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Therapeutic interventions and pulmonary function in pediatric patients with post-infectious bronchiolitis obliterans
1Department of Pediatric Emergency Medicine, Meyer Children's Hospital IRCCS, Florence 50139, Italy. serena.chiellino@meyer.it.
Insights
Post-infectious bronchiolitis obliterans (PIBO) in children causes significant lung function impairment. While some therapies offer short-term relief, long-term benefits are limited, necessitating further research and guidelines.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Chronic Obstructive Pulmonary Disease
Background:
- Post-infectious bronchiolitis obliterans (PIBO) is a rare, severe obstructive lung disease in children following respiratory infections.
- It leads to chronic respiratory issues, impacting long-term health and quality of life.
Purpose of the Study:
- To review and synthesize current evidence on pulmonary function in pediatric PIBO.
- To evaluate the efficacy of various therapeutic interventions for PIBO.
- To provide an overview of PIBO's epidemiology, risk factors, clinical presentation, and diagnostics.
Main Methods:
- Narrative review of existing literature on pediatric PIBO.
- Analysis of spirometric indices (e.g., FEV1, FVC, FEF25-75%) to assess pulmonary function.
- Synthesis of reported therapeutic strategies, including pharmacological and non-pharmacological approaches.
Main Results:
- Children with PIBO exhibit moderate to severe pulmonary function impairments.
- Corticosteroids and combination therapies provide short-term symptom relief but have limited long-term benefits and potential adverse effects.
- Pulmonary rehabilitation shows promise for lung function and quality of life, though evidence is limited.
Conclusions:
- Current therapeutic options for pediatric PIBO offer limited long-term efficacy and are associated with adverse effects.
- Further multicenter studies are crucial to establish evidence-based guidelines and improve long-term treatment outcomes.
- There is an urgent need for more research into effective, long-term management strategies for PIBO in children.
Abstract:
Post-infectious bronchiolitis obliterans (PIBO) is a rare chronic obstructive pulmonary disease affecting children after a severe respiratory infection. The primary goal of this narrative review is to synthesize evidence on pulmonary function in children with PIBO, with a focus on spirometric indices, and to evaluate the efficacy of therapies reported in the literature. It also provides an overview of the disease's epidemiology, risk factors, clinical presentation and diagnostic methods. Studies reported various spirometric parameters including forced expiratory volume in one second, forced vital capacity, the ratio between these two parameters, and forced expiratory flow at 25%-75%. A narrative synthesis described therapies including bronchodilators, corticosteroids, macrolides, combination regimens, novel therapies and non-pharmacological interventions. Most studies were small, but data showed moderate to severe impairments in pulmonary function in pediatric PIBO, with mild heterogeneity. Corticosteroids and combined therapies offered short-term relief, but long-term benefits were limited by adverse effects. Pulmonary rehabilitation may preserve lung function and quality of life, although evidence remains scarce. Given the limited research on therapy and pulmonary outcomes, further studies are necessary to understand the long-term effects of treatments. This review underscores the urgent need for multicenter studies and evidence-based guidelines to improve care for children with PIBO.
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