Azithromycin Reverses Airflow Obstruction in Established Bronchiolitis Obliterans Syndrome

Yates, Bryan; Murphy, Desmond M.; Forrest, Ian; Ward, Chris; Rutherford, Robert; Fisher, Andrew J.; Lordan, James; Dark, John H.; Corris, Paul A.

doi:10.1164/rccm.200411-1537oc

Cited by 219 publications

(148 citation statements)

References 37 publications

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“…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%

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%

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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“…The use of azithromycin in a randomized controlled trial has been shown to slow the progression of CLAD, potentially through its anti-inflammatory, antibiotic, or promotility effects, but the exact mechanism is unclear (Yates et al 2005;Murphy et al 2008;Vos et al 2011). Switching classes of immunosuppression may be of some benefit in slowing progression of the disease, but no therapy has yet been shown to reverse the disease process.…”

Section: Chronic Lung Allograft Dysfunctionmentioning

confidence: 99%

Overview of Clinical Lung Transplantation

Yeung

Keshavjee

2014

Cold Spring Harbor Perspectives in Medicine

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Since the first successful lung transplant 30 years ago, lung transplantation has rapidly become an established standard of care to treat end-stage lung disease in selected patients. Advances in lung preservation, surgical technique, and immunosuppression regimens have resulted in the routine performance of lung transplantation around the world for an increasing number of patients, with wider indications. Despite this, donor shortages and chronic lung allograft dysfunction continue to prevent lung transplantation from reaching its full potential. With research into the underlying mechanisms of acute and chronic lung graft dysfunction and advances in personalized diagnostic and therapeutic approaches to both the donor lung and the lung transplant recipient, there is increasing confidence that we will improve short-and long-term outcomes in the near future.

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“…Nesses pacientes, foi observada uma melhora da função pulmonar após 3 a 4 meses de uso desse macrolídeo em dias alternados 62,63 . Baseado nesses resultados, a azitromicina tem sido recomendada por alguns autores para pacientes com BOPI 8 , embora não existam estudos que avaliem sua eficácia nesse grupo até o momento.…”

Section: Antibióticosunclassified

Post-infectious bronchiolitis obliterans in children

Champs

Lasmar²,

Camargos³

et al. 2011

J Pediatr (Rio J)

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Objective: To review publications about the main features of postinfectious bronchiolitis obliterans and its history, etiology, epidemiology, risk factors, pathogenesis, histological findings, clinical presentation, complementary tests, diagnostic criteria, differential diagnosis, treatment and prognosis.Sources: Non-systematic review of MEDLINE and LILACS databases and selection of 66 most relevant studies. Summary of the findings:In the post-infectious bronchiolitis obliterans there is an insult to respiratory epithelial cells, and its clinical severity is associated with the degree of lesion and inflammation. Diagnosis is made according to clinical signs and symptoms, by exclusion of main differential diagnoses and with the aid of complementary tests. High resolution CT, particularly images obtained during inspiration and expiration, provide information for the evaluation of the small airways. Pulmonary function tests show fixed airway obstructions and marked decrease of FEF 25-75% . Treatment has not been definitely established, and corticoids have been administered as pulse therapy or by inhalation of high doses of steroids. However, data about its efficacy are scarce in the literature. Long-term prognosis is variable, and there might be either clinical improvement or deterioration into respiratory insufficiency and death.Conclusion: Post-infectious bronchiolitis obliterans is a disease with a high morbidity rate; it should be treated by a multidisciplinary team, and patients should be followed up for a long period of time.J Pediatr (Rio J). 2011;87(3):187-198: Bronchiolitis obliterans, diagnosis, spirometry, CT, child. ResumoObjetivo: Revisar os trabalhos publicados sobre os principais aspectos da bronquiolite obliterante pós-infecciosa, relacionados com sua história, etiologia, epidemiologia, fatores de risco, patogenia, alterações histológicas, manifestações clínicas, exames complementares, critérios diagnósticos, diagnóstico diferencial, tratamento e prognóstico. Fonte dos dados:Realizou-se uma revisão não sistemática nas bases de dados MEDLINE e LILACS, selecionando-se 66 referências mais relevantes. Síntese dos dados:Na bronquiolite obliterante pós-infecciosa ocorre lesão do epitélio respiratório, e a gravidade clínica está relacionada aos diferentes graus de lesão e ao processo inflamatório. O diagnóstico baseia-se no quadro clínico, na exclusão dos principais diagnósticos diferenciais e no auxílio dos exames complementares. A tomografia computadorizada de alta resolução, principalmente com imagens em inspiração e expiração, possibilta a avaliação das pequenas vias aéreas. As provas de função pulmonar caracterizam-se por padrão obstrutivo fixo com redução acentuada do FEF 25-75% . O tratamento não está bem estabelecido, e o uso de corticoides tem sido preconizado em forma de pulsoterapia ou por via inalatória em elevadas doses, no entanto, os dados da literatura a respeito de sua eficácia ainda são escassos. O prognóstico a longo prazo é variável, podendo haver melhora clínica ou evolução par...

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Azithromycin Reverses Airflow Obstruction in Established Bronchiolitis Obliterans Syndrome

Cited by 219 publications

References 37 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

Overview of Clinical Lung Transplantation

Post-infectious bronchiolitis obliterans in children

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