Bronchiolitis obliterans in children

Kurland, Geoffrey; Michelson, Peter H.

doi:10.1002/ppul.20145

Cited by 116 publications

(97 citation statements)

References 133 publications

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“…Bronchoalveolar lavage is not mandatory to make the diagnosis, but it may rule out other diseases. In postinfectious BO, there is a predominance of neutrophils and high IL-8 and IL-6 levels, in addition to an increase in T CD8+ lymphocytes (15,23) .…”

Section: Discussionmentioning

confidence: 99%

“…Open pulmonary biopsy, the criterion standard, is currently not used to diagnose BO because it is invasive, poses greater chances of complications and may lead to inconclusive results. The distribution of pulmonary disease is heterogeneous and there may be no clinical or radiological correlation with the specimen examined by the pathologist (4,14,15) .…”

Section: Discussionmentioning

confidence: 99%

“…The strategy in our service was to administer antibiotics to patients during the acute pulmonary phase (fever, increased cough, changes in viscosity, secretion amount or color). Some recent studies analyzed the role of azithromycin in the treatment of BO and showed that it reduces inflammatory markers in the bronchoalveolar lavage (BAL) and even improves pulmonary function (15,24,25) .…”

Section: Discussionmentioning

confidence: 99%

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Bronquiolite obliterante: perfil clínico e radiológico de crianças acompanhadas em ambulatório de referência

Lino

Batista

Soares

et al. 2013

Rev. paul. pediatr.

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Objectives: To describe the clinical and radiological characteristics of patients with bronchiolitis obliterans.Methods: This is a retrospective and descriptive study. Data were collected from patients diagnosed with bronchiolitis obliterans between 2004 and 2008 in the Pediatric Pulmonology Clinic of Hospital Infantil Albert Sabin, in Ceará, Northeast Brazil. Such diagnosis was based on clinical and tomographic criteria. Previous history, clinical findings at the diagnosis, complementary exams, and follow-up data were evaluated.Results: 35 children diagnosed with bronchiolitis obliterans were identified. There was a predominance of male patients (3:1). The mean age at the onset of symptoms was 7.5 months, and bronchiolitis obliterans was diagnosed at a mean age of 21.8 months. The most common clinical findings were crackles/wheezing, tachypnea, dyspnea, and chest deformity. Post-infectious etiology was the main cause of bronchiolitis obliterans. Predominant findings at chest X-ray and high resolution computed tomography were peribronchial thickening and mosaic pattern, respectively. The treatment was variable and individualized. The majority of patients improved during follow-up, despite the persistence of respiratory symptoms.Conclusions: In this study, the predominance of male patients and post-infectious etiology was noted, corroborating scientific literature. The most common tomographic findings were similar to those described in previous studies (mosaic pattern, peri-bronchial thickening, and bronchiectasis). Evidence about the treatment of this disease is still lacking. The diagnosis was delayed, which indicates that clinical suspicion of bronchiolitis obliterans is necessary in children with persistent and severe wheezing. Conclusões: A presente casuística de bronquiolite obliterante mostrou predominância de pacientes do sexo masculino e de etiologia pós-infecciosa, corroborando os dados da literatura. Os achados tomográficos mais encontrados foram semelhantes aos descritos em trabalhos anteriores (perfusão em mosaico, espessamento peribrôn-quico e bronquiectasias). Ainda faltam evidências acerca do tratamento para esta doença. O diagnóstico de bronquiolite obliterante foi tardio, necessitando da suspeição clínica por parte dos pediatras frente a lactentes chiadores graves e perenes. KeyPalavras-chave: bronquiolite obliterante; criança; tomografia computadorizada espiral; pneumopatias obstrutivas. RESUMENObjetivo: Describir las características clínico-radiológicas de los pacientes con bronquiolitis obliterante acompañados en el Ambulatorio de Pneumología Pediátrica del Hospital Infantil Albert Sabin en la provincia de Ceará (Brasil).Métodos: Estudio descriptivo y retrospectivo. Se recogieron datos de pacientes diagnosticados con bronquiolitis obliterante entre 2004 y 2008. El diagnóstico se basó en criterios clínicos y tomográficos. Se evaluaron la historia previa, el cuadro clínico en el momento del diagnóstico, exámenes complementares y evolución.Resultados: Se identificaron 35 pacientes diagno...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bronquiolite obliterante: perfil clínico e radiológico de crianças acompanhadas em ambulatório de referência

Lino

Batista

Soares

et al. 2013

Rev. paul. pediatr.

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“…In severe cases, the airway develops circumferential scarring with complete obliteration of the lumen, leading to the clinical presentation of cough, shortness of breath or wheezing. 2,3 BOS usually occurs in the first 2 years after SCT 4 and leads to high risk of death, with mortality rates reported between 13 and 100% in adults 5,6 and 40 and 60% in children. 7,8 Early detection is key for successful stabilization of the disease with immunosuppressant therapy before occurrence of end-stage fibrotic changes with significant reduction in pulmonary function tests (PFTs).…”

Section: Introductionmentioning

confidence: 99%

Chest health surveillance utility in the early detection of bronchiolitis obliterans syndrome in children after allo-SCT

Gassas

Craig-Barnes

Dell

et al. 2012

Bone Marrow Transplant

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To prospectively assess whether periodic chest health surveillance is beneficial for the early detection of bronchiolitis obliterans syndrome (BOS) in children after allo-SCT. Children up to 18 years of age receiving allo-SCT from September 2009 to September 2011 were included. Surveillance consisted of the following: a 7-item respiratory system questionnaire of cough, wheeze and shortness of breath; focused physical examination; and pulmonary function test (PFT) conducted before SCT and at 1, 3, 6, 9, 12, 18 and 24 months after SCT. Thirty-nine patients were enrolled. Five children developed BOS at a median time of 192 days (range 94-282). Positive response comparisons between the BOS group vs the non-BOS group were NS for history questionnaire (P ¼ 0.2), heart rate (P ¼ 0.3), respiratory rate (P ¼ 0.3) and oxygen saturation monitoring (P ¼ 0.8). Differences between the two groups for chest auscultation and PFT were statistically significant (P ¼ 0.03 and P ¼ 0.01, respectively). However, chest auscultation in the BOS group was only positive after BOS diagnosis. PFT reduction was evident in the asymptomatic phase (BOS group 33%; non-BOS group 4.5%, P ¼ 0.01). Changes in PFT, but not history/physical examination, allow the early detection of BOS in children after SCT. Our study is limited by the small sample size.

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“…The increase in lung and bone marrow transplantation has led to a heightened interest in BO, as this is one of the important complications of those procedures [2]. However, BO occurs most commonly after an episode of respiratory infection in children [3].…”

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confidence: 99%

Methacholine and adenosine 5′-monophosphate challenges in children with post-infectious bronchiolitis obliterans

Yoo

Kim

et al. 2006

Eur Respir J

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Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, but is also frequently demonstrated by children and adults with chronic obstructive lung diseases. AHR is usually measured by bronchial challenges using direct or indirect stimuli. The aim of this study was to compare these two types of bronchial challenge in children with post-infectious bronchiolitis obliterans (BO).Methacholine and adenosine 59-monophosphate (AMP) challenges were used as tools for the evaluation of AHR to direct and indirect stimuli, respectively, in children with post-infectious BO (n528). These results were compared with those of asthmatic (n530) and control children (n525).Altogether, twenty-two patients (78.6%) with post-infectious BO were hyperreactive to methacholine with a provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20) of ,16 mg?mL -1 , but only six (21.4%) were hyperreactive to AMP with a PC20of ,200 mg?mL -1. All patients with asthma responded positively to methacholine, and most (28, 93.3%) also responded positively to AMP. The majority of controls were insensitive to both challenges.Airway hyperresponsiveness to methacholine is a frequent, but by no means universal, finding in children with post-infectious bronchiolitis obliterans, but is usually not accompanied by airway hyperresponsiveness to adenosine 59-monophosphate. This finding suggests that airway hyperresponsiveness in patients with post-infectious bronchiolitis obliterans has characteristics that differ from those of asthmatic subjects.

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Bronchiolitis obliterans in children

Cited by 116 publications

References 133 publications

Bronquiolite obliterante: perfil clínico e radiológico de crianças acompanhadas em ambulatório de referência

Bronquiolite obliterante: perfil clínico e radiológico de crianças acompanhadas em ambulatório de referência

Chest health surveillance utility in the early detection of bronchiolitis obliterans syndrome in children after allo-SCT

Methacholine and adenosine 5′-monophosphate challenges in children with post-infectious bronchiolitis obliterans

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