Bronchiolitis obliterans in children: Clinical presentation, therapy and long-term follow-up

Aim: To delineate the predisposing factors, clinical, radiological features and outcomes of bronchiolitis obliterans (BO) in children for minimising morbidity and mortality. Methods: Ten children who had BO from July 1995 to July 2005 were retrospectively reviewed at a tertiary paediatric facility in northern Taiwan. Results: Bronchiolitis obliterans complicated by infections, Stevens-Johnson syndrome was found in eight and two patients, respectively. In children with post-infectious BO, adenoviruses were the most common etiologic agents (7/8). Among them, six patients needed intensive management and five patients needed mechanical ventilation. All patients presented persistent dyspneic respirations and wheezing since the initial lung infection. Initial focal atelectasis (n = 3) on chest radiographs progressed to atelectasis/lobar collapse (n = 8) when the diagnosis of BO was made. After adequate supportive management, atelectatic bronchiectasis was the most common complication (n = 5). Conclusion: Severe adenovirus bronchiolitis and/or pneumonia appear to have higher risk of development of BO in children. In order to minimise associated complications of BO, meticulous respiratory care for preventing pulmonary collapse may be considered in such instances.