25-Year-Old Concerned About Potential Bronchiolitis Obliterans After Short Silica Exposure — Seeking Opinions
Hello everyone, I've been observing this community for some time and felt compelled to share my situation in hopes of finding insights from those with similar experiences. I am a 25-year-old male, a non-smoker, who was exposed to silica and brick dust for a very limited time—approximately three days, during which I had some protective measures in place. Until recently, I was asymptomatic, but 15 months post-exposure (in December 2024), I began to notice some gradual onset symptoms. I underwent a series of tests in February 2025 and am currently on Symbicort, with no other medications involved. **Potential Bronchiolitis Obliterans:** Lately, I've delved into the subject of bronchiolitis obliterans (BO) and am increasingly anxious that this may align with my situation. The delayed emergence of symptoms, issues regarding my small airways, slight alterations in my HRCT scan, and the nature of my symptoms appear to fit the BO profile—especially considering my silica exposure. A specific case study I found particularly relevant can be reviewed here: [Case Study](https://onlinelibrary.wiley.com/doi/10.1002/ajim.4700280312) **Symptoms and Treatment Response:** - **Primary Issue:** My lungs have a persistent dry and obstructed sensation around the clock. It’s not the typical shortness of breath (SOB); rather, it feels mechanical, as though my lungs aren’t fully inflating, leading to a heavy feeling, though my breathing is nearly normal. - There is no coughing or mucus production. - Symbicort has proven quite effective (approx. 80% symptom relief) but does not completely alleviate the sensation. Notably, wheezing is minimal; I primarily experience a mild feeling of obstruction. - I've also noticed a slight change in my fingernail color, which has darkened to a hue approaching purplish. - My pulse oximetry shows a stable reading of 98%. - Exhaled Nitric Oxide (FENO) measures at 24 ppb. - Serum IgE level is at 271 kU/L, indicating a strong allergy to oak wood, as my family frequently utilizes a fireplace—this could be a contributing factor. **Imaging and Testing:** - **Chest X-ray:** Appeared normal. - **Inspiratory Supine HRCT:** Revealed mild thickening of bronchial walls, minimal small airways disease, and subtle changes at the periphery. Importantly, there was no evidence of fibrosis or emphysema; I still fear that this could indicate preliminary stages of BO. However, another expert review of the HRCT did not uncover any abnormalities. - **Echocardiogram:** Results were normal. **Pulmonary Function Tests (PFTs) (conducted prior to medication, during peak symptoms):** - **Spirometry Results:** |Parameter|Pre-BD|Post-BD| |:-|:-|:-| |FVC (%)|99|104| |FEV1 (%)|79|92| |FEV1/FVC|61|68| |FEF25-75% (%)|56|75| |PEF (%)|47|57| |FET100% (s)|7.54|7.45| |FIVC (%)|104|107| |FIF50% (L/s)|2.29|4.23| - **Lung Volume Measurements:** * VC: 6.90L (106%) * TLC: 7.27L (82%) * RV: 0.37L (16%) * FRC: 3.93L (83%) * ERV: 0.65L (30%) * IC: 3.34L (77%) * Raw: 1.75 cmH₂O/L/sec (**197% elevated**) * Vtg: 6.55L - **Diffusion Testing:** * DLCO: 52.4 (147% predicted) * DLCO/VA: 6.31 (134%) * VA: 8.3L (97%) **Additional Measurements:** * IVC: 6.54L * BHT: 8.04s **Critical Questions:** - **Investigating Bronchiolitis Obliterans:** - Could an **expiratory HRCT** provide evidence of subtle air trapping that might indicate BO? Is this test essential? - Might **oscillometry**, **expiratory HRCT**, or potentially **bronchoscopy** aid in confirming or dismissing BO? - Do the recorded increased Raw (197%), reversibility in FEF25-75%, and HRCT observations suggest early or unusual **bronchiolitis obliterans**? - Is it feasible that this is a mild/initial stage overlooked in standard inspiratory CT assessments? - Is it typical for patients diagnosed with BO to present normal spirometry and DLCO results yet continue to struggle with persistent mechanical symptoms? - **Silica Versus Oak Exposure:** - Could merely three days of silica exposure initiate BO months later? - Or does the chronic oak smoke exposure (IgE at 271) seem more likely to be the underlying cause? - **Interstitial Lung Disease/COPD Considerations:** - Considering the high DLCO (147%) and the absence of fibrosis/emphysema, is it possible this is an early form of ILD or BO-like COPD? - With a TLC of 82%, is that borderline low enough to indicate mild restriction or small airway remodeling? - **Mechanical Lung Sensation:** - What could explain the persistent heavy/restricted sensation in my lungs even though the spirometry and imaging results appear largely normal? **Input from the Community:** - Has anyone experienced **post-exposure bronchiolitis obliterans** with such delayed symptom onset? - What are your thoughts regarding the discrepancy between my symptoms and largely typical imaging/spirometry results? Thank you for taking the time to read this. The ongoing sensation of "dry/restrictive lungs" is quite distressing for me, and I would be extremely grateful for any expertise, personal stories, or advice on whether I should pursue an expiratory CT or bronchoscopy. 🙏 **Summary:** 25-year-old male with a brief silica exposure presents with persistent mechanical lung sensations. PFT results indicate small airways dysfunction (↑ Raw, ↓ FEF25-75%) alongside a high DLCO (147%). HRCT shows minor findings. Symbicort offers partial relief. Allergy to oak (IgE at 271) is noted. ILD/emphysema has been ruled out. **Concerns about early bronchiolitis obliterans — is an expiratory CT or bronchoscopy warranted?**
Answers (1)
4/4/2025, 12:21:21 AM
OpenHealth AI
It's understandable to be concerned about your potential bronchiolitis obliterans (BO) given your exposure to silica and the symptoms you are experiencing. The sensations in your lungs can be distressing, especially since they do not seem to correlate with the typical spirometry and imaging results. Here are key points to consider regarding your situation, along with some suggestions for next steps.
Key Points:
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Symptoms & Diagnostic Challenges: Your persistent sensation of lung obstruction, paired with normal spirometry and high DLCO, indicates a potential small airways issue. Symptoms of BO may sometimes present without clear abnormalities in standard tests.
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Role of Imaging and Testing: While your current HRCT and PFTs are largely normal, further testing may provide more insights. Specifically, an expiratory HRCT could help identify any hidden air trapping or structural changes.
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Exposure Risk Analysis: Both silica and oak smoke have been associated with respiratory issues. While your silica exposure was brief, ongoing allergy to oak may significantly contribute to your symptoms.
Next Steps:
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Consider Further Imaging:
- Expiratory HRCT: This test can help assess for subtle air trapping that might suggest bronchiolitis obliterans. Discuss with your healthcare provider the potential benefits versus risks of this investigation.
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Assess Exposure Contributions:
- Given your high serum IgE levels for oak, consider limiting exposure to smoke from the fireplace and other allergens. Reducing this exposure could help lessen your symptoms.
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Evaluate Symptoms and Treatments:
- Monitor how your symptoms respond to changes in your environment (like avoiding oak smoke) and medication adjustments under medical guidance. Document any patterns you observe.
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Explore Additional Testing Options:
- You might want to ask your doctor about the potential usefulness of oscillometry or bronchoscopy to better evaluate your airways and rule out other conditions.
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Stay Informed and Supportive:
- Keep a symptom diary that notes specific triggers and changes in sensations. This could provide valuable information for further discussions with your healthcare provider.
Summary:
Your ongoing pulmonary symptoms warrant closer examination, especially given your exposure to both silica and allergenic oak smoke. Consider asking for an expiratory HRCT and possibly reviewing your allergy management plan. Managing environmental exposures and staying mindful of your symptoms can provide relief as you navigate this situation. Take care, and feel free to reach out if you have more questions or need further clarification.
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