ABSTRACT
Post-infectious bronchiolitis obliterans (PIBO) is a chronic obstructive bronchial disease that develops after a viral respiratory infection, acquired before 2 years of age. In Bogotá, Colombia our group published in 2017 the description and follow-up of 21 cases of this pathology. The purpose of this publication is to describe the evolution of 38 children with PIBO living in Bogotá, Colombia at 2640 m above sea level, with an average of 6.5 years of follow-up. The estimated prevalence of PIBO in the population group in the group studied here was at least 1 case per 10,526 children under 15 years of age. The highest frequency of oxygen dependence and pulmonary hypertension are highlighted in this group of children living at high altitude
La bronquiolitis obliterante post-infecciosa (BOPI) es una enfermedad bronquial obstructiva crónica, que se desarrolla luego de una infección respiratoria viral, adquirida antes de los 2 años de vida. En Bogotá, Colombia nuestro grupo hizo en al año 2017 la descripción y seguimiento de 21 casos de esta patología. La presente publicación tiene como objetivo describir la evolución de 38 niños con BOPI que viven en la ciudad de Bogotá a 2640 m sobre el nivel del mar, con un segumiento de 6.5 años en promedio. Se calcula que la prevalencia de la enfermedad en el grupo poblacional de donde se refieren estos casos, es de al menos 1 caso por 10.526 menores de 15 años. Se destacan la mayor frecuencia de oxigeno dependencia e hipertensión pulmonar en este grupo de niños que viven a gran altura.
Subject(s)
Humans , Male , Female , Child , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/physiopathology , Bronchiolitis Obliterans/epidemiology , Respiratory Function Tests , Respiratory Tract Infections/complications , Forced Expiratory Volume , Prevalence , Follow-Up Studies , Colombia/epidemiology , Altitude , Hypertension, PulmonaryABSTRACT
Post-infectious bronchiolitis obliterans (BOPI) is a chronic obstructive disease, resulting from an acute injury and an abnormal repair process, with diffuse pulmonary fibrosis and peribronchiolar fibrosis, which cause chronic respiratory failure with prolonged oxygen dependence. The most common cause of this disease is severe bronchiolitis / pneumonia due to adenovirus (ADV), mainly in group B, before 2 years of age. In its pathogenesis are factors of the host and the characteristics of the virus that has mechanisms to prevent immunity and cause a chronic infection with great inflammatory response. This involves numerous cells (mainly lymphocytes) and cytokines that are produced by a chronic infection by ADV, which maintains a prolonged inflammatory process, determining different degrees of lung damage. In this article we will discuss the mechanisms by which this damage occurs.
La bronquiolitis obliterante postinfecciosa (BOPI) es una enfermedad obstructiva crónica, resultante de una injuria aguda y un proceso de reparación anómalo, con fibrosis pulmonar y peribronquiolar difusa, que causan insuficiencia respiratoria crónica con dependencia de oxigeno prolongada. La causa más frecuente de esta enfermedad es una bronquiolitis/neumonía grave por adenovirus (ADV), principalmente del grupo B, antes de los 2 años de vida. En su patogenia intervienen factores del huésped y las características del virus que tiene mecanismos para evitar la inmunidad y provocar una infección crónica con gran respuesta inflamatoria. En esta participan numerosas células (principalmente linfocitos) y citoquinas que se producen por una infección crónica por ADV, lo que mantiene un proceso inflamatorio prolongado, determinando distintos grados de daño pulmonar. En este artículo abordaremos los mecanismos por los cuales se produce este daño.
Subject(s)
Humans , Child , Bronchiolitis Obliterans/etiology , Pneumonia, Viral/complications , Bronchiolitis Obliterans/prevention & control , Bronchiolitis Obliterans/epidemiology , Adenovirus Infections, Human/complications , Risk FactorsABSTRACT
PURPOSE: The development of bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT) deteriorates patients' quality of life. This study aimed to analyze the prevalence, clinical features, risk factors and prognostic factors of BOS. MATERIALS AND METHODS: This retrospective study included patients who underwent allogeneic HSCT from January 2002 to December 2008 and survived for > or =100 days after transplantation. RESULTS: Of 860 patients who survived for > or =100 days, 36 (4.2%) met the diagnostic criteria. The duration of BOS development after transplantation was 466.00 (284.00-642.75) [median (interquartile range)] days. The risk factor for the development of BOS was peripheral blood as the stem cell source with a hazard ratio (HR) of 2.550 [95% confidence interval (CI): 1.274-5.104, p=0.008]. In multivariate analysis, pretransplant FEV1/FVC (HR: 0.956, 95% CI: 0.921-0.993, p=0.020) and time from HSCT to diagnosis of BOS (HR: 0.997, 95% CI: 0.994-0.999, p=0.009) were independent prognostic factors associated with mortality. CONCLUSION: Peripheral blood as a stem cell source is a risk factor for the development of BOS. A decreased pretransplant FEV1/FVC and shorter duration of time from transplantation to diagnosis of BOS are poor prognostic factors for BOS.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bronchiolitis Obliterans/epidemiology , Disease Progression , Graft vs Host Disease/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Multivariate Analysis , Prevalence , Proportional Hazards Models , Quality of Life , Respiratory Function Tests , Retrospective Studies , Risk Factors , Survival Analysis , Transplantation, HomologousABSTRACT
En la actualidad el trasplante pulmonar es considerado el tratamiento de elección para pacientes portadores de una enfermedad pulmonar avanzada que no presenten otras patologías severas y cuya sobrevida estimada es menor a dos años. La mejoría de la técnica quirúrgica y las drogas inmunosupresoras han permitido optimizar la calidad de vida, disminuyendo las complicaciones y extendiendo así la sobrevida. Hace 10 años Clínica Las Condes inicia su programa de trasplante pulmonar el que ha sido pionero nacional en número de injertos realizados y resultados obtenidos a largo plazo. Se realiza una revisión de las indicaciones, complicaciones precoces y tardías, capacidad física posterior al trasplante y sobrevida alejada de los pacientes trasplantados de pulmón en nuestro programa.
Currently the lung transplant is considered the treatment of choice for patients showing no other severe pathologies advanced lung disease carriers whose estimated survival rate is less than two years. The improvement of the surgical technique and immunosuppressive drugs has made it possible to optimize the quality of life, reducing complications and extending the survival rate. For 10 years Clínica las Condes has been initiating your lung transplantation program which has been pioneering national in number made grafts and results obtained long-term. Performs a review indications, early and late complications, transplantation and survival away from transplanted patients lung our physical capacity.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Child , Young Adult , Middle Aged , Aged , Lung Transplantation/adverse effects , Lung Transplantation/statistics & numerical data , Antibiotic Prophylaxis , Bronchiolitis Obliterans/epidemiology , Cause of Death , Chile , Follow-Up Studies , Immunosuppression Therapy , Postoperative Care , Graft Rejection/epidemiology , Survival Analysis , Lung Transplantation/mortalityABSTRACT
SETTING: Pulmonary department of a tertiary health care centre in India. OBJECTIVES: To study the clinical profile of diseases causing chronic airflow limitation (CAL). DESIGN: Standard criteria were used for the diagnosis for various diseases causing CAL. Severity of CAL was graded using forced expiratory volume in one second (FEV1)% predicted. Pulmonary hypertension (PH) was confirmed by 2-dimensional echocardiography with colour Doppler. RESULTS: Two hundred sixty eight consecutive patients of CAL, age range 12-75 years, 172 men and 96 women were included in the study. Sixty three percent had asthma, 17% had chronic obstructive pulmonary disease (COPD), 6% had bronchiectasis, 13% had obliterative bronchiolitis (OB) and 1% had occupational airway disease. 98% of COPD was caused by tobacco smoking, of which 84% were bidi smokers. Ninety-two percent cases of OB were post infectious, 78% being post tuberculosis. 37% of COPD, 33% of bronchiectasis, 53% of OB and 22% of asthma had severe airflow limitation. PH was observed in 15%, 19% and 13% cases of COPD, OB and bronchiectasis, while none with asthma had PH. CONCLUSION: Although, asthma was the leading cause of CAL, it caused least functional impairment. CAL due to OB was as common as COPD. Bidi smoke was an important cause of COPD, while respiratory infection was common cause for OB.