Cryptogenic organizing pneumonia (COP)
Catharine Thomas, Consultant Physiotherapist, Tameside Hospital NHS FT
Cryptogenic organizing pneumonia (COP), the idiopathic form of organizing pneumonia (formerly called bronchiolitis obliterans organizing pneumonia or BOOP), is a type of diffuse interstitial lung disease that affects the distal bronchioles, respiratory bronchioles, alveolar ducts, and alveolar walls The primary area of injury is within the alveolar wall.
Disease onset is typically in the fifth or sixth decades of life with men and women affected equally. Most patients are symptomatic for less than two months and have a clinical presentation that mimics community-acquired pneumonia (e.g., cough, dyspnoea with exertion, weight loss). Approximately half of cases are heralded by a flu-like illness.
The most common features of the history at presentation:
Persistent non productive cough (72%)
Weight loss of greater than 10 pounds (57%)
Hemoptysis is rarely reported as a presenting manifestation of COP.
As with all patients who present with interstitial lung disease, the history should include questions about any symptoms or history suggestive of connective tissue disease (eg, arthralgias, dry eyes, dry mouth, muscle weakness, numbness, tingling), current and recent medications, and history of exposure to therapeutic irradiation, fumes, or dusts..)
The most common chest imaging features of COP are:
CXR of a forty-eight year old woman with an eight week history of cough, dyspnea with exertion, fatigue, and slight weight loss. PA chest radiograph reveals bilateral volume loss with reticular opacities at both bases (reproduced with permission).
High Resolution CT Thorax of a forty-eight-year-old woman with an eight-week history of cough, dyspnea with exertion, fatigue, and slight weight loss. High resolution CT scan shows right lower lobe reticular and hazy opacities that are subpleural (reproduced with permission).
Pulmonary function tests
Pulmonary functiont esting usually shows a restrictive pattern with an associated gas transfer defect.
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