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Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy
Silvia Onoda Tomikawa1, Fabíola Villac Adde, Luiz Vicente Ribeiro Ferreira da Silva Filho
1Pediatric Pulmonology Division, Instituto da Criança, Hospital das Clínicas, University of São Paulo, Avenida Dr Enéas de Carvalho Aguiar, 647, São Paulo, CEP 05403-000, SP, Brazil. silviatomi@yahoo.com.br.
Insights
Corticosteroid pulse therapy effectively treats childhood Bronchiolitis Obliterans (BO), reducing symptoms and hospitalizations while allowing discontinuation of oral steroids. This method offers a safer alternative with fewer side effects.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Clinical Medicine
Background:
- Bronchiolitis obliterans (BO) is a severe pediatric respiratory disease.
- Current treatment guidelines for BO lack consensus on systemic corticosteroid use.
- This study investigates corticosteroid pulse therapy for pediatric BO.
Purpose of the Study:
- To evaluate the efficacy and safety of methylprednisolone pulse therapy in children with Bronchiolitis Obliterans.
- To assess the impact of pulse therapy on clinical outcomes and growth parameters.
- To compare pulse therapy with prolonged oral corticosteroid treatment.
Main Methods:
- Forty pediatric patients diagnosed with BO received monthly methylprednisolone pulse therapy.
- Clinical and laboratory data were monitored throughout the treatment period.
- Statistical analyses included non-parametric tests for repeated measures and paired nominal data.
Main Results:
- Pulse therapy significantly reduced wheezing exacerbations and hospitalizations (p<0.0042).
- Oxygen saturation improved (p=0.0002), and prolonged oral corticosteroid use was discontinued in 83% of patients.
- Growth parameters (length and weight Z-scores) showed significant improvement, with temporary and non-serious adverse effects.
Conclusions:
- Corticosteroid pulse therapy presents a safe alternative to prolonged oral corticosteroid treatment for pediatric BO.
- This approach may minimize adverse effects associated with long-term oral steroid use.
- Further prospective controlled studies are warranted to validate these findings.
Background:
Bronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. Here we report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy.
Methods:
Forty patients fulfilling the BO diagnosis criteria were treated with methylprednisolone pulse therapy in monthly cycles until clinical improvement. After the pulse therapy began, we analyzed the clinical and laboratory data at intervals. Statistical analyses were performed using non-parametric tests to compare repeated measures (Friedman, Wilcoxon) or paired nominal data (McNemar) (α = 5%).
Results:
The frequency of wheezing exacerbations and hospitalizations was reduced (p = 0.0042 and p < 0.0001, respectively) and oxygen saturation improved (p = 0.0002) in the pulse therapy-treated patients. Prolonged oral corticosteroid therapy was discontinued in 83% of these patients. The mean Z-score length for age improved from -1.08 to -0.63, and the mean Z-score weight for age improved from -0.91 to -0.59. The adverse effects during the infusion were temporary and none were serious.
Conclusions:
Our data suggest that pulse corticotherapy could be a safe alternative to prolonged systemic oral corticotherapy in children with BO, thus minimizing the adverse effects of the oral therapy. New prospective controlled studies are required to confirm this proposition.
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