Abstract
BackgroundBronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. Here we report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy.MethodsForty patients fulfilling the BO diagnosis criteria were treated with methylprednisolone pulse therapy in monthly cycles until clinical improvement. After the pulse therapy began, we analyzed the clinical and laboratory data at intervals. Statistical analyses were performed using non-parametric tests to compare repeated measures (Friedman, Wilcoxon) or paired nominal data (McNemar) (α = 5%).ResultsThe frequency of wheezing exacerbations and hospitalizations was reduced (p = 0.0042 and p < 0.0001, respectively) and oxygen saturation improved (p = 0.0002) in the pulse therapy-treated patients. Prolonged oral corticosteroid therapy was discontinued in 83% of these patients. The mean Z-score length for age improved from -1.08 to -0.63, and the mean Z-score weight for age improved from -0.91 to -0.59. The adverse effects during the infusion were temporary and none were serious.ConclusionsOur data suggest that pulse corticotherapy could be a safe alternative to prolonged systemic oral corticotherapy in children with BO, thus minimizing the adverse effects of the oral therapy. New prospective controlled studies are required to confirm this proposition.
Highlights
Bronchiolitis obliterans (BO) is a rare but severe disease in children
Bronchiolitis obliterans (BO) is a rare form of chronic obstructive lung disease that follows an infection-induced injury to the lower respiratory tract
The aim of the present study was to review the clinical, laboratory and radiological data collected before and after treatment from patients with bronchiolitis obliterans who were treated with methylprednisolone pulse therapy
Summary
Bronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. We report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy. Bronchiolitis obliterans (BO) is a rare form of chronic obstructive lung disease that follows an infection-induced injury to the lower respiratory tract. This condition results in partial or complete obliteration of the small airways [1,2,3]. Corticosteroid therapy seeks to modify the fibroblastic response in the early phase of illness. This approach is based on a study conducted in 1958 in which steroids were administered to rabbits to prevent development of BO [9]. Others studies have reported variable efficacy of corticosteroid therapy in patients with BO [1,5,10]
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