Prediction of postinfectious bronchiolitis obliterans prognosis in children

Abstract

Introduction The prognosis of postinfectious bronchiolitis obliterans (PIBO) has many implications, ranging between reduced quality of life and life‐threatening complications. We evaluated the prognostic factors for PIBO using the baseline clinical characteristics of patients and built a prediction model for determining the prognoses of PIBO patients using the identified parameters. Methods We included 47 PIBO patients who underwent spirometry and impulse oscillometry and followed them up for at least 1 year. A patient's prognosis was classified as poor if the patient experienced at least one of the following: persistent respiratory symptoms for more than 1 year, two or more instances of hospitalizations due to respiratory symptoms, or more than one intensive care unit admission. Results The prognoses of 32/47 (68.1%) patients was good, while that of 15/47 (31.9%) was poor. Spirometry results showed significantly lower forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiratory flow at 25%–75% of FVC, and post‐bronchodilator (BD) FEV1 values in the poor prognosis group; chest computed tomography (CT) demonstrated more inflammatory bronchiolitis findings. We created a nomogram for predicting prognoses using post‐BD FEV1 and inflammatory bronchiolitis on chest CT. The area under the curve for the nomogram was 84.6% (95% confidence interval: 72.8%–96.4%). Conclusions PIBO patients with lower pulmonary function values and more findings of inflammatory bronchiolitis on initial examination have poor prognoses. The nomogram for predicting PIBO prognosis is easy to use and can be applied at the time of diagnosis.

Importance of early follow‐up of Mycoplasma pneumoniae pneumonia in pediatric patients: A case series

“…However, the duration of inflammatory injury remains unclear. 1 Acute bronchiolitis is associated with the incidence of PIBO, and the lesional distribution matches that of bronchiolitis. 3 Partial or total obstruction of the airway lumen results from the inflammatory development of granulation or fibrosis over time.…”

“…pneumoniae infection correlates epidemiologically with asthma and PIBO. 1 These relationships have been the focus of research; however, many clinical problems remain. For example, when BO is diagnosed in nonsevere MPP cases, the optimal time for treatment has long passed.…”

“…Most children, as in our three cases, experience considerably improved lung function throughout the recovery period; however, recovery is slower for the small airways, which are more severely damaged. 5 Jung et al 1 discovered that infectious bronchiolitis and impaired pulmonary function at the time of initial diagnosis were risk factors for a poor prognosis. To improve the prognosis of MPP, we recommend follow-up pulmonary imaging and pulmonary function testing of high-risk groups before and after discharge.…”

“…Data indicate that Mycoplasma pneumoniae pneumonia (MPP) with bronchiolitis is closely related to asthma and bronchiolitis obliterans (BO). 1 Nonoptimal timing of treatment increases the risk of progression to BO. Thus, early followup and intervention following the acute phase of MPP are necessary to prevent complications.…”

Development and external validation of a simple nomogram for predicting apnea in children hospitalized with bronchiolitis

“…A nomogram is a simple and intuitive expression of statistical model analysis results, which makes the prediction model more concise and effective in quantifying risks and has a higher application value. This advantage gives the nomogram more attention and application in medical research and clinical practice ( 7 , 29 , 30 ). At present, this study is the first to establish an early predictive nomogram model of apnea in patients with bronchiolitis.…”