Clinical Research Of 99 Children With Bronchiolitis Obliterans

Objective:To summarize the clinical features and Follow-up data of the bronchiolitis obliterans(BO)in Hunan Provincial People’s Hospital pediatric ward in the past 6 years,and to improve clinicians’understanding of BO.Method:A retrospectively research was conducted in order to study 99 pediatric patients who was diagnosed with BO in Hunan Provincial People’s Hospital pediatric ward from January 2011 to January 2017.Our aim was to analyze the clinical characteristics of bronchiolitis obliterans(BO),including clinical manifestations and signs,etiology,high-resolution chest CT(HRCT)and pulmonary function,ICU and assisted mechanical ventilation,the performance of fiberoptic bronchoscopy,cause of death in BO patients,therapy and prognosis.Early follow-up aerosolization therapy was performed in 56 patie:nts with BO followed up for the intervention group.The diagnosis was only started after the atomization therapy was performed in the no intervention group.The proportion of the statistical intervention group and the non-intervention group’s prognosis,including exercise intolerance and exercise tolerance,oxygen therapy and non-oxygen therapy,dyspnea and no dyspnea,were tested with chi-square test.Results:(1)Clinical manifestations:There were 73 males and 26 females.Age of onset in 2 months to 9 years old,mainly infants and toddlers.All children had symptoms of repeated cough,most of them had sputum 93.9%(93/99)and fever 85.8%(85/99),wheezing 82.8%(82/99),Shortness of breath and cyanosis after exercise 70.7%(70/99),and dyspnea 25.3%(25/99).Signs:lung moist rale is 89 cases(89.9%)(89/99),wheezing is 43 cases(43.4%)(43/99),and inspiratory three concave sign is 69 cases(69.7%)(69/99).(2)Etiology:The incidence is mainly related to infection.Pathogen detection in 97 cases(97.9%).66 cases(66.67%)of adenovirus infection,14 cases(14.14%)of mycoplasma infection,4 cases(4.04%)of cytomegalovirus infection.EB virus,parainfluenza 3 virus,and influenza A virus infection in 2 cases(2.02%)each.Respiratory syncytial virus,measles virus,invasive Aspergillus,and Serratia liquefaciens infection in 1 case(1.01%)each.The etiology was unknown in 1 cases(1.01%).4 cases of BO due to other complicated reasons,One case(1.01%)of Steven-Johnson syndrome,1 case(1.01%)of high IgM anemia combined with Penicillium marneffei infection,1 case(1.01%)of familial Mediterranean fever with adenovirus infection,Cilia syndrome and Epstein-Barr virus infection in 1 case(1.01%).(3)The features of pulmonary imaging:All cases of HRCT had mosaic perfusion sign.Bronchial wall thickening in 37 cases(37.4%).Bronchiectasis in 32 cases(32.3%).(4)Pulmonary function testing:Pulmonary function test was performed in 52 cases(52.5%),revealing obstructive ventilation disorder in all cases.15 cases of severe airway obstruction,30 cases(30.3%)of moderate airway obstruction,7 cases(7.1%)of small airway obstruction.(5)The therapy and prognosis:A total of 63 patients were followed up by telephone for follow-up,with 7 deaths(5 deaths during hospitalization and 2 deaths during follow-up).Fifty-six patients had treated with inhaled budesonide suspension supplemented with inhaled compound ipratropium bromide and low dose azithromycin.Among them,there were 39 patients with suspected early diagnosis of BO who underwent early nebulization intervention(inhaled corticosteroids supplemented with bronchodilators).After diagnosis of BO,17 patients received aerosol treatment.Early nebulization intervention and early intervention were not included.Compared with treatment,early atomization intervention can obviously improve children’s exercise tolerance,improve dyspnea,and reduce oxygen intake.Conclusion:1.Respiratory tract infections are an important cause of BO in children in the region,especially adenoviruses.2.The lack of specificity in clinical manifestations is mainly long-term persistent wheezing,cough,activity intolerance,shortness of breath,and three concave signs.HRCT showed typical mosaic sign,bronchiectasis,and bronchial wall thickening.Pulmonary function shows varying degrees of ventilation dysfunction3.Although there is no specific treatment for BO at present,early intervention with inhaled glucocorticoid therapy and symptomatic and supportive treatment maybe be beneficial to improve the prognosis of children.