Clinical Analysis Of 31 Children With Bronchiolitis Obliterans

Objective: To delineate the clinical,radiological features and outcomes of bronchiolitis obliterans(BO)in children for minimising morbidity and mortality.Methods: 31 patients with BO from November 1,2009 to December 5,2018 were retrospectively analyzed in First Affiliated Hospital of Guangxi Medical University.Results: BO was diagnosed in 22 boys and 9 girls with a median age of1.79 years(0.42-12.59 years).Persistent cough and wheezing were the main manifestations.24 cases were post-infectious BO(PIBO),among them,20cases(64.5%)had history of severe pneumonia and 14 cases(45.2%)needed for mechanical ventilation.4 cases with adenovirus infection,1 case with adenovirus and measles virus infection,2 cases with mycoplasma pneumoniae infection,1case with influenza virus infection,1 case with respiratory syncytial virus infection.7 cases occurred by other etiologies,in 2 cases BO occurred after Steven-Johnson syndrome,1 case after erythema multiforma exudativum,1 case after severe drug eruption,2 cases after hematopoietic stem cell transplantation,1case after castleman’s disease.Obstructive pattern occurred mostly in 23 cases with pulmonary tidal function tests and 3 cases with pulmonary ventilation function tests,Chest high resolution computerized tomography(HRCT)revealed mosaic perfusion in 29 cases(93.5%),bronchial wall thickening in 13cases(41.9%),bronchiectasia in 5 cases(16.1%),atelectasis in 3 cases(9.7%),bronchial stenosis in 2 cases(6.5%),hyperinflation in 2 cases(6.5%),nodular high density in 1 case(3.2%)and bullae in 1 case(3.2%).Cytological classification of bronchoalveolar lavage fluid(BALF)showed percentage of neutrophil increased in 20 cases.Percentage of CD3+T cells increased in 6 cases,decreased in 1 case and was normal in 1case.Percentage of CD4+T cells decreased,percentage of CD8+T cells increased and CD4/CD8 ratio decreased in 8 cases.Azithromycin and budesonide nebulization treatment in 23 cases and montelukast treatment in 21 cases and systemic corticosteroid treatment in 8cases.The median follow-up time was 20.8 months(3.7-94.5 months)in 25cases(80.6%)and clinical presentation were obviously improved in 11 cases(35.5%),partially improved in 6 cases(19.4%),not improved in 8 cases(25.8%).Conclusion: PIBO was common and severe pneumonia appear to have higher risk of development of BO in children.Persistent cough and wheezing were the main manifestations and the characteristic HRCT finding was mosaic perfusion.Received azithromycin,inhalation corticosteroid and/or systemic corticosteroid and montelukast treatment,the condition was partially improved in children with BO.The prognoses of BO caused by different etiologies maybe different and PIBO seemed to be relatively good.Airway neutrophils and CD8+T cell may be involved in the pathogenesis.