-years) and typical changes on computed tomography of the lungs (emphysema and abnormalities of small or large bronchi). In the context of active hostilities, an important competitive diagnosis in such patients is obliterative bronchiolitis. This disease is manifested by external compression and sometimes obliteration of bronchioles, and should be considered when five factors are combined, including an atypical young age for COPD, typical symptoms, persistent bronchial obstruction on spirometry, the formation of the “air trapping” symptom on computed tomography of the lungs, no signs of emphysema, and an anamnesis of inhalation of toxic substances. Thus, confirmation of the diagnosis of COPD in people under 50 years of age requires a comprehensive assessment of the patient's condition, which should include pulmonary function testing (spirometry), imaging studies (computed tomography of the lungs), and genetic testing (alpha-1 antitrypsin deficiency). Given that in the context of active hostilities related to the War for Independence of Ukraine, both military personnel and civilians may be exposed to significant negative effects of toxic and irritating substances on the respiratory system, obliterative bronchiolitis should be considered as a mandatory component of the differential diagnosis in young patients. To verify the diagnosis of obliterative bronchiolitis, computed tomography of the lungs and confirmation of inhalation of toxic substances are crucial. However, in certain clinical situations, only lung biopsy assessment can distinguish between these two diagnoses.