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Abstract
Purpose
Bronchiolitis obliterans (BO), an uncommon chronic obstructive lung disease in children, is most often seen following a severe lower respiratory tract infection (LRTI). We investigated the clinical characteristics, etiology, possible risk factors, radiological findings, and response to treatment in children diagnosed with post-infectious BO.
Methods
A retrospective study was performed on 62 patients diagnosed with post-infectious BO based on clinical and high-resolution computed tomography (HRCT) findings from 2005 to 2010. Forty-eight age-matched children who were admitted with the first episode of LRTI and did not subsequently develop BO were also studied as control subjects.
Results
Median ages at diagnosis and initial insult were 28 and 17 months, respectively. The median duration from initial LRTI until diagnosis was 5 months. Children who developed BO showed more respiratory compromise during their acute episodes of LRTI than those who did not. Symptom severity score decreased significantly after adequate treatment, which was significantly greater in patients treated with pulse steroid therapy than those treated with other controllers.
Conclusion
The results suggest that the development of post-infectious BO should be suspected in the children showing persistent respiratory symptoms after severe LRTIs. They also suggest that adequate treatment including pulse steroid therapy may improve clinical status and the prognosis of these patients.
References
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Fig. 1.
(A) High resolution computed tomography (HRCT) shows mosaic perfusion in both lung fields. (B) Severe air-trapping is shown on plain chest X-ray and HRCT.
Fig. 2.
Symptom severity score was reduced significantly after treatment in both patient groups: the patients treated with corticosteroid pulse therapy and other controller therapy. F/U, follow-up.
Fig. 3.
Symptom severity score was significantly lower in the patients treated with corticosteroid pulse therapy than in the patients treated with other controller therapy at 3 and 6 month-follow up after treatment, respectively.
Table 1.
Age Distribution of the Patients at Diagnosis and Initial Insults
| Age (mo) | At diagnosis (n=62) | At initial insult (n=62) |
|---|---|---|
| <6 | 11 (18) | |
| 6–12 | 6 (10) | 6 (10) |
| 12–36 | 6 (10) | 30 (49) |
| 36–72 | 25 (40) | 8 (12) |
| >72 | 17 (27) | 4 (6) |
| Unknown | 8 (13) | 3 (5) |
Table 2.
Duration Between Initial Insults and Diagnosis of Bronchiolitis Obliterans (n=62)
| Duration (mo) | No. (%) |
|---|---|
| <3 | 21 (34) |
| 3–6 | 13 (21) |
| 6–12 | 15 (24) |
| >12 | 10 (16) |
| Unknown | 3 (5) |
Table 3.
Clinical Characteristics of the Patients Diagnosed on Admission and at Out Patient Department
Table 4.
High Resolution Computed Tomography Findings of the Patients at Diagnosis (n=62)
| Findings | No. (%) |
|---|---|
| Mosaic perfusion | 55 (89) |
| Air trapping | 51 (82) |
| Atelectasis | 16 (26) |
| Bronchiectasis | 1 (2) |
| Effusion | 1 (2) |
Table 5.
Clinical Features During Acute Episodes in Children With vs. Without Bronchiolitis Obliterans (BO)
| BO group (n=44) | Non-BO group (n=48) | |
|---|---|---|
| Age at onset (mo), median (range) | 19 (2–46) | 15 (1–36) |
| Sex, M/F | 31/13 | 29/19 |
| Season, SS/FW | 23/21 | 14/34 |
| Fever, n (%)∗ | 31 (70) | 22 (46) |
| Wheezing, n (%) | 43 (98) | 39 (81) |
| Crackles, n (%) | 43 (98) | 37(77) |
| Tachypnea, n (%)† | 25 (57) | 9 (19) |
| Accessory muscle use, n (%)† | 19 (43) | 7 (15) |
| O2 saturation <92%, n (%) | 14 (32) | 10 (21) |
| Systemic corticosteroid use, n (%) | 37 (84) | 21 (42) |
| Systemic corticosteroid, mean, day† | 10.1±5.9 | 4.5±2.1 |
| IV theophylline use, n (%) | 17 (39) | 5 (10) |
| Duration of admission, mean, day† | 11.9±6.7 | 6.2±2.3 |
| Re-admission within 6 mo, n (%) | 12 (27) | 13 (27) |
| Re-admission within 6–12 mo, n (%)‡ | 12 (27) | 5 (10) |
| Severity score≥3, n (%)† | 23 (52) | 7 (15) |
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