Chest
Volume 120, Issue 4, October 2001, Pages 1101-1106
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Clinical Investigations
Diffuse Lung Disease
Bronchiolitis Obliterans in the 1990s in Korea and the United States

https://doi.org/10.1378/chest.120.4.1101Get rights and content

Study objectives

Our current knowledge of pediatric bronchiolitis obliterans (BO) is based largely on a few small series of patients that were reported in the older literature. In these older cases, the mortality rate was high. This study was conducted to investigate the characteristics of pediatric BO cases in two different countries.

Design

We extracted specific information regarding predisposing factors, symptoms and signs, diagnostic studies, treatment, and outcome from the medical records of 31 children who received diagnoses of BO at four university medical centers in Korea and the United States in the 1990s.

Results

The large number of Asian children reflects a clustering of cases in Korea due to adenovirus and Mycoplasma pneumoniae epidemics. The characteristic diagnostic features of BO were present in 29 of 30 high-resolution CT (HRCT) studies. Seven of nine children who underwent biopsies had histologic confirmations of BO. In two patients whose biopsy results were nondiagnostic, the diagnosis was established by HRCT together with pulmonary function testing results that were consistent with nonreversible small airways obstruction. Fifteen children (48.4%) had evidence of hypoxemia. At present, all but one are alive. Patients with elevated severity-of-illness scores were observed to have increased likelihoods of lung transplantation or death.

Conclusions

We conclude that BO has a good overall prognosis and that the mortality rate has declined over the past decade. This could be related primarily to the use of HRCT for accurate diagnosis and the availability of pediatric lung transplantation. BO cases in Korea were associated with infectious epidemics, whereas those in United States had variable predisposing factors.

Section snippets

Materials and Methods

The medical records of children who had received diagnoses of BO between 1990 and 1999 at two university medical centers in Korea (ie, Inje University Sanggye Paik Hospital, Seoul, South Korea, and Seoul National University Hospital, Seoul, South Korea) and two university medical centers in the United States (ie, University of Colorado Health Sciences Center, Denver, CO, and Washington University Hospital, St. Louis, MO) were retrospectively reviewed.

Patients were included in the study if they

Clinical Presentation

A total of 31 children with BO were evaluated. Demographic data are presented in Table 1. The large number of Asian children in this group reflects a clustering of cases in Korea due to an adenovirus type 7 epidemic in 1996 and a Mycoplasma epidemic in 1995. In our series, a male predominance was noted. The mean age at the onset of symptoms was 46.4 months (age range, 7 to 183 months). The mean age at the time of diagnosis was 70.3 months (age range, 10 to 224 months). The mean duration of

Discussion

Our data demonstrate that BO in children is less severe than it has been known to be in the past and that the mortality rate has declined over the past decade. This could be related primarily to the use of HRCT for accurate diagnosis and the availability of pediatric lung transplantation.

To our knowledge, this is the largest series of pediatric BO patients reported to date. In contrast to older studies that utilized bronchography, ventilation-perfusion scans, and lung biopsies for diagnosis,

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  • Cited by (0)

    This study was supported in part by a Clinician Scientist Grant awarded in 1998 to Dr. Chang Keun Kim by Inje University, Korea, and by a year 1999 Brain Korea 21 project for Medicine, Dentistry, and Pharmacy.

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