Post-infectious bronchiolitis obliterans in children

Abstract

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...

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

“…BO diagnoses are currently made according to clinical and CT findings (2,9) . This disease stands out because of the persistence of respiratory symptoms that do not respond to different treatments, which may lead to the misdiagnosis of other lung diseases (9) .…”

“…This disease stands out because of the persistence of respiratory symptoms that do not respond to different treatments, which may lead to the misdiagnosis of other lung diseases (9) . In this study, BO diagnoses were delayed a mean 14 months from symptom onset, and other diagnoses had been made previously.…”

“…Current treatments aim at inflammation control because of the role of the immunological response in the physiopathology of this disease. Further studies should define the role of corticosteroids in inflammation in BO, as well as their capacity to prevent the disease progression (9) . The use of steroids is based on the reports of improvement of isolated cases, as well as on the empirical observation of improvement after their administration and deterioration when they are discontinued (9,20) .…”

“…Further studies should define the role of corticosteroids in inflammation in BO, as well as their capacity to prevent the disease progression (9) . The use of steroids is based on the reports of improvement of isolated cases, as well as on the empirical observation of improvement after their administration and deterioration when they are discontinued (9,20) . The use of corticosteroids in the initial phase of the disease may minimize inflammation.…”

“…Currently, BO is diagnosed according to history of insult to the lower respiratory tract, usually infections, and persistent symptoms that do not respond to administration of systemic corticoids and bronchodilators for two weeks, tomographic (CT) findings and exclusion of other diseases (2,9) . BO is a frequent disease that has a variable progression, but it often goes undiagnosed in Brazil and may be misdiagnosed as other childhood lung diseases, mainly wheezing syndromes.…”