Childhood bronchiolitis obliterans in Hong Kong‐case series over a 20‐year period

Chan, Kate Ching Ching; Yu, Michelle; Cheung, Tammy W Y; Lam, David Sy.; Leung, T. N.; Tsui, Tak Kong; Ip, Ka Ian; Chau, Christy Sk; Lee, So Lun; Yip, Ada Yf; Wong, Tak-Wai; Mak, Vivien Cw; Li, Albert M.

doi:10.1002/ppul.25166

Cited by 11 publications

(9 citation statements)

References 38 publications

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“…Huang calculated that the median age of the 56 children with PIBO was 17.71 (7–91) months ( 23 ). Hong Kong’s 20-year single-center research data show that the median age at diagnosis was 1.39 years (IQR: 0.84–4.99 years), 26 patients were included with a male predominance (72.2%) ( 24 ). Our meta-analysis showed that younger children and males were at higher risk of PIBO than older children.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Post-infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis

Liu

Zhang

et al. 2022

Front. Pediatr.

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BackgroundPost-infectious bronchiolitis obliterans (PIBO) is a long-term sequela after an initial insult to the lower respiratory tract. A comprehensive understanding of the factors that contribute to a high risk of developing PIBO is important to help define therapeutic strategies and improve prognosis.MethodsWe performed a systematic review of published literature available in the online databases including PubMed, Embase, Web of Science, CNKI, Wan Fang, and VIP, with the last search updated on 27 January 2022. Observational studies and case-control studies that provide sufficient data to examine associations between potential risk factors and PIBO were included. Pooled odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) and heterogeneity were calculated.ResultsA total of 14 risk factors were selected from 9 studies included in the analysis. The strongest risk factors were hypoxemia, mechanical ventilation, tachypnea, and wheezing. Hypoxemia conferred the greatest risk with pooled OR of 21.54 (95% CI: 10–46.36, p < 0.001). Mechanical ventilation ranked second (pooled OR 14.61, 95% CI: 7.53–28.35, p < 0.001). Use of γ-globulin, use of glucocorticoids, co-infection of bacteria, a history of wheezing, and being male were other prominent risk factors. The effects of premature birth, allergic rhinitis, and imaging finding (pulmonary consolidation, atelectasis, pleural effusion) are less clear and require further confirmation. Cases that developing PIBO had a lower age compared with controls (MD, −8.76 months, 95% CI: −16.50 to −1.02, p = 0.03). No significant differences were observed in the duration of fever (MD, 1.74 days, 95% CI: −0.07 to 3.54, p = 0.06). Children diagnosed with PIBO had higher LDH levels (MD, 264.69 U/L, 95% CI: 67.43 to 461.74, p = 0.008) and duration of hospitalization (MD, 4.50 days, 95% CI: 2.63 to 6.37, p < 0.001).ConclusionIn this study, we found that the strongest risk factors for PIBO were hypoxemia, mechanical ventilation, tachypnea, and wheezing. Use of glucocorticoids, γ-globulin, co-infection of bacteria, a history of wheezing, and being male may also play a role. The factors discussed above can inform the generation of a clinical prediction model for the developing PIBO in children.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Post-infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis

Liu

Zhang

et al. 2022

Front. Pediatr.

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“…Previous studies have found that patients with PIBO with the positive bronchial dilation test are not significantly associated with a family history of asthma or allergy ( 26 , 27 ). However, some studies have found that more than 50% of patients with PIBO have allergies, and this study suggested that PIBO can coexist with bronchial asthma ( 28 , 29 ). It is difficult to say whether this was a concomitant allergy or a specific symptom of PIBO.…”

Section: Discussionmentioning

confidence: 64%

“…At present, the mechanism of airway hyperreactivity in patients with PIBO is not clear. Some scholars found that patients with high airway reactivity were more likely to suffer from PIBO, and positive bronchodilation may occur in the later phase of the disease ( 27 , 29 ); or whether it was related to repeated inflammatory stimulation and airway repair, promoting the formation of airway hyperresponsiveness. However, it should be noted that a study found that airway hyperresponsiveness in PIBO was different from that caused by eosinophilic or atopic airway inflammation in patients with asthma ( 30 ), and the specific pathogenesis is needed to be further explored in the future.…”

Section: Discussionmentioning

confidence: 99%

Effects of Inhaled Corticosteroids on Lung Function in Children With Post-infectious Bronchiolitis Obliterans in Remission

Zheng

Chen

et al. 2022

Front. Pediatr.

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BackgroundPost-infectious bronchiolitis obliterans (PIBO) is a rare and irreversible chronic obstructive pulmonary disease with no specific treatment, especially for patients with PIBO in remission. In this study, we evaluated the effects of continuous inhaled corticosteroids (ICSs) and intermittent ICSs on lung function in the remission of PIBO.MethodsThis was a retrospective study, and all the subjects we included were divided into continuous ICS group and intermittent ICS group according to treatment regimens. Patients in continuous ICS group received continuous ICSs (2 times a day), and patients in intermittent ICS group received intermittent ICSs (inhaled corticosteroids after acute respiratory tract infection or wheezing). Different lung function tests were performed at different ages. Tidal breathing lung function tests were performed in patients with PIBO aged ≤ 5 years, and the lung ventilation function test and the bronchial dilation test were performed in patients with PIBO aged more than 5 years. Lung function was assessed at the beginning of follow-up and at the end of follow-up (1 year of ICSs).ResultsAfter 1 year of ICSs, patients aged more than 5 years, forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1) were significantly higher than at the beginning of follow-up. After 1 year of ICSs, the difference in VT/Kg, TPTEF/TE, and VPEF/VE between the end and the beginning of follow-up in continuous ICS group shows an upward trend. But those showed a downward trend in intermittent ICS group. FVC, FEV1, and maximal mid-expiratory flow velocity 25–75% (MMEF25–75%) of continuous ICS group were significantly higher than at the beginning of follow-up. The difference in FEV1 and MMEF25–75% between the end of follow-up and the beginning of follow-up in continuous ICS group was significantly higher than that in intermittent ICS group. A total of 52.94% of patients with PIBO aged more than 5 years were positive for bronchial dilation tests.ConclusionInhaled corticosteroids can effectively improve lung function and relieve airway obstruction in patients aged more than 5 years in PIBO remission, especially continuous ICSs. Patients with PIBO may have reversible airflow limitations.

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“…Several groups have reported that co-infection is less severe than a single infection and even beneficial, possibly due to viral competition for resources [72][73][74][75]. On the contrary, other studies have reported the association between co-infection and severe disease outcomes including pediatric intensive care unit (PICU) admission [15,[76][77][78]. Despite the controversy, it is evident that drugs targeting multipathogens during viral co-infections should be beneficial for respiratory illness control.…”

Section: Discussionmentioning

confidence: 99%

Broad Impact of Exchange Protein Directly Activated by cAMP 2 (EPAC2) on Respiratory Viral Infections

Choi

et al. 2021

Viruses

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The recently discovered exchange protein directly activated by cAMP (EPAC), compared with protein kinase A (PKA), is a fairly new family of cAMP effectors. Soon after the discovery, EPAC has shown its significance in many diseases including its emerging role in infectious diseases. In a recent study, we demonstrated that EPAC, but not PKA, is a promising therapeutic target to regulate respiratory syncytial virus (RSV) replication and its associated inflammation. In mammals, there are two isoforms of EPAC—EPAC1 and EPAC2. Unlike other viruses, including Middle East respiratory syndrome coronavirus (MERS-CoV) and Ebola virus, which use EPAC1 to regulate viral replication, RSV uses EPAC2 to control its replication and associated cytokine/chemokine responses. To determine whether EPAC2 protein has a broad impact on other respiratory viral infections, we used an EPAC2-specific inhibitor, MAY0132, to examine the functions of EPAC2 in human metapneumovirus (HMPV) and adenovirus (AdV) infections. HMPV is a negative-sense single-stranded RNA virus belonging to the family Pneumoviridae, which also includes RSV, while AdV is a double-stranded DNA virus. Treatment with an EPAC1-specific inhibitor was also included to investigate the impact of EPAC1 on these two viruses. We found that the replication of HMPV, AdV, and RSV and the viral-induced immune mediators are significantly impaired by MAY0132, while an EPAC1-specific inhibitor, CE3F4, does not impact or slightly impacts, demonstrating that EPAC2 could serve as a novel common therapeutic target to control these viruses, all of which do not have effective treatment and prevention strategies.

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Childhood bronchiolitis obliterans in Hong Kong‐case series over a 20‐year period

Cited by 11 publications

References 38 publications

Risk Factors for Post-infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis

Risk Factors for Post-infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis

Effects of Inhaled Corticosteroids on Lung Function in Children With Post-infectious Bronchiolitis Obliterans in Remission

Broad Impact of Exchange Protein Directly Activated by cAMP 2 (EPAC2) on Respiratory Viral Infections

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