Clinical And Radiological Evaluation Of Patients With Postinfectious Bronchiolitis Obliterans

Introduction Postinfectious bronchiolitis obliterans is characterized by persistent symptoms and signs of obstructive pulmonary disease following acute bronchial injury. It usually occurs with persistent wheezing and cough as a result of severe viral infections. The aim of this study was to investigate the socio-demographic characteristics, treatment status, and clinical response of our cases of postinfectious bronchiolitis obliterans. Methods The records of 102 patients with postinfectious bronchiolitis obliterans who were followed-up in our clinic were retrospectively reviewed. Sociodemographic characteristics, treatments, pre-treatment and post-treatment complaints, pulmonary function tests, clinical status, radiological changes were evaluated. Results 68.6% (n = 70) of our patients were male. The mean age of the patients at the time of the study was 88.8 ± 53.5 months, and the age of diagnosis was 34.3 ± 36.4 months. The mean period from the first complaints to the date of diagnosis was 22.8 ± 33.8 months. 59% (57) of the patients had a history of smoking in one of their parents. In 62.7% of the cases, the first lower respiratory tract infection was bronchopneumonia and 36.3% was in the acute bronchiolitis. Before the diagnosis, 35 patients had intensive care hospitalization (34.3%). Persistent cough (90.2%), wheezing (96.1%), shortness of breath (91.2%) and purulant cough (75%) were the most frequent findings. When treatments of the patients were evaluated; inhaled corticosteroids were 92.2%, 6 months azithromycin 69.6%, 6 months oral steroid 61.8%. 11 patients (10.8%) needed oxygen and 10 patients (9.8%) required Bilevel Positive Airway Pressure (BPAP) support. Before and after treatment of 49 patients, lung CTs were evaluated by radiologist and modified Bhalla scores were calculated. Pre-treatment mosaism and peribronchial thickening were detected in all patients. There were bronchiectasis 67.3%, atelectasis 91.8%, hyperinflation 81.6%, air trapping 98% of patients. Post-treatment radiological evaluation revealed mosaism 93.9%, peribronchial thickening 100%, bronchiectasis 51%, atelectasis 65.3%, hyperinflation 69.4%, air trapping 87.8%. The mean Bhalla score was 9.1 ± 4.1 before the treatment and it was found to be 6.8 ± 4.6 after treatment. Discussion and Conclusion Postinfectious bronchiolitis obliterans is a rare condition with obstruction findings. It occurs as a result of immune mechanisms after severe lung infection, especially at a young age. In this study, we aimed to present sociodemographic characteristics, clinical features and especially response to long-term sterolid and azithromycin treatment in patients with bronchiolitis obliterans.