Abstract
Evidence about disease progression in PIBO is scarce. Although it seems to stabilize over time there are no clear markers of outcome.
Aims: To ascertain if clinical and lung function(LF) indices qualify stability in PIBO.
Methods: Retrospective chart review of the medical records of 45 children with PIBO on follow-up at a tertiary hospital. Twenty-eight (62,2%) patients with at least 8 years of follow-up were included (diagnosis based on history, chest HRCT and fixed airway obstruction). Clinical stability was assumed if ≤2 exacerbations/year; LF stability if ≤5% variation in %PredFEV1 (ATS/ERS, GLI2012)between yearly tests, all for 2 consecutive years. Descriptive analysis SPSS®.
Results: Twenty(71%) patients were boys, initial injury occurred at median age of 11(0,6-68) months, 9(32%) needed mechanical ventilation. Adenovirus was the most common etiologic agent(10; 36%). Sixteen(57%) patients were atopic (positive skin prick tests/IgE). Median time of follow-up was 17,4(8,3-23,0)y; 4 had long-term home oxygen. Clinically, all patients stabilized at a median of 4,2(0,7-12,1)y after initial lung injury, yet only 9(32%) had no lung exacerbations for 2 years, which occurred at 8,0(3,1-17,4)y after initial injury. LF never stabilized by study criteria, but in 7(35%) it improved over time and in 50% varied ≤10% in %PredFEV1 from start to end of follow-up.
Conclusion: Number of exacerbations/year showed to be a more sensible marker to define stability in PIBO. Assuming 10% variation in %PredFEV1 is probably wiser due to the propensity of PIBO/asthma overlap syndrome. Increasing sample size and analyzing trends in LF may inform about PIBO's prognosis and help design specific interventions.
- Copyright ©the authors 2016
