Follow-up on the therapeutic effects of a budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in children with post-infectious bronchiolitis obliterans

Abstract

Background: Post-infectious bronchiolitis obliterans (PIBO) is a rare, severe chronic lung disease without optimal treatment. Currently, treatment in children mainly relies on systemic corticosteroids, but long-term use of these drugs may lead to adverse reactions. This study aimed to evaluate the short-term efficacy of the budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in paediatric PIBO patients and whether it can reduce systemic corticosteroid use.Methods: This was a prospective study. From June 2017 to July 2020, patients diagnosed with PIBO at Yuying Children's Hospital of Wenzhou Medical University were treated with the BAMA regimen for 3 months. Methylprednisolone was added only when the clinical manifestations did not improve or deteriorated. All patients were followed up every 2 to 4 weeks, and changes in clinical symptoms were recorded. Pulmonary function tests and high-resolution computed tomography (HRCT) were performed, and systemic corticosteroid use was recorded after the 3-month follow-up.Results: A total of 75 patients with PIBO were included; overall, 54 patients completed the course of treatment. After treatment, the respiratory manifestations were improved in 37 patients (68.5%), but 4 patients (7.4%) showed decreased exercise tolerance, and 2 patients (3.7%) were readmitted to the hospital. Additionally, 17 (56.7%) of the 30 patients whose pulmonary function was re-examined showed improvement, and 28 (77.8%) of the 36 patients who underwent HRCT showed marked improvement.Importantly, 20 patients (54.1%) received systemic corticosteroids for 2 weeks or less, while 31.5% of patients used no corticosteroids. Conclusions:The BAMA regimen effectively relieved clinical symptoms and signs of PIBO in children, improved pulmonary function and HRCT manifestations, and reduced the use of systemic corticosteroids.

Artificial Intelligence Algorithm‐Based High‐Resolution Computed Tomography Image in the Treatment of Children with Bronchiolitis Obliterans by Traditional Chinese Medicine Method of Resolving Phlegm and Removing Blood Stasis

“…After treatment, the proportion of patients with moderate and severe obstruction in group C was significantly lower than that in group A and group B, and that in group B was significantly lower than that in group A ( P < 0.05). The proportion of patients with mild obstruction in group C was significantly higher than that in groups A and B, and that in group B was significantly higher than that in group A ( P < 0.05), which was similar to the results of Weng et al [ 25 ]. Under the guidance of HRCT images after iterative reconstruction, a targeted TCM treatment plan for eliminating phlegm and removing blood stasis was developed, which had better efficacy for children with bronchiolitis obliterans and significantly improved their lung ventilation function.…”

Bronquiolitis obliterante postinfecciosa en niños: serie de casos en un hospital pediátrico de Perú

“…Los corticoides inhalados podrían formar parte del tratamiento antiinflamatorio 4 . En China, en un estudio de 54 pacientes con BOPI, utilizaron la terapia BAMA (budesonida, azitromicina, montelukast y acetilcisteína) y reportaron mejoría clínica y de la función pulmonar 17 ; en otro estudio realizado en menores de 5 años con BOPI, los autores detectaron que la terapia con budesonida, montelukast y azitromicina mejoraba los síntomas respiratorios y la función pulmonar 18 . El uso de la fluticasona como parte de la terapia FAM (fluticasona, azitromicina y montelukast) también se ha descrito en pacientes con bronquiolitis obliterante post trasplante de médula ósea, y ha reportado buena adherencia y disminución del deterioro pulmonar en estos pacientes 19 .…”