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Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Pediatric Bronchiolitis Obliterans and Bronchiolitis Obliterans Syndrome: Nursing Considerations
1Jared Deffler is a nurse practitioner in the cardiac intensive care unit at the Children's Hospital of Philadelphia, Pennsylvania.
Insights
Bronchiolitis obliterans (BO) is a serious lung disease. Early recognition of risk factors like respiratory infections or transplants and prompt treatment are key for nurses to slow its progression in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Critical Care Nursing
- Transplant Medicine
Background:
- Bronchiolitis obliterans (BO) and bronchiolitis obliterans syndrome (BOS) are irreversible obstructive lung diseases.
- Characterized by progressive airway narrowing due to fibrosis, inflammation, and scarring.
- Affects pediatric patients, posing significant long-term health challenges.
Purpose of the Study:
- To summarize the disease process, causes, and treatments of BO in pediatric patients.
- To equip acute care, transplant, and critical care nurses for early recognition of BO signs.
- To enhance nursing knowledge for managing at-risk pediatric populations.
Main Methods:
- Descriptive literature review of articles published from 2013 onwards.
- Searched PubMed and CINAHL databases for "bronchiolitis obliterans" and "pediatric".
- Appraised 22 selected articles using the Johns Hopkins Nursing Evidence-Based Practice tool.
Main Results:
- Identified three primary patient groups at risk for BO: post-respiratory infection, post-lung transplant, and post-stem cell transplant.
- Highlighted the importance of recognizing specific risk factors in pediatric populations.
- Emphasized the need for timely diagnosis and intervention.
Conclusions:
- Definitive BO diagnosis requires lung biopsy and histopathology.
- Clinical identification of BOS involves spirometry and high-resolution CT scans when biopsy is not feasible.
- Systemic corticosteroids are the primary treatment, with ongoing research into second-line therapies.
Background:
Bronchiolitis obliterans/bronchiolitis obliterans syndrome is an irreversible, obstructive lung disease characterized by the narrowing of bronchioles by lung fibrosis, inflammation, and scarring.
Objective:
To provide acute care, transplant, and critical care nurses a summary of the disease process, causes, and treatment options for bronchiolitis obliterans in pediatric patients to promote early recognition of signs in at-risk patients.
Methods:
This descriptive literature review was limited to articles published in 2013 or later. Searches of the PubMed and CINAHL databases using the terms bronchiolitis obliterans and pediatric yielded 432 articles. Of these articles, 22 were used for this review. The Johns Hopkins Nursing Evidence-Based Practice appraisal tool was used to assess levels of evidence and methodologic quality of the articles.
Results:
Patients in 3 main groups are at risk for bronchiolitis obliterans: those who have had respiratory infection, those who have received lung transplant, and those who have received stem cell transplant.
Discussion:
A diagnosis of bronchiolitis obliterans requires lung biopsy and histopathology. For patients who are unable to undergo biopsy or whose biopsy results are inconclusive, bronchiolitis obliterans syndrome can be clinically identified with spirometry (forced expiratory volume in first second of expiration and forced expiratory flow at 25% to 75% of forced vital capacity) and high-resolution computed tomography. Systemic corticosteroids are often the first-line treatment; second-line strategies are under investigation.
Conclusion:
Knowledge of risk factors, signs, and current treatments for bronchiolitis obliterans/bronchiolitis obliterans syndrome can help acute care and critical care nurses decelerate progression of the disease.
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