Respiratory exacerbations in post infectious obliterative bronchiolitis

Abstract

Post infectious obliterative bronchiolitis (PIBO) is an unusual and rare complication of lower respiratory tract infections in children, with Adenovirus being the most common cause. The condition is non progressive and treatments mostly supportive. Little is known about the respiratory morbidity from frequent exacerbations of respiratory symptoms.

Methods: We describe the frequency and symptoms during exacerbation in a cohort of 12 patients for a mean 2.6 years after diagnosis. Diagnosis of PIBO was based on CT findings together with a suggestive clinical course. The exacerbations were classified as wheezy or infective based on the predominant symptom. Data on the types of symptoms and treatments given were collected.

Results: Median age at diagnosis was 2 yrs 4 months. Most cases were post infective (80%) and the most common aetiologic agents were Adenovirus (60%), Rhinovirus (40%) and RSV (30%). Most patients were managed on long term anti-inflammatory therapy with Azithromycin and inhaled steroids. 5 patients were on home oxygen. The mean time between outpatient follow-up was 3 months. There was significant variability in the number of exacerbations ranging between 0 to 4 per year. Most children had infective exacerbations which did not usually lead to hospitalisation. Most were treated with oral antibiotics usually Co-amoxiclav. In the same individual the exacerbations are usually of the same types.

Conclusion: There is considerable heterogeneity in the presentation of children with exacerbations. These may correlate with the extent of bronchiectasis radiologically. Outcomes could be improved by proactive antibiotic treatment if such a correlation can be studied in a larger cohort using a national database.