Histopathology of Bronchiolar Disorders

Christian Couture, Thomas V. Colby

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


Bronchiolar pathologic lesions result from the interplay between inflammatory and mesenchymal cells following injury to bronchioles. Offending agents include viruses, bacteria, fungi, cigarette smoke, toxic inhalants, inorganic dusts, allergens, and systemic or localized autoimmune or inflammatory processes. Bronchiolar pathologic lesions also arise in the context of allograft transplantation and pathology of the large airways and in the setting of an idiopathic disorder. Given the great variety of sources of injury and diversity of clinical, radiological, and functional patterns that result, it is no surprise that most morphological abnormalities of the bronchioles are not specific. They thus represent a diagnostic challenge to the surgical pathologist, and the necessity of a multidisciplinary (clinical/radiological/pathologic) approach cannot be overemphasized. After a survey of the normal histology of bronchioles, we present a pragmatic classification that reflects the spectrum of bronchiolar pathology, illustrating the intimate interdependence of clinical, radiological, and pathologic findings in assessing the significance of bronchiolar lesions. This classification is intended to be applicable to surgical pathology material that can be correlated with clinical disease syndromes. It includes asthma-associated bronchiolar changes, chronic bronchitis/emphysema-associated bronchiolar changes, cellular bronchiolitis, respiratory bronchiolitis, bronchiolitis obliterans with intraluminal polyps/. BOOP, constrictive bronchiolitis, mineral dust small airway disease, peribronchiolar fibrosis and bronchiolar metaplasia, and bronchiolocentric nodules.

Original languageEnglish (US)
Pages (from-to)489-498
Number of pages10
JournalSeminars in Respiratory and Critical Care Medicine
Issue number5
StatePublished - Oct 1 2003


  • Bronchiolitis
  • Bronchiolitis obliterans
  • Constrictive bronchiolitis
  • Respiratory bronchiolitis
  • Small airway disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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