Diagnosis and Treatment of Postinfection Bronchiliotis Obliterans_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHU Haiyan , HAO Chuangli

Department of Respiratory Mediciney, Children′s Hospital Affiliated to Soochow University. Suzhou, Jiangsu,215003, ChinaCorresponding Author: HAO Chuang-li, E-mail: hcl_md@ 163. com;

Corresponding author：

Keywords：

Bronchiolitis obliterans; Clinical features; Children

DOI：

DOI: 10 . 7507 /1671 -6205 . 20130121

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Objective To summarize the clinical features, diagnosis and treatment of postinfection bronchiolitis obliterans.
Methods Clinical manifestation, chest X-ray, characteristics of lung function,computed tomography ( CT) of 6 patients with postinfection bronchiolitis obliterans from August 2009 to June
2012 were analyzed retrospectively.
Results All 6 cases were diagnosed as bronchiolitis obliterans after pneumonia. One patient had severe pneumonia complicated with congenital atrial septal defect and heart failure. 3 cases were complicated with varying degrees of cardiac insufficiency. Adenovirus in sputumsample were found in2 cases, smear positive for parainfluenza virus was found in1 case, mycoplasma were found in 2 cases, and no specific pathogen was found in the last one. All 6 cases were suffered frompersistent cough,wheezing and shortness of breath with three depression sign in 4 cases. The symptoms lasted for at least 6 weeks. Crackles and wheezing were present in all 6 cases. Small airway lesion was presented by pulmonary CT. Bronchiectasis was showed in 2 cases, atelectasis in 1 case, and consolidation in 1 case. Pulmonary function tests showed mixed ventilatory dysfunction. Bronchofiberscope examination was operated in5 cases,
only endotracheitis was found. Prednisone and azithromycin were given orally in all the cases, but the clinical symptoms were persistent in the course of treatment and no death occured. Conclusions Clinical symptoms of bronchiolitis obliterans are characterized by persistent cough and wheezing. Small airway lesions were present in pulmonary CT. Repeated lower respiratory infection is common. Prednisone is widely used in treatment of bronchiolitis obliterans, but the therapeutic effect is uncertain.

Citation： ZHU Haiyan,HAO Chuangli. Diagnosis and Treatment of Postinfection Bronchiliotis Obliterans. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(5): 505-508. doi: DOI: 10 . 7507 /1671 -6205 . 20130121 Copy

1.	刘秀云, 江载芳, 申昆玲, 等. 闭塞性毛细支气管炎临床分析.中华儿科杂志, 2003, 41: 839-841.
2.	Zhang L, Irion K, Kozakewich H, et al. Clinical course of postinfectious bronchiolitis obliterans. Pediatr Puhnonol, 2000, 29 :341 -350.
3.	Kurland G, Michelson P. Bronchiolitis obliterans in children.Pediatr Pulmonol, 2005, 39 : 193 -208.
4.	Moonnumakal SP, Fan LL. Bronchiolitis obliterans in children.Curr Opin Pediat, 2008 , 20: 272-278 .
5.	Kiln CK, Kim SW, Kim JS, et al. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest, 2001, 120 : 1101 -1106.
6.	Hardy KA, Schidlow DV, Zaeri N, et al. Obliterative bronchiolitis in children. Chest, 1988, 93: 460 -466.
7.	王维, 申昆玲, 曾津津. 儿童闭塞性细支气管炎42 例临床分析. 中华儿科杂志, 2008, 46: 732 -738.
8.	Yalcin E, Dogru D, Haliloglu M, et al. Postinfectious bronchiolitis obliterans in children: clinical and radiological profile and prognostic factors. Respiration, 2003 , 70: 371-375.
9.	Zhang L, Silva FA. Bronchiolitis obliterans in children. Pediatr ( Rio J) , 2000, 76: 185 -192.
10.	刘秀云, 江载芳. 腺病毒肺炎后遗症的再认识. 临床儿科杂志, 2009, 27: 91-93.
11.	Colom AJ, Teper AM, Vollmer WM , et al. Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis. Thorax, 2006, 61: 503 -506.
12.	Jensen SP, lynch DA, Brown KK, et al. High-resolution CT features of severe asthma and bronchiolitis obliterans. Clin Radiol, 2002 ,57: 1078-1085.
13.	刘秀云, 江载芳, 彭云. 闭塞性细支气管炎23 例临床分析. 中国实用儿科杂志, 2008, 23: 263-265.
14.	赵顺英. 闭塞性细支气管炎的诊治. 中国实用儿科杂志, 2006 ,21: 241-243 .
15.	Kurland G, Michelson P. Bronchiolitis Obliterans in Children.Pediatric Pulmonology, 2005 , 39: 193 -208.
16.	王全, 赵德育. 闭塞性细支气管炎5 例临床分析. 临床儿科杂志, 2012, 30: 124 -127.
17.	Verleden GM, Dupont LJ. Azithromydn therapy for patients with bronchiolitis obliterans syndrome after lung transplantation.Transplantation, 2004 , 77: 1465-1467.

1. 刘秀云, 江载芳, 申昆玲, 等. 闭塞性毛细支气管炎临床分析.中华儿科杂志, 2003, 41: 839-841.
2. Zhang L, Irion K, Kozakewich H, et al. Clinical course of postinfectious bronchiolitis obliterans. Pediatr Puhnonol, 2000, 29 :341 -350.
3. Kurland G, Michelson P. Bronchiolitis obliterans in children.Pediatr Pulmonol, 2005, 39 : 193 -208.
4. Moonnumakal SP, Fan LL. Bronchiolitis obliterans in children.Curr Opin Pediat, 2008 , 20: 272-278 .
5. Kiln CK, Kim SW, Kim JS, et al. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest, 2001, 120 : 1101 -1106.
6. Hardy KA, Schidlow DV, Zaeri N, et al. Obliterative bronchiolitis in children. Chest, 1988, 93: 460 -466.
7. 王维, 申昆玲, 曾津津. 儿童闭塞性细支气管炎42 例临床分析. 中华儿科杂志, 2008, 46: 732 -738.
8. Yalcin E, Dogru D, Haliloglu M, et al. Postinfectious bronchiolitis obliterans in children: clinical and radiological profile and prognostic factors. Respiration, 2003 , 70: 371-375.
9. Zhang L, Silva FA. Bronchiolitis obliterans in children. Pediatr ( Rio J) , 2000, 76: 185 -192.
10. 刘秀云, 江载芳. 腺病毒肺炎后遗症的再认识. 临床儿科杂志, 2009, 27: 91-93.
11. Colom AJ, Teper AM, Vollmer WM , et al. Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis. Thorax, 2006, 61: 503 -506.
12. Jensen SP, lynch DA, Brown KK, et al. High-resolution CT features of severe asthma and bronchiolitis obliterans. Clin Radiol, 2002 ,57: 1078-1085.
13. 刘秀云, 江载芳, 彭云. 闭塞性细支气管炎23 例临床分析. 中国实用儿科杂志, 2008, 23: 263-265.
14. 赵顺英. 闭塞性细支气管炎的诊治. 中国实用儿科杂志, 2006 ,21: 241-243 .
15. Kurland G, Michelson P. Bronchiolitis Obliterans in Children.Pediatric Pulmonology, 2005 , 39: 193 -208.
16. 王全, 赵德育. 闭塞性细支气管炎5 例临床分析. 临床儿科杂志, 2012, 30: 124 -127.
17. Verleden GM, Dupont LJ. Azithromydn therapy for patients with bronchiolitis obliterans syndrome after lung transplantation.Transplantation, 2004 , 77: 1465-1467.

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