Bronchiolitis obliterans in 28 children / 中华实用儿科临床杂志

ABSTRACT

Objective To recognize the clinical characteristics and treatment of bronchiolitis obliterans (BO) in children.Methods Clinical analysis was done on data of 28 patients with BO diagnosed in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Dec.2001 to Aug.2012.Clinical manifestation,etiology,chest X-ray,computed tomography (CT),pulmonary function,flexible bronchoscopy,treatment and prognosis of the children were analyzed.Results Boys were common in all 28 children (20 boys and 8 girls) aged from 4 months to 7 years.All cases presented with persistent cough and wheezing for more than 6 weeks,and crackles as well as wheezing were heard.Twenty-three cases were post-infectious BO (PBO),and 5 cases occurred after Steven-Johnson syndrome(SJS).Pulmonary CT showed mosaic perfusion in all cases,atelectasis in 7 cases,and bronchiectasis in 4 cases.Lung function revealed obstructive ventilatory dysfunction in 16 cases,and mixed ventilatory dysfunction in 3 cases.Thirteen cases received flexible bronchoscopy,and the cell of the bronchoalveolar lavage fluid showed increased level of neutrophils.All the cases received oral corticosteroid,azithromycin and inhalation of corticosteroid and bronchodilator,or oral leukotrienes receptor antagonists.After a follow-up in 23 cases for 5 months to 7 years,there was no death occurred.Besides 7 cases experienced regular treatment were ameliorated in clinical presentation,pulmonary imaging and function,the rests experenced persistent symptoms.Conclusions BO in children mostly follows lower respiratory tract infection and SJS.Diagnosis is made according to clinical productive cough and wheezing,mosaic perfusion in pulmonary CT and airway obstructions in pulmonary function.Corticosteroid is mainly used in treatment of BO,and its overall prognosis is poor.