Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy

Abstract

BackgroundBronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. Here we report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy.MethodsForty patients fulfilling the BO diagnosis criteria were treated with methylprednisolone pulse therapy in monthly cycles until clinical improvement. After the pulse therapy began, we analyzed the clinical and laboratory data at intervals. Statistical analyses were performed using non-parametric tests to compare repeated measures (Friedman, Wilcoxon) or paired nominal data (McNemar) (α = 5%).ResultsThe frequency of wheezing exacerbations and hospitalizations was reduced (p = 0.0042 and p < 0.0001, respectively) and oxygen saturation improved (p = 0.0002) in the pulse therapy-treated patients. Prolonged oral corticosteroid therapy was discontinued in 83% of these patients. The mean Z-score length for age improved from -1.08 to -0.63, and the mean Z-score weight for age improved from -0.91 to -0.59. The adverse effects during the infusion were temporary and none were serious.ConclusionsOur data suggest that pulse corticotherapy could be a safe alternative to prolonged systemic oral corticotherapy in children with BO, thus minimizing the adverse effects of the oral therapy. New prospective controlled studies are required to confirm this proposition.

Short-Term Variation of Lung Function and Airway Inflammation in Children and Adolescents with Bronchiolitis Obliterans

“…Current knowledge suggests that BO is immune mediated, so causal therapeutic interventions are focused on the suppression of the inflammatory response. Anti-inflammatory therapies such as corticosteroids have been tried in small trials with minimal success [15]. Other studies suggest a potential role for long-term macrolide therapy in the treatment of BO in which the anti-inflammatory properties and ability of macrolide therapy to reduce the inflammatory mediators of interleukins IL-1, IL-6 and IL-8, and demonstrate a role for the therapy [16].…”

Severe Stevens‐Johnson syndrome/toxic epidermal necrolysis overlap syndrome—beyond skin involvement

“…Although the pulmonary biopsy findings were nonspecific, the peribronchial fibrosis and the severe obstructive pattern, with no response to bronchodilators, were consistent with the diagnosis of bronchiolitis obliterans. There is no consensus as to the optimal treatment for bronchiolitis obliterans . Although systemic corticosteroids are frequently used, their use is controversial, and large‐scale studies are lacking regarding optimal treatment and prognosis in bronchiolitis obliterans associated with SJS/TEN …”

“…There is no consensus as to the optimal treatment for bronchiolitis obliterans. 11 Although systemic corticosteroids are frequently used, their use is controversial, and large-scale studies are lacking regarding optimal treatment and prognosis in bronchiolitis obliterans associated with SJS/TEN. 11 Management of SJS/TEN requires careful, intensive monitoring of possible multisystem complications and an interdisciplinary team approach to provide optimal care and follow-up.…”

Synthèse N° 3 : Bronchites chroniques obstructives de l’enfant : un concept émergent

“…Le point de départ est une infection virale, et les nourrissons sont les plus vulnérables. A moyen terme, ces patients gardent une altération de leur fonction respiratoire avec un syndrome obstructif sur les petites voies aériennes, une distension thoracique parfois importante, des anomalies de ventilation sans anomalies de perfusion, et une réponse aux beta-2 variable [41,42]. Certains restent symptomatiques et entrent dans la définition de la BPCO de l'adulte avec une évolution vers l'insuffisance respiratoire chronique.…”