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Post-infectious bronchiolitis obliterans in children: pathogenesis, treatment strategies, and future directions
Elad Ben-Meir1, Alejandro Teper2, Lisa Strug3
1Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel.
Insights
Post-infectious bronchiolitis obliterans (PIBO) in children involves neutrophilic inflammation and genetic factors. Current PIBO management is supportive, but understanding disease mechanisms may lead to targeted therapies.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Genetics
Background:
- Post-infectious bronchiolitis obliterans (PIBO) is a significant cause of chronic lung disease in children.
- It often follows severe respiratory infections, leading to irreversible airway obstruction.
Purpose of the Study:
- To offer a detailed review of PIBO in children.
- Focusing on its pathogenesis, diagnosis, and management.
- Highlighting new insights into mechanisms and future treatments.
Main Methods:
- Literature review of recent studies on PIBO.
- Analysis of pathogenesis, diagnostic criteria, and therapeutic strategies.
- Synthesis of emerging mechanistic data and future directions.
Main Results:
- Recent research highlights neutrophilic inflammation, inflammasome activation (IL-18, caspase-1), and genetic susceptibility in PIBO.
- PIBO is a heterogeneous, often underdiagnosed condition.
- Management is primarily empirical and supportive, lacking disease-modifying therapies.
Conclusions:
- A structured diagnostic approach using clinical, functional, and radiologic data is crucial for PIBO.
- Limited evidence exists for current disease-modifying therapies.
- Further understanding of PIBO mechanisms could facilitate targeted, phenotype-specific interventions.
Purpose Of Review:
To provide a comprehensive and updated overview of post-infectious bronchiolitis obliterans (PIBO) in children, focusing on pathogenesis, diagnostic approaches, and current management strategies, while highlighting emerging mechanistic insights and future therapeutic directions.
Recent Findings:
Recent studies emphasize neutrophilic inflammation, inflammasome activation (e.g., interleukin-18, caspase-1), and genetic susceptibility as key contributors to disease development and progression.
Summary:
PIBO is a heterogeneous and often underrecognized chronic lung disease requiring a structured diagnostic approach based on clinical, functional, and radiologic criteria. Management remains largely empirical and supportive, with limited evidence for disease-modifying therapies. Improved understanding of disease mechanisms may enable the development of targeted, phenotype-directed interventions in the future.
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