Post-infectious bronchiolitis obliterans in children
https://doi.org/10.22627/2072-8107-2025-24-4-54-60
Abstract
Post-infectious bronchiolitis obliterans (PIBO) is a chronic obstructive lung disease that develops in children following lower respiratory tract infections (LRTI). The pathogenesis is based on impaired reparative processes in the bronchiolar epithelium, productive-sclerotic inflammation, and the formation of peribronchiolar fibrosis, accompanied by chronic neutrophilic-lymphocytic inflammation and cytokine imbalance. The clinical presentation of PIBO is characterized by chronic cough, expiratory dyspnea, hypoxemia, and prolonged bronchial obstruction. The diagnosis is established based on a history of severe LRTI, persistent clinical signs of airway obstruction, and characteristic findings on chest computed tomography, including mosaic attenuation and air-trapping phenomena. Despite the use of various pharmacological strategies, including systemic and inhaled corticosteroids, macrolides, and leukotriene receptor antagonists, a standardized therapy protocol for PIBO has not yet been established. The disease course is variable: most patients demonstrate a reduction in respiratory symptoms and improvement in functional parameters with age, whereas others may experience slow disease progression. Computed tomography features of small airway involvement may persist or vary over time.
About the Authors
E. V. Boytsova
Saint Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Saint Petersburg
D. Yu. Ovsyannikov
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Moscow
E. V. Ermolaeva
Children's Clinical Hospital
Russian Federation
Russian Federation
Saint Petersburg
Sh. A. Gitinov
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Moscow
O. G. Malyshev
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Moscow
References
1. Jerkic S.-P., Brinkmann F., Calder A., Casey A., Dishop M., Griese M., Kurland G., Niemitz M., Nyilas S., Schramm D., Schubert R., Tamm M., Zielen S., Rosewich M. Postinfectious bronchiolitis obliterans in children: diagnostic workup and therapeutic options: a workshop report. Can Respir J. 2020:5852827. doi: 10.1155/2020/5852827.
2. Lange W. Ueber eine eigenthumliche Erkrankung der kleinen Bronchien und ronhilen (Bronchitis und Bronchiolitis obliterans). Dtsch. Arch. Klin. Med. 1901; 70:324—364.
3. Skvortsov M.A. Pathological anatomy of the most important diseases of childhood. Moscow: Medgiz; 1946:89—121.
4. de Deus Vieira G., Yamagishi A.Y., Vieira N.N., Dias Fogaca R.M.M., da Cunha Alves T., Amaral G.M.B., Macie C. Complication of post-infectious bronchiolitis obliterans (Swyer-James syndrome). Rev Assoc Med Bras. 2015; 61(5):404—406. doi: 10.1590/1806-9282.61.05.404.
5. Tortajada M., Gracia M., García E., Hernández R. Diagnostic considerations in unilateral hyperlucency of the lung (Swyer-James-MacLeod syndrome). Allergol Immunopathol (Madr). 2004; 32(5):265—270. doi: 10.1016/s0301-0546(04)79253-8.
6. Petryaykina E.S., Boitsova E.V., Ovsyannikov D.Yu., Gitinov Sh.A., Petryaykina E.E. Modern concepts of obliterative bronchiolitis in children. Pediatriya Im G.N. Speranskogo. 2020; 99(2):255—262. (In Russ.) doi:10.24110/0031-403x-2020-99-2-255-262.
7. Colom A.J., Teper A.M. Post-infectious bronchiolitis obliterans. Pediatr Pulmonol. 2019; 54(2):212—219. doi: 10.1002/ppul.24221.
8. Yazan H., Khalif F., Shadfaan L.A., Bilgin S., Nursoy M., Cakir F.B., Cakin Z.E., Uzuner S., Cakir E. Post-infectious bronchiolitis obliterans in children: clinical and radiological evaluation and long-term results. Heart Lung. 2021; 50:660—666. doi: 10.1016/j.hrtlng.2021.05.001.
9. Lee E., Lee Y.Y. Risk factors for the development of post-infectious bronchiolitis obliterans after Mycoplasma pneumoniae pneumonia in the era of increasing macrolide resistance. Respir Med. 2020; 175:106209. doi: 10.1016/j.rmed.2020.106209.
10. Huang F., Ma Y.C., Wang F., Li Y.N. Clinical analysis of adenovirus postinfectious bronchiolitis obliterans and nonadenovirus postinfectious bronchiolitis obliterans in children. Lung India. 2021; 38(2):117—121. doi: 10.4103/lungindia.lungindia_374_20.
11. Ovsyannikov D.Yu., Gitinov Sh.A., Tswerava A.G., Ayrapetyan M.I., et al. Obliterative bronchiolitis in children: epidemiology, etiological structure, clinical and CT semiotics, functional features, and therapy. Pediatriya Im G.N. Speranskogo. 2025; 104(2):15—23. (In Russ.)
12. Rosewich M., Zissler U.M., Kheiri T., Voss S., Eickmeier O., Schulze J., Herrmann E., Dücker R.P., Schubert R., Zielen S. Airway inflammation in children and adolescents with bronchiolitis obliterans. Cytokine. 2015; 73(1):156— 162. doi: 10.1016/j.cyto.2014.10.026.
13. Kurland G., Michelson P. Bronchiolitis obliterans in children. Pediatr Pulmonol. 2005; 39:193—208. doi: 10.1002/ppul.20145.
14. Chernyaev A.L., Samsonova M.V. Pathological anatomy of bronchiolitis. In: Belevsky A.S., editor. Bronchiolitis: Monograph. Moscow: Atmosfera; 2023:16—23. (In Russ.)
15. Avdeev S.N. Bronchiolitis in adults. In: Chuchalin A.G., editor. Respiratory Medicine: A Guide in 4 Volumes. 3rd ed., rev. and enl. Moscow: PulmoMedia; 2024; 2:265—274. doi:10.18093/978-5-6048754-6-9-2024-2-265-274. (In Russ.)
16. Mauad T., Dolhnikoff M., Paulo S. Histology of childhood bronchiolitis obliterans. Pediatr Pulmonol. 2002; 33(6):466—474. doi:10.1002/ppul.10097.
17. Spichak T.V. Postinfectious obliterative bronchiolitis. Moscow: Nauchny Mir; 2005:80. (In Russ.)
18. Li Y., Liu L., Qiao H., Cheng H., Cheng H. Post-infectious bronchiolitis obliterans in children: a review of 42 cases. BMC Pediatr. 2014; 14:238. doi: 10.1186/1471-2431-14-238.
19. Bandeira T., Negreiro F., Ferreira R., Salgueiro M., Lobo L., Aguiar P., Trindade J.C. Clinical, radiological, and physiological differences between obliterative bronchiolitis and problematic severe asthma in adolescents and young adults: the early origins of the overlap syndrome? Pediatr Pulmonol. 2011; 46:573—580. doi: 10.1002/ppul.21405.
20. Yoon H.M., Lee J.S., Hwang J.-Y., Cho Y.A., Yoon H.-K., Yu J., Hoong S.-J., Yoon C.H. Post-infectious bronchiolitis obliterans in children: CT features that predict responsiveness to pulse methylprednisolone. Br J Radiol. 2015; 88(1049):20140478. doi:10.1259/bjr.20140478.
21. Martinez-Jimenez S., Rosado-de-Christenson M.L., Carter B.W. Radiologic Diagnosis: HRCT of the Lungs. Transl. from English. Moscow: Panfilov Publishing; 2022:124—129. (In Russ.)
22. Castro-Rodriguez J.A., Giubergia V., Fischer G.B., Castaños C., Sarria E.E., Gonzalez R., Mattiello R., Vega-Briceño L.E., Murtagh P. Postinfectious bronchiolitis obliterans in children: the South American contribution. Acta Paediatr. 2014; 103(9):913—921. doi: 10.1111/apa.12689.
23. Marshall H., Horsley A., Taylor C.J., Smith L., et al. Detection of early subclinical lung disease in children with cystic fibrosis by lung ventilation imaging with hyperpolarised gas MRI. Thorax. 2017; 72(8):760—762. doi: 10.1136/thoraxjnl-2016-208948/
24. Renne J., Lauermann P., Hinrichs J.B., Schönfeld C., et al. Chronic lung allograft dysfunction: oxygen-enhanced T1-mapping MR imaging of the lung. Radiology. 2015; 276(1):266—273. doi: 10.1148/radiol.15141486.
25. Voskrebenzev A., Greer M., Gutberlet M., Schönfeld C. et al. Detection of chronic lung allograft dysfunction using ventilation-weighted Fourier decomposition MRI. Am J Transplant. 2018; 18(8):2050—2060. doi: 10.1111/ajt.14759.
26. Tatochenko V.K. Respiratory diseases in children: A guide for physicians. 8th ed., rev. Moscow: StatusPraesens; 2025:237—240. (In Russ.) 27. Mustafina M.Kh., Chernyak A.V. Inert gas washout methods: their significance in the diagnosis of respiratory diseases. Prakticheskaya Pulmonologiya. 2014; (1):39—44. (In Russ.)
27. Nyilas S., Carlens J., Price T., Singer F., Müller C., Hansen G., Warnecke G., Latzin P., Schwerk N. Multiple breath washout in pediatric patients after lung transplantation. Am J Transplant. 2018; 18(1):145—153. doi: 10.1111/ajt.14432.
28. Kim Y.H., Shin H.J., Sol I.S., Kim S.Y., Kim J.D., Yoon H., Kim K.W., Kim M.J., Lee M.J., Hyun M.S. Lung clearance index and quantitative computed tomography of post-infectious bronchiolitis obliterans in infants. Sci Rep. 2017; 7(1):15128. doi: 10.1038/s41598-017-15330-8.
29. Evans D.J., Schultz A., Verheggen M., Hall G.L., Simpson S.J. Identifying pediatric lung disease: a comparison of forced oscillation technique outcomes. Pediatr Pulmonol. 2019; 54(6):751—758. doi: 10.1002/ppul.24286.
30. Yu J. Postinfectious bronchiolitis obliterans in children: lessons from bronchiolitis obliterans after lung transplantation and hematopoietic stem cell transplantation. Korean J Pediatr. 2015; 58(12):459—465. doi: 10.3345/kjp.2015.58.12.459.
31. Colom A.J., Teper A.M. Clinical prediction rule to diagnose postinfectious bronchiolitis obliterans in children. Pediatr Pulmonol. 2009; 44:1065— 1069. doi: 10.1002/ppul.21080.
32. Potapova N.L., Markovskaya A.I. Analysis of anti-inflammatory therapy options for obliterative bronchiolitis in children. Doktor.Ru. 2023; 22(3):40— 44. doi:10.31550/1727-2378-2023-22-3-40-44. (In Russ.)
33. Moonnumakal S.P., Fan L.L. Bronchiolitis obliterans in children. Curr Opin Pediatr. 2008; 20(3):272—278. doi: 10.1097/MOP.0b013e3282ff62e9.
34. Tomikawa S.O., Adde F.V., da Silva Filho L.V.R., Leone C., Rodrigues J.C. Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy. Orphanet J Rare Dis. 2014; 9(1):128. doi: 10.1186/s13023-014-0128-2.
35. Avdeev S.N. Role of macrolides in the treatment of chronic inflammatory diseases of the lower respiratory tract. Lechebnoe Delo. 2011; 1:90—101. (In Russ.)
36. Gao Y.H., Guan W.J., Xu G. et al. Macrolide therapy in adults and children with non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis. PLoS One. 2014; 9(3):e90047. doi: 10.1371/ journal.pone.0090047.
37. Yadav H., Peters S.G., Keogh K.A., et al. Azithromycin for the treatment of obliterative bronchiolitis after hematopoietic stem cell transplantation: a systematic review and meta-analysis. Biol Blood Marrow Transplant. 2016; 22(12):2264—2269.
38. Verleden G.M., Verleden S.E., Vos R., De Vleeschauwer S.I., Dupont J.L., Van Raemdonck D., Vanaudenaerde B.M. Montelukast for bronchiolitis obliterans syndrome after lung transplantation: a pilot study. Transpl Int. 2011; 24(7):651—656.
39. Ruttens D., Verleden S.E., Demeyer H., Van Raemdonck D.E., Yserbyt J., Dupont L.J., Vanaudenaerde B.M., Vos R., Verleden G.M. Montelukast for bronchiolitis obliterans syndrome after lung transplantation: a randomized controlled trial. PLoS One. 2018; 13(4):e0193564.
40. Norman B.C., Jacobsohn D.A., Williams K.M., Au B.K.C., Au M.A., Lee S.J., Moravec C.K., Chien J.W. Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients. Bone Marrow Transplant. 2011; 46(10):1369—1373. doi: 10.1038/bmt.2010.311.
41. Weng T., Lin X., Wang L., Lv J., Dong L. Follow-up on the therapeutic effects of a budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in children with post-infectious bronchiolitis obliterans. J Thorac Dis. 2021; 13(8):4775—4784. doi:10.21037/jtd-20-3195.
42. Askari M., Faryabi R., Mozaffari H., Mofrad M.D. The effects of N-acetylcysteine on serum level of inflammatory biomarkers in adults: findings from a systematic review and meta-analysis of randomized clinical trials. Cytokine. 2020; 135:155239. doi:10.1016/j.cyto.2020.155239. 44. Teixeira M.F.C., Rodrigues J.C., Leone C., Adde F.V. Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children. Chest. 2013; 144(3):974—980. doi: 10.1378/chest.12-2280.
43. Zhang X.-M., Lu A.-Z., Yang H.W., Qian L.L., Wang L.-B., Zhang X.B. Clinical features of postinfectious bronchiolitis obliterans in children undergoing long term nebulization treatment. World J Pediatr. 2018; 14(5):441—448. doi:10.1007/s12519-018-0193-z.
44. Zheng H., Yu X., Chen Y., Lin W., Liu L. Effects of inhaled corticosteroids on lung function in children with post-infectious bronchiolitis obliterans in remission. Front Pediatr. 2022; 10:827508. doi:10.3389/fped.2022.827508.
45. Zang L., Irion K., Kozakewich H., Reid L., Camargo J., Silva Porto N. da, Abreu e Silva F. Clinical course of postinfectious bronchiolitis obliterans. Pediatr Pulmonol. 2000; 29(5):341—350. doi: 10.1002/(sici)1099-0496(200005)29:5<341
46. Spichak T.V., Lukina O.F., Markov B.A., Ivanov A.P. Postinfectious obliterative bronchiolitis at different ages. Pulmonologiya. 2002; (4):25—29. (In Russ.)
47. Colom A.J., Maffey A., García Bournissen F., Teper A. Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans: a long-term follow-up. Thorax. 2015; 70:169—174. doi: 10.1136/thoraxjnl-2014-205328.
48. Mosquera R.A., Hashmi S.S., Pacheco S.E., Reverdin A., Chevallier J., Colasurdo G.N. Dysanaptic growth of lung and airway in children with post-infectious bronchiolitis obliterans. Clin Respir J. 2014; 8:63—71. doi: 10.1111/crj.12037.
Review
For citations:
Boytsova E.V., Ovsyannikov D.Yu., Ermolaeva E.V., Gitinov Sh.A., Malyshev O.G. Post-infectious bronchiolitis obliterans in children. CHILDREN INFECTIONS. 2025;24(4):54-60. (In Russ.) https://doi.org/10.22627/2072-8107-2025-24-4-54-60
Views:
23
Email this article 