Non-Linear Dysanaptic Lung Growth in Patients With Post-Infectious Bronchiolitis Obliterans

Few studies have assessed longitudinal pulmonary function outcomes in post-infectious bronchiolitis obliterans (PIBO). This study analyzes pulmonary function changes from patients with PIBO at a single center with respect to time and inciting respiratory pathogen.

Patients with PIBO were identified via retrospective observation using the Research Derivative at Vanderbilt University Medical Center. Serial spirometry was analyzed by generalized mixed-effects models. An exploratory analysis was performed to test interactions with pathogen, age at sentinel infection, and systemic corticosteroid exposure.

Fifteen patients were diagnosed with PIBO from 1998 to 2023. Twelve (80%) were male. Median age of infection was 3.0 years (IQR: 1.3-6.5 years). Commonly identified pathogens were adenovirus (n = 8/15) and Mycoplasma pneumoniae (n = 4/15). Patients with M. pneumoniae were older at infection (p = 0.02). Eleven (73%) patients performed a median of 14 pulmonary function tests per patient (IQR: 6.5-23). Median z-scores at initial spirometry were forced expiratory volume in 1 second (FEV1) -3.83, forced vital capacity (FVC) -2.92, and FEV1/FVC ratio -2.61. FEV1, FVC, and FEV1/FVC z-scores changed by 0.008, 0.185, and -0.143/year, respectively (p = 0.69, 0.003, 0.004). Four of 9 (44%) patients tested were bronchodilator responsive. The rate of annual FVC z-scores improved more in adenovirus-infected patients than in those with other pathogens (p < 0.001).

Patients with PIBO demonstrate non-linear dysanaptic lung growth with stagnant FEV1 growth with respect to time. Subjects infected with adenovirus demonstrated lower FVC initially but accelerated FVC growth than those infected with other pathogens. Future research is needed on how severe respiratory infections contribute to non-linear dysanaptic lung growth in susceptible children.