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.