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

Abstract

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...

Impact of long-term treatment with inhaled corticosteroids and bronchodilators on lung function in a patient with post-infectious bronchiolitis obliterans

“…Antibiotics, preferably macrolides, together with systemic corticosteroids and inhaled bronchodilators, are administered during acute disease exacerbations. 9 In patients with reversible airflow limitation, ß 2 agonists are prescribed as maintenance therapy. 10 In fact, most studies have shown that patients with PIBO show no response to bronchodilators.…”

“… 3 - 8 PIBO is characterized by small-airway obstruction that is generally unresponsive or poorly responsive to bronchodilators. 9 We report the case of a relatively young man diagnosed with PIBO, whose airway obstruction improved after long-term treatment with inhaled bronchodilators and corticosteroids. In addition, a short-term pulmonary rehabilitation program resulted in better physical performance.…”

Post-infectious Bronchiolitis Obliterans: HRCT, DECT, Pulmonary Scintigraphy Images, and Clinical Follow-up in Eight Children

“…Bronchiolitis obliterans (BO) is an uncommon but severe lung disease (1). It is currently diagnosed according to a history of lower respiratory tract insults and persistent symptoms that do not respond well to the administration of systemic corticoids and bronchodilators for 2 weeks (2). Due to the chronic irreversible inflammatory process and limited treatment options for BO, it is important to make an early diagnosis and start treatment as soon as possible.…”

Exercise Capacity in Children and Adolescents With Post-Infectious Bronchiolitis Obliterans: A Systematic Review

“…Inflammation and fibrosis of terminal bronchioles causes narrowing and/or complete obliteration of the airway lumen, leading to chronic airflow obstruction. 1 , 2 , 3 , 4 , 5 , 6 , 7 These anatomofunctional changes can result in progressive loss of strength/endurance of ventilatory muscles, directly contributing to the reduction in activities of daily living (ADLs), with a consequent negative impact on exercise tolerance. 8 …”