Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report

Abstract

Bronchiolitis obliterans (BO) is a rare, chronic form of obstructive lung disease, often initiated with injury of the bronchiolar epithelium followed by an inflammatory response and progressive fibrosis of small airways resulting in nonuniform luminal obliteration or narrowing. The term BO comprises a group of diseases with different underlying etiologies, courses, and characteristics. Among the better recognized inciting stimuli leading to BO are airway pathogens such as adenovirus and mycoplasma, which, in a small percentage of infected children, will result in progressive fixed airflow obstruction, an entity referred to as postinfectious bronchiolitis obliterans (PIBO). The present knowledge on BO in general is reasonably well developed, in part because of the relatively high incidence in patients who have undergone lung transplantation or bone marrow transplant recipients who have had graft-versus-host disease in the posttransplant period. The cellular and molecular pathways involved in PIBO, while assumed to be similar, have not been adequately elucidated. Since 2016, an international consortium of experts with an interest in PIBO assembles on a regular basis in Geisenheim, Germany, to discuss key areas in PIBO which include diagnostic workup, treatment strategies, and research fields.

Bronchiolitis obliterans after severe adenovirus pneumonia:a review of 46 cases

“…Patients with more than two pathogens and two kinds of bacterial infection in BO group were more than those in non BO group (P < 0.05). It is consistent with the literature that bacterial and viral infections increase the risk of BO (6) . The prevalence of adenovirus co infection may be related to the increased susceptibility to bacterial infection after viral infection.Research (19) has showed that viral infection can increase bacterial binding and decrease barrier function in innate and adaptive immune level, and cause secondary bacterial infection.…”

“…It is speculated that the use of glucocorticoids in the early stage of adenovirus pneumonia may reduce the incidence of BO by reducing granulation tissue formation. This conclusion is consistent with the literature that glucocorticoid should be used during the development of the disease and agreed as soon as possible before the formation of airway brosis Give agreement as soon as possible (6) . On the other hand, our research on the use of gamma globulin in BO shows that gamma globulin has no obvious effect on reducing the formation of BO caused by adenovirus infection.…”

“…found that 52.6% of severe children had BO (5), a kind of chronic irreversible obstructive pulmonary disease caused by chronic in ammation and injury of the airway and the repair of airway brosis, thus leading to small airway obstruction and / or occlusion. The histological classi cation of BO can be divided into proliferation type and constriction type (6) . Mauad T and other studies have found that 97% of bronchiolitis obliterans in children are constrictive type (7) .…”

Therapeutic effect of budesonide, montelukast and azithromycin on post‑infectious bronchiolitis obliterans in children

“…The etiology of BO include infection, organ transplantation, connective tissue disease and exposure to toxic fumes, and the most common cause of BO in children is infection (5,6). Post-infectious bronchiolitis obliterans (PIBO) often occurs secondary to severe lower respiratory tract infections (7). PIBO is a rare disease and as there are no national or international databases on PIBO, its incidence is unpredictable but is more frequent among certain populations such as Argentinians, Native Americans and native Koreans (8).…”

“…The etiology of BO in children is not completely understood and PIBO is especially common in children (9,12). At present, there is no precise treatment for PIBO (7). It is argued that long-term use of glucocorticoid for treating PIBO cannot reverse the pre-existing airway obstruction, but can reduce airway hyperresponsiveness and bronchial stenosis (13).…”