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Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up.
Thorax 2015; 70(2):169-74T

Abstract

BACKGROUND

Postinfectious bronchiolitis obliterans (BO) is a chronic respiratory disease that usually follows a severe adenovirus infection.

OBJECTIVE

To determine the evolution of pulmonary function and clinical outcome of children with postinfectious BO during childhood.

METHODS

The study included patients diagnosed with postinfectious BO in whom at least two spirometries were performed within a minimum interval of 3 months.

RESULTS

46 met the inclusion criteria. The mean (±SD) follow-up period was 12.5 (±3.5) years. 197 spirometries and 41 plethysmographies were performed. Initial (9±3 years old) lung function was as follows (z score, mean±SD): forced vital capacity (FVC) -3.8±1; forced expiratory volume in 1 s (FEV1) -4.4±1; FEV1/FVC -2.2±1; forced expiratory flow (FEF)(25-75) -3.7±1; total lung capacity (TLC) 120±26%; residual volume (RV) 309±108%; and RV/TLC 55±13. During childhood, FVC and FEV1 increased by a mean of 11%/year (95% CI 9.3% to 12.6%; p<0.0001) and 9%/year (95% CI 7.7% to 10.2%; p<0.0001), and the FEV1/FVC ratio decreased by 1.9%/year (95% CI 1% to 2.8; p<0.001). The z score for FVC, FEV1 and FEV1/FVC decreased by 0.07 z score/year (95% CI 0.1 to 0.01; p<0.05), 0.09 z score/year (95% CI 0.1 to 0.05; p<0.01) and 0.04 z score/year (95% CI 0.09 to 0.001; p<0.02), respectively. During the follow-up period, 69% of patients required at least one hospital readmission and five required mechanical ventilation. Nine patients developed a thoracic deformity, and seven whose bronchiectasis did not respond to clinical treatment underwent a lobectomy.

CONCLUSIONS

After a 12 year follow-up period, pulmonary function remained severely impaired, showing an obstructive pattern with air trapping that slowly improved during childhood. An unequal growth of lung parenchyma over the airways suggests dysinaptic growth. Patients required frequent readmission due to recurrent respiratory infections, and hypoxaemia improved slowly over time.

Authors+Show Affiliations

Respiratory Centre, R Gutierrez Children's Hospital, Buenos Aires, Argentina.Respiratory Centre, R Gutierrez Children's Hospital, Buenos Aires, Argentina.Parasitology and Chagas Service, R Gutierrez Children's Hospital, Buenos Aires, Argentina.Respiratory Centre, R Gutierrez Children's Hospital, Buenos Aires, Argentina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25388479

Citation

Colom, Alejandro J., et al. "Pulmonary Function of a Paediatric Cohort of Patients With Postinfectious Bronchiolitis Obliterans. a Long Term Follow-up." Thorax, vol. 70, no. 2, 2015, pp. 169-74.
Colom AJ, Maffey A, Garcia Bournissen F, et al. Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. Thorax. 2015;70(2):169-74.
Colom, A. J., Maffey, A., Garcia Bournissen, F., & Teper, A. (2015). Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. Thorax, 70(2), pp. 169-74. doi:10.1136/thoraxjnl-2014-205328.
Colom AJ, et al. Pulmonary Function of a Paediatric Cohort of Patients With Postinfectious Bronchiolitis Obliterans. a Long Term Follow-up. Thorax. 2015;70(2):169-74. PubMed PMID: 25388479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. AU - Colom,Alejandro J, AU - Maffey,Alberto, AU - Garcia Bournissen,Facundo, AU - Teper,Alejandro, Y1 - 2014/11/11/ PY - 2014/11/13/entrez PY - 2014/11/13/pubmed PY - 2015/5/13/medline KW - Paediatric Lung Disaese SP - 169 EP - 74 JF - Thorax JO - Thorax VL - 70 IS - 2 N2 - BACKGROUND: Postinfectious bronchiolitis obliterans (BO) is a chronic respiratory disease that usually follows a severe adenovirus infection. OBJECTIVE: To determine the evolution of pulmonary function and clinical outcome of children with postinfectious BO during childhood. METHODS: The study included patients diagnosed with postinfectious BO in whom at least two spirometries were performed within a minimum interval of 3 months. RESULTS: 46 met the inclusion criteria. The mean (±SD) follow-up period was 12.5 (±3.5) years. 197 spirometries and 41 plethysmographies were performed. Initial (9±3 years old) lung function was as follows (z score, mean±SD): forced vital capacity (FVC) -3.8±1; forced expiratory volume in 1 s (FEV1) -4.4±1; FEV1/FVC -2.2±1; forced expiratory flow (FEF)(25-75) -3.7±1; total lung capacity (TLC) 120±26%; residual volume (RV) 309±108%; and RV/TLC 55±13. During childhood, FVC and FEV1 increased by a mean of 11%/year (95% CI 9.3% to 12.6%; p<0.0001) and 9%/year (95% CI 7.7% to 10.2%; p<0.0001), and the FEV1/FVC ratio decreased by 1.9%/year (95% CI 1% to 2.8; p<0.001). The z score for FVC, FEV1 and FEV1/FVC decreased by 0.07 z score/year (95% CI 0.1 to 0.01; p<0.05), 0.09 z score/year (95% CI 0.1 to 0.05; p<0.01) and 0.04 z score/year (95% CI 0.09 to 0.001; p<0.02), respectively. During the follow-up period, 69% of patients required at least one hospital readmission and five required mechanical ventilation. Nine patients developed a thoracic deformity, and seven whose bronchiectasis did not respond to clinical treatment underwent a lobectomy. CONCLUSIONS: After a 12 year follow-up period, pulmonary function remained severely impaired, showing an obstructive pattern with air trapping that slowly improved during childhood. An unequal growth of lung parenchyma over the airways suggests dysinaptic growth. Patients required frequent readmission due to recurrent respiratory infections, and hypoxaemia improved slowly over time. SN - 1468-3296 UR - https://www.unboundmedicine.com/medline/citation/25388479/Pulmonary_function_of_a_paediatric_cohort_of_patients_with_postinfectious_bronchiolitis_obliterans__A_long_term_follow_up_ L2 - http://thorax.bmj.com/cgi/pmidlookup?view=long&amp;pmid=25388479 DB - PRIME DP - Unbound Medicine ER -