Management of bronchiolitis obliterans in a group of Tunisian children

Abstract

Introduction: Bronchiolitis obliterans (BO) is a rare lung disease. Treatment lacks strong evidence and developing countries may have challenges in the management of the disease.

Objectives: To assess the impact of therapeutic measures instaured to our pediatric patients diagnosed with BO in the disease's course.

Methods: We conducted a retrospective study including children with BO treated in a Tunisian pulmonology department between January 2008 and December 2021. We recorded patients’ characteristics, different treatment modalities and courses of the disease.

Results: We have included 17 patients with BO mainly boys (76,5%). Mean age was 10,2 years. Mean age in the moment of diagnosis was 5,8 years [1-17 years]. Symptoms mainly consisted of cough (76%), recurrent lower respiratory infections (47%), wheezing dyspnea (47%) and exertional dyspnea (17%). An etiology was identified in 10 patients (post bone marrow transplantation (47%) and postinfectious (11%)). Patients were treated with inhaled corticosteroids (n=17), long action beta agonists (n=9), oral corticosteroids (n=6), azithromycin (n=10) and anti-leukotrienes (n=4). Mean follow-up time was 53 months. Twelve patients had > 1 exacerbations of their BO requiring their hospitalization (70%). Two patients required a hospitalization in an intensive care unit (24%). Long term oxygen therapy was indicated in 3 cases (4%). The median forced expiratory volume in 1 second, performed in 12 children, was 50% at the time of diagnosis. A declin in lung function was seen in 25% of patients.

Conclusion: Morbidity associated with BO is high. Management of this disease in pediatric patients is a challenge in the absence of recommandations. Further multicenter studies are needed.