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Original Article

Clinical course of children with postinfectious bronchiolitis obliterans with versus without comorbid bronchopulmonary dysplasia

Lamia Medghoul¹, Julien Grosjean², Christophe Marguet³, Hortense Petat³ 

¹Department of Medical Pediatrics, Centre Hospitalier Universitaire de Rouen, EA2656 université de Normandie, UNIRouen, F-7600 Rouen, France, ROUEN, France
²Departement of Digital Health, Centre Hospitalier Universitaire de Rouen & LIMICS UMR 1142, Sorbonne Université & Sorbonne Paris Nord, France, ROUEN, France
³Univ Rouen Normandie, Dynamicure INSERM UMR 1311, CHU Rouen, Department of pediatrics and adolescent medicine F-76000 Rouen, France., Rouen, France

Correspondence Hortense Petat ,Email: hortense.petat1@univ-rouen.fr

Received: January 17, 2025; Revised: March 5, 2025   Accepted: March 11, 2025.

Abstract

Background
Post-infectious bronchiolitis obliterans (PIBO) is a rare chronic obstructive pulmonary disease that occurs after a respiratory infection. Its diagnosis is generally based on clinical history, respiratory symptoms, and computed tomography (CT) findings.
Purpose
Here we evaluated the frequency of exacerbations, clinical progress, and inhaled corticosteroid (ICS) usage in children diagnosed with PIBO with or without comorbid bronchopulmonary dysplasia (BPD).
Methods
This retrospective observational study was conducted in Rouen, France. The inclusion criteria were as follows: child diagnosed with PIBO (history of respiratory infection, airway obstruction with no or poor response to bronchodilation treatment, and/or mosaic pattern or trapping on chest high-resolution CT (HRCT) in 2009–2024 treated with intravenous corticosteroid pulses.
Results
Fifty-seven patients were included: 13 (23%) with BPD and 44 (77%) without BPD. The mean age at diagnosis was 7 ± 3.6 months, with no significant intergroup difference. We observed a significant reduction in exacerbations following corticosteroid pulse treatment as soon as 6 months (p<0.001), with persistent effects observed up to 24 months (p=0.02). We also noted a reduced daily ICS dose starting at 12 months (p=0.03). Respiratory syncytial virus is the most commonly identified causative virus, followed by rhinoviruses and adenoviruses. The viral co-detection rates were 18% and 61% in the BPD and non-BPD groups, respectively.
Conclusion
In our cohort, intravenous corticosteroid pulse treatment effectively treated PIBO, with a rapid and long-lasting reduction in exacerbations and ICS requirements. BPD was a significant comorbidity of PIBO.

Keywords :Postinfectious bronchiolitis obliterans, Respiratory viruses, Children, Respiratory outcome, Bronchopulmonary dysplasia