OP- COP- BOOP

OP- COP- BOOP 

Σ Α Παπίρης

Organizing pneumonia is 

a non-specific 

response to 

various 

forms of lung injury and is 

the pathological hallmark 

of the distinct 

clinical entity termed 

cryptogenic organizing 

pneumonia

Organizing pneumonia is one of the 

main reparative reactions 

to acute injury by the lung and 

reflects the incomplete 

resolution of inflammation within 

the alveoli, and to a lesser extent the 

distal bronchioles

OP- COP- BOOP 

• Organising pneumonia of determined 

cause 

• Organising pneumonia of undetermined 

cause but occurring in a specific and 

relevant context 

• Cryptogenic (idiopathic) organising 

pneumonia

Causes of organizing pneumonia and associations with other conditions

The “typical”” COP syndrome 

Flu-likelike illness accompanied with fever, 

non-productive 

cough, malaise, anorexia and weight 

loss. 

Dyspnoea is common but usually mild and evident 

only on exertion. 

Less common symptoms are bronchorrhoea, haemoptysis 

(but 

severe haemoptysis is exceedingly rare), 

chest pain, 

arthralgia and night sweats.

OP – COP - BOOP 

Lange, a German pathologist, first described the pathological findings of 

BOOP in two autopsies in 1901 

• Davison AG, Heard BE, McAllister WAC, and Turner- 

Warwick ME. Cryptogenic organizing pneumonitis. 

Q J Med 1983; 52: 382-394 

394 

• Epler GR, Colby TV, McLoud TC, and Gaensler EA. 

Bronchiolitis obliterans organizing pneumonia. 

N Engl J Med 1985; 312: 152-158 

158

Liebow & 

Carrington 1969 

Katzenstein 

1997 

Müller & Colby 

1997 

ATS / ERS 2002 

UIP 

UIP 

UIP 

UIP 

DIP 

DIP / RBILD 

DIP 

DIP /RBILD 

BIP 

BOOP 

COP 

AIP 

AIP 

AIP 

NSIP 

NSIP 

NSIP 

LIP 

LIP 

GCIP

BOOP (COP) 

Κατάταξη των διάμεσων παρεγχυματικών 

νοσημάτων πνεύμονα 

Διάχυτα Παρεγχυματικά Νοσήματα Πνεύμονα 

Φάρμακα, Αυτοανοσία, 

Επαγγελματικά, Λοιμώδη, 

Κακοήθη κλπ 

ΙΔΠς 

Κοκκιωματώσεις 

Άλλα σπάνια 

IPF 55% 

Άλλες 

DIP 15% 

RBILD 

AIP

BOOP Επιδημιολογικά δεδομένα 

• 6-77 ασθενείς /100.000 εισαγωγές σε μεγάλα νοσοκομεία 

• Μη καπνιστές / καπνιστές: 2 / 1 

• Ομοιόμορφη κατανομή ανάμεσα στα 2 φύλα 

• Μέση ηλικία εμφάνισης 55 έτη 

Alasaly K, et al. Medicine 1995; 74: 201-211 

211

Organizing pneumonia: 

the many morphological faces

Cordier et al. divided patients with BOOP in to two groups based on 

radiographic patterns and used this classification to predict outcome 

in each group. 

Patients with localized disease were rarely symptomatic and had 

overall a good prognosis, whereas patients with diffuse disease were 

more often symptomatic, required treatment with corticosteroids and 

had variable outcomes

Bronchiolitis obliterans organizing 

pneumonia in cancer 

A bar graph illustrating the relationship of radiographical patterns and the type of 

underlying malignancy in 43 patients with cancer and BOOP. Nodules (■), mass (▒) 

and infiltrate (□).


treatment 

• Corticosteroid therapy is the most common treatment. 

• Complete clinical recovery, physiological 

improvement, and normalization of the chest film are 

seen in two thirds of patients 

• Approximately one-third 

demonstrate persistent 

disease. In general, clinical improvement is rapid, 

within several days or a few weeks. Occasionally, 

recovery is quite dramatic 

• Delay in treatment increases the risk of more severe 

disease and relapses


treatment


treatment 

•The 

therapy of choice is prednisone, , 0.75 mg/kg 

kg/day 

with gradual 

tapering of dosage in the following several months 

•Several 

day course of high-dose 

parenteral corticosteroid therapy may 

be needed in patients with rapidly progressive COP 

•The 

usual duration of corticosteroid therapy is 6 to 12 months 

•Relapse 

is seen in one-third 

of the patients if a short treatment course 

of less than 3 months of corticosteroid therapy is used 

•Prednisone 

can eventually be given on an alternate day dosage. 

•Some 

of these patients require low-dose 

maintenance prednisone 

therapy for several years to maintain stabilization with chronic 

symptoms

start 

with 0.75 mg/kg/day of prednisone for 4 weeks, 

then 

0.5 mg/kg/day for 6 weeks, 

then 20 mg/day for 6 weeks, 

then 5 mg/day for 6 weeks.

The 

occurrence of relapses in COP could be 

regarded as a relatively benign and acceptable 

phenomenon, rather than a dangerous event 

requiring aggressive management.

1 

delayed treatment increases 

the risk of relapses; 

2 

mild cholestasis identifies a subgroup of 

patients with multiple relapses; 

3 

relapses do not affect outcome, 

and prolonged therapy to suppress 

relapses appears unnecessary; 

4 

a standardized treatment allows a 

reduction in steroid doses.

• Difffuse 

Panbronchiolitis 

• Cystic Fibrosis 

• Bronchiectasis 

• Chronic Sinusitis 

• Chronic otitis media 

• Nasal poliposis 

• Chronic Bronchitis 

• BOOP

While the use of 

macrolide therapy for treatment of COP/BOOP is 

feasible, the decision to use it should be made on a 

case-by 

by-case basis. 

Before any definitive recommendations 

can be made, more information is needed, 

such as which patients are likely to respond to 

macrolide therapy, and the proper dosage and duration 

of macrolide therapy.

OP- COP- BOOP

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