CME reviewPost Infectious Bronchiolitis Obliterans in Children
Introduction
Bronchiolitis Obliterans is a rare form of chronic obstructive lung disease secondary to a severe insult to the lower respiratory tract that leads to a variable degree of inflammation and scarring. The ultimate result of this process is the narrowing and/or complete obliteration of the small airways.1 In children, the most common form is post-infectious bronchiolitis obliterans (PBO), except in locations with a considerable number of paediatric lung or bone marrow transplant recipients.
As a disease, PBO has been reported in North and South America, Western and South-Eastern Europe, India, South-Korea, Taiwan, Malaysia, New Zealand, and Australia. In the last two decades of the 20th century, South American countries accumulated an unexpected number of cases: more than seven hundred, according to the Bronchiolitis Obliterans in Latin America (BOLAT) initiative. This review covers important information on the epidemiology, risk factors, diagnosis, imaging, lung function, treatment and prognosis of PBO.
Section snippets
Epidemiology
There are reports of PBO secondary to influenza, parainfluenza, measles, respiratory syncytial virus, varicella, and Mycoplasma pneumoniae. However, adenovirus (Ad) is by far the most common agent linked to the development of PBO.2, 3, 4 Thus, although the prevalence of PBO is not known, its epidemiology is directly related to the epidemiology of severe viral respiratory tract infections in young children, particularly of adenoviral aetiology. The serotypes mostly involved are Ad3, Ad7 and
Conclusion
Post-infectious bronchiolitis obliterans is an infrequent chronic obstructive pulmonary disease that develops in children as sequelae of a severe viral LRTI that injured irreversibly the bronchiolar micro-environment. The diagnosis is reached only through the integration of clinical, radiological and laboratory data suggestive of the disease. The treatment requires a multidisciplinary strategy and a multi-centred approach to address the challenges in terms of defining the molecular pathology,
Practice points
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Post-infectious bronchiolitis obliterans is a chronic obstructive lung disease occurring in children following a severe viral lower respiratory tract infection during their first two years of life.
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Mechanical ventilation and adenoviral infection are two strong risk factors for the development of the disease.
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The diagnostic approach should be based on the summation of clinical, microbiological, epidemiological and imaging information.
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Lung function is characterized by a moderately severe to severe
Educational aims
The reader will become familiar with:
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The risk factors and epidemiology of post-infectious bronchiolitis obliterans (PBO)
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The diagnostic criteria of PBO
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The importance of imaging and pulmonary function testing in the diagnosis and follow-up of PBO
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The multidisciplinary strategy for treating PBO
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What is known about outcomes and prognosis of PBO
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