Background: Postinfectious bronchiolitis obliterans (BO) designates a clinical syndrome of chronic airflow obstruction associated with inflammatory changes in the small airways. Objectives: The aim of this study was to determine the etiology, clinical and radiological features and define prognostic factors of postinfectious BO in children. Methods: We undertook a review of the medical records of 20 children with postinfectious BO, who were followed up between January 1994 and August 2001. Results: Postinfectious BO was diagnosed in 11 boys and 9 girls with a median age of 21.5 months (6–69 months) who were followed up for a median of 23 months. Cough and wheezing persisted since the initial lung infection in all patients. Postinfectious BO was diagnosed in an average of 6 months (1–42 months) after the acute illness. Adenoviruses were the most common etiologic agents identified serologically. The diagnoses of postinfectious BO was made by thoracic high-resolution computed tomography and clinical features. Corticosteroid therapy was used in 17 patients and supportive treatment was applied in all patients. Age at initial lung infection, gender, time of starting corticosteroid treatment, presence of bronchiectasis or atelectasis and etiologic agents identified on presentation did not predict severity in our study. Conclusions: Despite the prominent role of inflammation in the pathogenesis of postinfectious BO, the use of anti-inflammatory agents remains controversial. We could not identify any prognostic factors related to disease severity. In order to minimize associated complications, patients with postinfectious BO should be closely followed up and receive meticulous lung care.

Keywords:
Bronchiolitis obliterans, Clinical course, Postinfectious, Prognosis
1.
Epler GR, Colby TV: The spectrum of bronchiolitis obliterans. Chest 1983;83:161–162.
2.
Penn C, Liu C: Bronchiolitis following infection in adults and children. Clin Chest Med 1993;14:645–654.
3.
Wohl ME, Chernick V: Bronchiolitis. Am Rev Respir Dis 1978;118:759–781.
4.
Wohl ME: Bronchiolitis; in Chernick V, Kendig EL (eds): Kendig’s Disorders of the Respiratory Tract in Children. Philadelphia, Saunders, 1998, pp 480–485.
5.
Leong MA, Nachajon R, Ruchelli E, Allen JL: Bronchitis obliterans due to Mycoplasma pneumonia. Pediatr Pulmonol 1997;23:375–381.
6.
Sly PD, Soto-Quiros ME, Landau LI, Hudson I, Newton JH: Factors predisposing to abnormal pulmonary function after adenovirus type 7 pneumonia. Arch Dis Child 1984;59:935–939.
7.
Hardy KA, Schidlow DV, Zaeri N: Obliterative bronchiolitis in children. Chest 1988;93:460–466.
8.
McLoud TC, Epler GR, Colby TV, Gaensler EA, Carrington CB: Bronchiolitis obliterans. Radiology 1986;159:1–8.
9.
Chang AB, Masel JP, Masters B: Post-infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae. Pediatr Radiol 1998;28:23–29.
10.
Zhang L, Irion K, Kozakewich H, Reid L, Camargo J, Porto NS, Silva F: Clinical course of postinfectious bronchiolitis obliterans. Pediatr Pulmonol 2000;29:341–350.
11.
Calabria MD: Bronchiolitis obliterans in the child. Allergol Immunopathol 1995;23:267–270.
12.
Milner AD, Murray M: Acute bronchiolitis in infancy: Treatment and prognosis. Thorax 1989;44:1–5.
13.
Lentz D, Bergin CJ, Berry GJ, Stoehr C, Theodore J: Diagnosis of bronchiolitis obliterans in hearth-lung transplantation patients: Importance of bronchial dilatation on CT. Am J Roentgenol 1992;159:463–467.
14.
Goinsk BB, Friedman PJ, Liebow AA: Bronchiolitis obliterans: Roentgenologic-pathologic correlation. Am J Roentgenol 1973;117:816–832.
15.
Moran TJ: Experimental aspiration pneumonia. IV. Inflammatory and reparative changes produced by intratracheal injections of autologous gastric juice and hydrochloric acid. Arch Pathol 1955;60:122–129.
16.
Hodges IGC, Milner AD, Groggins RC, Stokes GM: Causes and management of bronchiolitis with chronic obstructive features. Arch Dis Child 1982;57:495–499.
17.
Phan SM: New strategies for treatment of pulmonary fibrosis. Thorax 1995;50:415–421.
18.
Meyer B, de Blic J, Pariente D, Lamaur C, Benoist MR, Nezelof C, Scheinmann P: Bronchiolitis obliterans: Technics of exploration and diagnosis. Semin Hôp 1983;59:2699–2703.
19.
Kim CK, Kim SW, Koh YY, Cohen AH, Deterding RR, White CW: Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest 2001;120:1101–1106.
20.
Fan LL, Langston C: Chronic intestitial lung disease in children. Pediatr Pulmonol 1993;16:184–196.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.