ABSTRACT
Postinfectious bronchiolitis obliterans (PiBO) is a rare and severe form of chronic obstructive lung disease caused by an infectious injury to the lower respiratory tract. The most commonly recognized inciting stimuli leading to PiBO are airway pathogens, such as adenovirus and Mycoplasma. PiBO is characterized by persistent and nonreversible airway obstruction, with functional and radiological evidence of small airway involvement. The literature has limited information on the aetiology, clinical profile, treatment, and outcome of PiBO.
ABSTRACT
Bronchiolitis obliterans is a rare and severe chronic lung disease resulting from a lower respiratory tract injury. It may occur after a bone marrow or lung transplantation, infectious diseases, or less frequently after inhaling toxic substances or connective tissue diseases. Pathogenesis and molecular biology, as well as the best treatment of bronchiolitis obliterans, remain the subject of ongoing research. This review discusses our current knowledge of lung function of post-infectious bronchiolitis obliterans.
La bronquiolitis obliterante es una enfermedad pulmonar crónica rara y grave que resulta de una lesión del tracto respiratorio inferior. Puede ocurrir después de un trasplante de médula ósea o pulmón, enfermedades infecciosas, o menos frecuentemente después de inhalar sustancias tóxicas o después de enfermedades del tejido conectivo. La patogénesis y la biología molecular, así como el mejor tratamiento de la bronquiolitis obliterante, siguen siendo objeto de investigación. Esta revisión analiza nuestro conocimiento actual sobre la función pulmonar de los pacientes con bronquiolitis obliterante secundaria a infecciones.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Respiratory Tract Infections/complications , Bronchiolitis Obliterans/physiopathology , Prognosis , Respiratory Function Tests , Bronchiolitis Obliterans/diagnosis , Lung/physiopathologyABSTRACT
Bronchiolitis obliterans is a rare and severe chronic lung disease resulting from a lower respiratory tract lesion. It may occur after a bone marrow or lung transplantation, infectious diseases, or less frequently after inhaling toxic substances or after connective tissue diseases. Pathology, pathogenesis, and molecular biology, as well as the best treatment of bronchiolitis obliterans, remain the subject of ongoing research. This review discusses our current knowledge of different areas of bronchiolitis obliterans associated with infectious lesions.
Subject(s)
Bronchiolitis Obliterans/etiology , Respiratory Tract Infections/complications , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/pathology , Bronchiolitis Obliterans/therapy , Humans , PrognosisABSTRACT
BACKGROUND: Postinfectious bronchiolitis obliterans (BO) is a chronic respiratory disease that usually follows a severe adenovirus infection. OBJECTIVE: To determine the evolution of pulmonary function and clinical outcome of children with postinfectious BO during childhood. METHODS: The study included patients diagnosed with postinfectious BO in whom at least two spirometries were performed within a minimum interval of 3â months. RESULTS: 46 met the inclusion criteria. The mean (±SD) follow-up period was 12.5 (±3.5) years. 197 spirometries and 41 plethysmographies were performed. Initial (9±3â years old) lung function was as follows (z score, mean±SD): forced vital capacity (FVC) -3.8±1; forced expiratory volume in 1 s (FEV1) -4.4±1; FEV1/FVC -2.2±1; forced expiratory flow (FEF)(25-75) -3.7±1; total lung capacity (TLC) 120±26%; residual volume (RV) 309±108%; and RV/TLC 55±13. During childhood, FVC and FEV1 increased by a mean of 11%/year (95% CI 9.3% to 12.6%; p<0.0001) and 9%/year (95% CI 7.7% to 10.2%; p<0.0001), and the FEV1/FVC ratio decreased by 1.9%/year (95% CI 1% to 2.8; p<0.001). The z score for FVC, FEV1 and FEV1/FVC decreased by 0.07 z score/year (95% CI 0.1 to 0.01; p<0.05), 0.09 z score/year (95% CI 0.1 to 0.05; p<0.01) and 0.04 z score/year (95% CI 0.09 to 0.001; p<0.02), respectively. During the follow-up period, 69% of patients required at least one hospital readmission and five required mechanical ventilation. Nine patients developed a thoracic deformity, and seven whose bronchiectasis did not respond to clinical treatment underwent a lobectomy. CONCLUSIONS: After a 12 year follow-up period, pulmonary function remained severely impaired, showing an obstructive pattern with air trapping that slowly improved during childhood. An unequal growth of lung parenchyma over the airways suggests dysinaptic growth. Patients required frequent readmission due to recurrent respiratory infections, and hypoxaemia improved slowly over time.
Subject(s)
Adenoviridae Infections/complications , Bronchiolitis Obliterans/physiopathology , Adolescent , Body Height , Bronchiectasis/etiology , Bronchiectasis/surgery , Bronchiolitis Obliterans/complications , Bronchiolitis Obliterans/virology , Child , Child, Preschool , Female , Follow-Up Studies , Forced Expiratory Volume , Humans , Infant , Male , Maximal Midexpiratory Flow Rate , Oxygen Inhalation Therapy , Patient Readmission , Plethysmography , Residual Volume , Spirometry , Time Factors , Vital Capacity , Young AdultABSTRACT
RATIONALE: Infant pulmonary function testing has a great value in the diagnosis of post-infectious bronchiolitis obliterans (BOs), because of characteristic patterns of severe and fixed airway obstruction. Unfortunately, infant pulmonary function testing is not available in most pediatric pulmonary centers. OBJECTIVE: To develop and validate a clinical prediction rule (BO-Score) to diagnose children under 2 years of age with BOs, using multiple objectively measured parameters readily available in most medical centers. METHODS: Study subjects, children under 2 years old with a chronic pulmonary disease assisted at R. Gutierrez Children's Hospital of Buenos Aires. Patients were randomly divided into a derivation (66%) and a validation (34%) set. ROC analyses and multivariable logistic regression included significant clinical, radiological, and laboratory predictors. The main outcome measure was a diagnosis of BOs. The performance of the BO-Score was tested on the validation set. RESULTS: Hundred twenty-five patients were included, 83 in the derivation set and 42 in the validation set. The BO-Score (area under ROC curve = 0.96; 95% CI, 0.9-1.0%) was developed by assigning points to the following variables: typical clinical history (four points), adenovirus infection (three points), and high-resolution computed tomography with mosaic perfusion (four points). A Score > or =7 predicted the diagnosis of BOs with a specificity of 100% (95% CI, 79-100%) and a sensitivity of 67% (95% CI, 47-80%). CONCLUSIONS: The BO-Score is a simple-to-use clinical prediction rule, based on variables that are readily available. A BO-Score of 7 or more predicts a diagnosis of post-infectious BOs with high accuracy.
Subject(s)
Bronchiolitis Obliterans/diagnostic imaging , Severity of Illness Index , Tomography, X-Ray Computed , Adenovirus Infections, Human/complications , Bronchiolitis Obliterans/etiology , Cohort Studies , Humans , Infant , Infant, Newborn , Odds Ratio , ROC Curve , Respiratory Tract Infections/complications , Respiratory Tract Infections/virology , Retrospective StudiesABSTRACT
Bronchiolitis obliterans is an uncommon and severe form of chronic obstructive lung disease that results from an insult to the lower respiratory tract. The bronchiolitis obliterans was described as a complication of graft versus host disease in bone marrow or lung transplant recipients. Bronchiolitis obliterans is most commonly seen in children after severe viral lower respiratory tract infections. The understanding of pathology, pathogenesis and molecular pathology, as well as the best treatment in bronchiolitis obliterans remain the subject of ongoing investigations. This review discusses our current knowledge on the different areas of bronchiolitis obliterans associated to infectious disease.
Subject(s)
Bronchiolitis Obliterans/virology , Bronchiolitis Obliterans/diagnosis , Child , Child, Preschool , Humans , InfantABSTRACT
La bronquiolitis obliterante es una enfermedad pulmonar crónica infrecuente y grave producto de una lesión del tracto respiratorio inferior.Puede ocurrir luego de un trasplante de médula ósea o de pulmón, de enfermedades infecciosas o, menos frecuentemente, luego de inhalaciones tóxicas o enfermedades del tejido conectivo. La patología, patogenia y biología molecular, como así también el mejor tratamiento para la bronquiolitisobliterante son áreas aún en investigación. Esta revisión discute el estado actual del conocimiento en las diferentes áreas de la bronquiolitis obliterante secundaria a una lesión infecciosa.
Bronchiolitis obliterans is an uncommon and severe form of chronic obstructive lung disease that results from an insult tothe lower respiratory tract. The bronchiolitis obliterans was described as a complication of graft versus host disease in bone marrow or lung transplant recipients. Bronchiolitis obliterans is most commonly seen in children after severe viral lower respiratory tract infections. The understanding of pathology, pathogenesis and molecular pathology, as well as the best treatment in bronchiolitis obliterans remain the subject of ongoing investigations. This review discusses our current knowledge on the different areas of bronchiolitisobliterans associated to infectious disease.
Subject(s)
Adolescent , Adult , Infant , Child, Preschool , Child , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/etiology , Bronchiolitis Obliterans/history , Bronchiolitis Obliterans/pathology , Bronchiolitis Obliterans/therapy , Pulmonary Disease, Chronic ObstructiveABSTRACT
La bronquiolitis obliterante es una enfermedad pulmonar crónica infrecuente y grave producto de una lesión del tracto respiratorio inferior.Puede ocurrir luego de un trasplante de médula ósea o de pulmón, de enfermedades infecciosas o, menos frecuentemente, luego de inhalaciones tóxicas o enfermedades del tejido conectivo. La patología, patogenia y biología molecular, como así también el mejor tratamiento para la bronquiolitisobliterante son áreas aún en investigación. Esta revisión discute el estado actual del conocimiento en las diferentes áreas de la bronquiolitis obliterante secundaria a una lesión infecciosa.(AU)
Bronchiolitis obliterans is an uncommon and severe form of chronic obstructive lung disease that results from an insult tothe lower respiratory tract. The bronchiolitis obliterans was described as a complication of graft versus host disease in bone marrow or lung transplant recipients. Bronchiolitis obliterans is most commonly seen in children after severe viral lower respiratory tract infections. The understanding of pathology, pathogenesis and molecular pathology, as well as the best treatment in bronchiolitis obliterans remain the subject of ongoing investigations. This review discusses our current knowledge on the different areas of bronchiolitisobliterans associated to infectious disease.(AU)
Subject(s)
Adolescent , Adult , Infant , Child, Preschool , Child , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/history , Bronchiolitis Obliterans/pathology , Bronchiolitis Obliterans/therapy , Pulmonary Disease, Chronic Obstructive , Bronchiolitis Obliterans/etiologyABSTRACT
Our objective was to evaluate the efficacy and safety of two doses of fluticasone propionate (FP) in young children with recurrent wheezing and risk factors for asthma. Our study design was a randomized, double-blind, placebo-controlled comparison of inhaled FP 50 mcg twice daily (FP 100) and 125 mcg twice daily (FP 250), for 6 months. Outcome measures included number of wheezing episodes, days on albuterol, height standard deviation score (height SDS), osteocalcin (OC), bone alkaline phosphatase fraction (AKP), insulin-like growth factor-binding protein 3 (IGFBP-3), and serum levels of cortisol (SC). Our subjects were 30 patients, aged 7-24 months. Mean wheezing episodes were 6.0 +/- 1.9, 1.9 +/- 1.9, and 2.8 +/- 1.2; mean days of albuterol use were 24.3 +/- 1.3, 6.5 +/- 0.8, and 9.1 +/- 0.8, per patient for placebo, FP100, and FP250 groups, respectively. There was a significant reduction in clinical outcome in the two FP groups compared to placebo (P < 0.01). No significant correlations were found between FP dosage and height SDS, OC, AKP, IGFBP-3, and SC. In conclusion, in young children with asthmatic symptoms, FP at 50 and 125 mcg b.i.d. for 6 months significantly improved respiratory symptoms without causing significant side effects on growth and bone metabolism.
Subject(s)
Androstadienes/administration & dosage , Asthma/drug therapy , Bronchodilator Agents/administration & dosage , Administration, Inhalation , Albuterol/therapeutic use , Androstadienes/metabolism , Androstadienes/therapeutic use , Asthma/complications , Bone and Bones/metabolism , Bronchodilator Agents/metabolism , Bronchodilator Agents/therapeutic use , Child, Preschool , Dose-Response Relationship, Drug , Double-Blind Method , Female , Fluticasone , Growth/drug effects , Humans , Infant , Insulin-Like Growth Factor Binding Protein 3/metabolism , Male , Recurrence , Respiratory Sounds/etiology , Treatment OutcomeABSTRACT
Acute viral bronchiolitis (AVB) is a common disease found throughout the world. Various aspects of it are being studied: its epidemiology, diagnosis, prognosis and treatment. Most of these studies are being conducted in developed countries, with only a few taking place in developing countries. Risk factors such as poor nutrition, an adverse environment and early weaning should be studied where these features are common. Treatment aspects such as cost-effectiveness in low income settings need further study. Use of ribavirin and respiratory syncytial virus (RSV)-immunoglobulin are good examples. Post-bronchiolitic sequelae also need to be studied in low income countries. There is evidence that bronchiolitis obliterans is unusually frequent in some Latin-American countries such as Argentina and Brazil. It will be helpful to undertake combined studies in countries with the same socio-economics, investigating the preventive and management aspects of AVB and its sequelae to reduce the morbidity and mortality.
