Bronchoalveolitis Leading to Bronchitis and Pneumonia

What Is Lymphocytic Bronchoalveolitis?

[dropcap]L[/dropcap]ymphocytic bronchoalveolitis is a pulmonary disorder characterized by lymphocytic airway inflammation of the bronchi (main passageways branching from the windpipe), bronchioles (small passageways), and alveoli (air sacs) at the end.

The chronic, productive cough that develops and worsens with progression is due to increased mucus secretion in the large and small airways.

If infection develops in the bronchioles, it is call bronchopneumonia. If infection develops in the alveoli, it is called interstitial pneumonia. The most common organism causing infection is staphylcoccus aureus.

Q: What effect does inflammation have on the lungs?

A: Alveoli are air sacs, each only one cell thick, where oxygen is obtained by the bloodsteam from air breathed into them and carbon dioxide is released from the bloodstream to air that is breathed out of air sacs. Two things happen:

1. Inflammation  impairs exchange of gases in alveoli, resulting in lack of sufficient oxygen (O2) for body cell functions, called hypoxia, and build-up of carbon dioxide (CO2) in blood, called CO2 retention.
2. Inflammation narrows passageways, which reduces the movement of air to and from the alveoli, and this puts stress on the right side of the heart.

Lymphocytes, which are a type of white blood cell, can be collected and assessed by a procedure called bronchoalveolar lavage to determine the degree of involvement.

What Is Lymphocytic Bronchoalveolitis In Celiac Disease and/or Gluten Sensitivity?

• Lymphocytic bronchoalveolitis is a pulmonary feature of untreated celiac disease and can be a presenting symptom that brings the patient to the doctor.
• Inflammation that advances to bronchopneumonia is a common cause of death in celiac disease.¹

How Prevalent Is Lymphocytic Bronchoalveolitis In Celiac Disease and/or Gluten Sensitivity?

• • Lymphocytic bronchoalveolitis is documented in association with celiac disease.²
  • A study investigating disease present within 4 hours of death in 24 cases of deceased patients with celiac disease at autopsy showed that bronchopneumonia was a common terminal complication in 11 cases.³

What Are The Symptoms Of Lymphocytic Bronchoalveolitis?

Lymphocytic bronchoalveolitis is marked by these symptoms:

• Chronic cough productive of sputum that becomes progressively worse.
• Some degree of shortness of breath.
• Drowsiness.
• Fatigue that worsens with progrssion of disease.
• Weakness.
• Frequent respiratory infections may develop.
• Right-sided heart failure may develop with swelling of the ankles due to progressive decreased lung function.

How Does Lymphocytic Bronchoalveolitis Develop In Celiac Disease and/or Gluten Sensitivity?

• Lymphocytic bronchoalveolitis has a probable causal relationship with celiac disease.²

Does Lymphocytic Bronchoalveolitis Respond To Gluten-Free Diet?

Yes. Lymphocytic bronchoalveolitis improves markedly on gluten free diet.²,⁴

6 Steps To Improve Lymphocytic Bronchoalveolitis In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both lung and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁵
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁶
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁶
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁶.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁶
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁶
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁶[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications used to treat bronchoalveolitis deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

• Penicillins deplete Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.⁷
• Erythromycin depletes Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.⁸

BRONCHODILATORS

• Inhaled corticosteroid inhalers (Flovent, Pulmicort and others) that are breathed in on a daily basis as a long term therapy to reduce inflammation in airways deplete potassium, calcium, vitamin D, and B vitamins.
• Albuterol inhalers that are breathed in on a daily basis as a long term therapy and also for quick relief as rescue inhalers to open airways depletes potassium.
• Theophylline by mouth as a long term therapy to open airways depletes potassium.

[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• B-Complex vitamins to restore adequate levels of vitamin B2, vitamin B12, biotin, and folic acid as needed.
• Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
• Vitamin D3 as prescribed following blood test for status.
• Vitamin K as prescribed following blood test for status.
• Potassium must not be taken as a supplement except as prescribed by a doctor based on blood testing for status.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Lymphocytic Bronchoalveolitis in Celiac Disease?

RESEARCH STUDY SUMMARIES

“Necropsy studies on adult coeliac disease.“ This study investigating disease present within 4 hours of death in 24 cases of deceased patients with celiac disease at autopsy showed that bronchopneumonia was a common terminal complication in 11 cases.⁹

CASE REPORT SUMMARIES

“Celiac disease presenting as chronic cough in an 8-year-old child.” This case report describes a chronic cough due to bronchoalveolitis in an otherwise asymptomatic 8-year-old girl. As a result of having a low threshold of suspicion for underlying celiac disease, a diagnosis was made and the long-term health risks of undiagnosed disease have been improved in both the patient and her immediate family.¹⁰

“A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet.” This case report describes the course of bronchoscopic evidence of lymphocytic airway inflammation in association with newly diagnosed celiac disease in a patient presenting with chronic cough with unclear cause after investigations and poor response to treatment. The sole feature of bronchoalveolitis was a heightened cough reflex that did not respond to treatment.

An autoantibody screen showed positive endomysial and anti-gliadin antibodies with raised serum IgA of 2.08 g/l (normal 0.8 – 1.4).  Duodenal biopsy revealed partial villous atrophy. All pulmonary features improved markedly on a gluten free diet, suggesting causal relationship between celiac disease, cough, and lymphocytic bronchoalveolitis.²

Sources:

1. Thompson H. Necropsy studies on adult coeliac disease. J Clin Pathol. 1974 Sep;27(9):710-21. [↩]
2. Brightling CE, Symon FA, Birring SS, Wardlaw AJ, Robinson R, Pavrod ID. A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet. Thorax. Jan 2002;57(1):91-2. [↩] [↩] [↩] [↩]
3. Thompson H. Necropsy studies on adult coeliac disease. J Clin Pathol. 1974 Sep;27(9):710-21. [↩]
4. Hayat S, Pitchaikani  PK, Williams N, Cosgrove M. Coeliac disease presenting as chronic cough in an 8-year-old child. BMJ Case Reports 2011; doi:10.1136/bcr.10.2011.5064 [↩]
5. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
6. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
7. https://umm.edu/health/medical/altmed/depletion/antibiotic-medications-penicillin-derivatives. [↩]
8. http://umm.edu/health/medical/altmed/depletion/antibiotic-medications-macrolides [↩]
9. Thompson H. Necropsy studies on adult coeliac disease. J Clin Pathol. 1974 Sep;27(9):710-21. [↩]
10. Hayat S, Pitchaikani  PK, Williams N, Cosgrove M. Coeliac disease presenting as chronic cough in an 8-year-old child. BMJ Case Reports 2011; doi:10.1136/bcr.10.2011.5064 [↩]