Post-Infectious Bronchiolitis Obliterans

Abstract

Bronchiolitis obliterans is an infrequent and severe chronic obstructive pulmonary disease caused by an injury of the lower airway. Many conditions may trigger bronchiolitis obliterans, such as pulmonary aspiration, Stevens-Johnson syndrome, and bone marrow transplant, but post-infectious bronchiolitis obliterans is the most common cause in South America. The disease appears more frequently in children after a serious viral infection of the lower respiratory tract, particularly adenovirus, that may develop a severe pneumonia with prominent sequelae. Diagnosis is suggested when a patient presents with persistent respiratory symptoms after a severe pneumonia associated to radiological changes and lung function impairment. The gold standard for diagnosis is lung biopsy. Most patients show slow but gradual clinical improvement over time. Treatment focuses on suppression of the inflammatory response. Antiinflammatory treatments, such as steroids, chloroquine, and hydroxychloroquine, have been proposed with variable results. Support measures such as bronchodilators, chest physiotherapy, antibiotics, diuretics, and gastroesophageal reflux therapy are useful as part of the main treatment.