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Review Interstitial Lung Disease Diffuse Panbronchiolitis is not Restricted to East Asia—a Mini Literature Review Ram Kumar Mishra Epidemiology and HEOR Team, ODC 3, Tata Consultancy Services, Thane (W), Maharashtra, India D iffuse panbronchiolitis (DPB) is a rare inflammatory lung disease, and is well recognized in East Asian countries like Japan, China, Taiwan and Korea. Over the years, sporadic DPB cases have been reported worldwide from other countries. This literature review presents an overview of 48 DPB cases from other regions of the world including the US, European countries and Australia. Identification of DPB cases from different racial groups across the globe indicates toward a need to educate pulmonologists to correctly diagnose and initiate treatment. Keywords Diffuse panbronchiolitis, erythromycin, interstitial lung disease, macrolide therapy, rare disease Disclosure: Ram Kumar Mishra has nothing to declare in relation to this article. Opinions expressed in this article are the author’s own findings and do not in any manner reflect or represent the view of the organization to which he is affiliated. Compliance with Ethics: This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: October 11, 2017 Accepted: December 7, 2017 Citation: US Respiratory & Pulmonary Diseases, 2017;2(1):30–2 Corresponding Author: Ram Kumar Mishra, Epidemiology and HEOR Team, ODC 3, Tata Consultancy Services (TCS), 5th Floor, Lexington, Hiranandani Estate, Thane (W), Maharashtra, India 400 607. E: mishra.ram@tcs.com Support: No funding was received in the publication of this article. 30 Diffuse panbronchiolitis (DPB) is a rare inflammatory lung disease. It was first identified in 1969 and is well recognized in East Asian countries such as Japan, China, Taiwan, and Korea. 1 ‘Diffuse’ and ‘pan’ words in the name indicate ‘presence of lesions through both the lungs,’ and inflammation in all layers of bronchioles. At the time of its discovery, DPB had poor prognosis because of recurrent respiratory infections leading to respiratory failure. In the years following the initial description of DPB in Japan, cases were also identified in other parts of Asia including China and Taiwan, thus giving it recognition as a distinct clinical entity. Over the years, sporadic DPB cases have been reported worldwide in countries other than Japan, China, Taiwan, and Korea (hereafter referred to as rest of the world [ROW]). This stimulated us to undertake a comprehensive search for available case studies on DPB. The aim of this study was to present the current clinical evidence captured as DPB case studies across the globe excluding East Asian countries. A total of 657 studies regarding DPB were retrieved from PubMed in a systematic manner (Figure 1). Forty-eight case studies published in ROW and indexed in PubMed were included in the final review. As indicated in Figure 2, the maximum number of DPB cases among ROW countries were published from the US (18.75%, n=9), 2–10 jointly followed by Australia, 11–15 France, 16–20 and Italy 21–25 (each 10.41%, n=5), respectively. There were three DPB cases published each from India 26–28 and Turkey, 29–31 and two case studies each from Belgium, 32,33 Brazil, 34,35 Germany, 36,37 and Thailand. 38,39 One case report each was reported from Canada, 40 Ireland, 41 Malaysia, 42 Netherlands, 43 New Zealand, 44 Norway, 45 Portugal, 46 Singapore, 47 Spain, 48 and the UK. 4 It is interesting to note that a majority (50%, n=24) of DPB studies were from four developed countries. Twelve of 48 studies (25%) reported DPB in patients of East Asian origin (either they immigrated to other countries or were born to East Asian parents). Patients were reported either by race (Caucasian, 13,40 Hispanic, African-American 4,9 ) or ethnicity (American citizens, White patients, Oriental [Asian] immigrant, 3 Cambodian man, White man in Turkey, 29 Turkish girl, 30 Italian man, 21,22 man of Indian ethnicity, 44 Scandinavian patient, 45 non-Asian Brazilian citizen, 34 and Caucasian man of Canadian origin 40 ). None of these patients with DPB had ever travelled outside of their country until DPB was diagnosed, except for one Hispanic patient with an extensive travel history to Far Eastern countries including Japan. 5 Though most of the cases reported adult patients with DPB, two studies presented DPB cases in children. One case presented a 10-year-old child of Korean birth, 10 and the other reported a 12-year-old Turkish girl with DPB. One study reported DPB recurrence in an African-American man after bilateral sequential lung transplantation. 4 TOUCH ME D ICA L ME D IA