Plastic Bronchitis

What Is Plastic Bronchitis?

Plastic bronchitis happens when fluid collects in the lungs. Instead of draining out, it leaks into the airways and forms rubbery plugs called casts. The casts block small airways and make it hard for air to move in and out of the lungs.

The lymphatic system is a drainage network that runs throughout the body. A fluid called lymph moves through it. Lymph is made of extra fluid and protein that comes from body tissues. When lymph doesn't drain from the lungs, it can become solid and form casts.

Doctors work to find the cause of plastic bronchitis and treat it to stop casts from forming.

What Are the Signs & Symptoms of Plastic Bronchitis?

Kids with plastic bronchitis (brong-KYE-tis) often have trouble breathing, then have coughing spells that bring up the casts. Casts:

• usually are white or tan
• can be rod-shaped and often have branches
• can be different lengths, from shorter than a fingernail to longer than a finger
• may be as thin as thread or thicker than a pencil

Some kids with plastic bronchitis might get a lot of lung infections.

Who Gets Plastic Bronchitis?

Plastic bronchitis is rare. It happens more often in kids with some kinds of conditions or health problems. These include:

• congenital heart disease treated with the Fontan procedure
• problems with the lymphatic system
• some lung conditions
• sickle cell disease
• rarely, allergies

How Is Plastic Bronchitis Diagnosed?

Doctors may use a tiny camera to look for casts inside the airways. They might do other tests too, such as:

• chest X-ray
• magnetic resonance imaging (MRI)
• mapping the flow of lymphatic fluid (lymphangiogram)

How Is Plastic Bronchitis Treated?

Doctors must figure out why lymph is building up in the lungs. Usually this means checking how the lymphatic system is working.

Mapping Flow in the Lymphatic System

A doctor will map the flow of lymphatic fluid. They may use a long, thin tube (catheter) and MRI, ultrasound, or X-ray to do this. When they understand the flow path of the lymph, they can often seal off areas causing problems.

Treating the Casts

Kids with plastic bronchitis need to loosen and cough up casts. To loosen the casts, a child might:

• Get chest physiotherapy (called chest PT), where a person thumps on the outside of the chest with their hand.
• Wear a special vest that gently shakes the chest.

Doctors might need to remove casts that can't be coughed up. They use a long, thin tool with a light and camera to pull out the cast, or dissolve it with medicine. Doctors also may give medicine to help prevent new casts.

If a child has an infection or the airways are swollen from the plastic bronchitis, the doctor may prescribe medicines.

How Can Parents Help?

To help your child:

• Tell the care team about any coughing, wheezing, trouble breathing, or other new symptoms.
• Encourage everyone in your family to wash their hands well and often. Especially during the winter, this can help prevent the spread of infection.
• Give all recommended medicines as directed.
• Follow the doctor's instructions for chest PT.