Therapeutic interventions and pulmonary function in pediatric patients with post-infectious bronchiolitis obliterans

Abstract

Post-infectious bronchiolitis obliterans (PIBO) is a rare chronic obstructive pulmonary disease affecting children after a severe respiratory infection. The primary goal of this narrative review is to synthesize evidence on pulmonary function in children with PIBO, with a focus on spirometric indices, and to evaluate the efficacy of therapies reported in the literature. It also provides an overview of the disease’s epidemiology, risk factors, clinical presentation and diagnostic methods. Studies reported various spirometric parameters including forced expiratory volume in one second, forced vital capacity, the ratio between these two parameters, and forced expiratory flow at 25%-75%. A narrative synthesis described therapies including bronchodilators, corticosteroids, macrolides, combination regimens, novel therapies and non-pharmacological interventions. Most studies were small, but data showed moderate to severe impairments in pulmonary function in pediatric PIBO, with mild heterogeneity. Corticosteroids and combined therapies offered short-term relief, but long-term benefits were limited by adverse effects. Pulmonary rehabilitation may preserve lung function and quality of life, although evidence remains scarce. Given the limited research on therapy and pulmonary outcomes, further studies are necessary to understand the long-term effects of treatments. This review underscores the urgent need for multicenter studies and evidence-based guidelines to improve care for children with PIBO.

Keywords: Post-infectious bronchiolitis obliterans; Pediatric pulmonary function; Children; Therapeutic interventions; Spirometric monitoring

Core Tip: Post-infectious bronchiolitis obliterans leads to permanent small-airway obstruction and significant spirometric deficits in children, notably reduced forced expiratory volume in one second and forced expiratory flow at 25%-75% with poor bronchodilator response, while diffusing capacity of the lung for carbon monoxide often remains normal. This narrative review links these pulmonary function parameters with therapeutic interventions, showing that early use of inhaled or systemic corticosteroids and macrolides can stabilize or modestly improve lung function. Emerging combination regimens, such as fluticasone-azithromycin-montelukast, show promise but need further validation. Integrating regular spirometric monitoring with tailored anti-inflammatory strategies may optimize clinical outcomes and underlines the need for prospective studies.