Allergy Asthma Respir Dis.  2022 Apr;10(2):89-96. 10.4168/aard.2022.10.2.89.

Clinical characteristics of bronchiolitis obliterans without preceding severe lower respiratory tract infection

• Hyun JH
• Jeong JE
• Kim YH
• Jang YY
• Chung HL

• KMID: 2529491
• DOI: http://doi.org/10.4168/aard.2022.10.2.89

Abstract

Purpose
We investigated young children who developed bronchiolitis obliterans (BO) without preceding severe lower respiratory tract infection (LRTI).
Methods
Twenty patients referred for chronic respiratory symptoms and diagnosed with BO were enrolled and divided into 2 age groups: group 1 ( < 2 years, n = 12) and group 2 ( ≥ 2, < 6 years, n = 8). A diagnosis of BO was made based on clinical and radiologic findings: (1) persistent cough or abnormal breath sounds which were not responsive to any treatment for more than 6 weeks; and (2) mosaic perfusion on high-resolution computed tomography. None of the subjects had experienced LRTI since birth, and those who had any underlying problems were excluded. The clinical characteristics and disease course were examined retrospectively.
Results
Mean age of the patients was 6.8 months and 3.4 years in group 1 and 2, respectively. All patients presented with chronic cough and the most common type of cough was mixed (wet and dry), 67% in group 1 and 50% in group 2. Persistent stridor was the major respiratory sign in group 1 (67%), but 63% of group 2 patients showed no abnormal breath sounds. Chest x-ray finding was nonspecific in 75% each of both groups. The respiratory symptoms and signs resolved rapidly in most patients treated with pulse corticosteroid therapy. Bronchial hyperresponsiveness and decreased forced expiratory volume in 1 second were observed in 3 of group 2 children at age 6, during the follow-up.
Conclusion
Our study shows that BO could develop without preceding severe LRTI. It also suggests that BO should be considered in the infants with persistent stridor accompanied by chronic cough.

Keyword

Bronchiolitis obliterans; Preschool child; Infant