Successful treatment of postinfectious bronchiolitis obliterans with gamma globulin in a tertiary center: 10 years of experience.
bronchiolitis obliterans
intravenous immunoglobulin
postinfectious bronchiolitis obliterans
Journal
Pediatric pulmonology
ISSN: 1099-0496
Titre abrégé: Pediatr Pulmonol
Pays: United States
ID NLM: 8510590
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
23
05
2023
received:
08
01
2023
accepted:
18
06
2023
medline:
23
10
2023
pubmed:
20
7
2023
entrez:
20
7
2023
Statut:
ppublish
Résumé
Bronchiolitis obliterans is characterized by partial or total occlusion of the bronchioles due to inflammation and fibrosis, and the most common form is postinfectious bronchiolitis obliterans (PIBO). This study aimed to retrospectively present our intravenous immunoglobulin (IVIG) treatment experience in PIBO patients with a clinically severe course despite receiving commonly used treatment protocols. The study included patients aged 0-18 with subtle immunological abnormalities who were followed up in our center for PIBO between 2010 and 2021. Clinical evaluation, body mass index (BMI), computerized tomography (CT) image scoring, and immunological parameters were recorded before and after IVIG treatment. Of the 11 patients included in the study, 90% were male, the mean age at diagnosis was 27.1 months (range: 5-68 months) and the mean current age was 81.4 months (range: 15-188 months). The number of hospital visits due to infection and the frequency of hospitalizations decreased markedly in the patients who underwent IVIG therapy. Oxygen therapy was discontinued in all patients, and improvements in radiological severity scores were observed. BMI z-scores improved over the baseline values after IVIG therapy. Corticosteroids are considered the best first-line treatment to control inflammation in PIBO. In our study group, PIBO patients showed favorable clinical and radiological responses to regular IVIG treatment, possibly due to minor immune deficiency secondary to steroids or as a result of undetected adaptive and innate immune defects involved in the etiology of severe PIBO.
Substances chimiques
gamma-Globulins
0
Immunoglobulins, Intravenous
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2769-2776Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Colom AJ, Teper AM. Post-infectious bronchiolitis obliterans. Pediatr Pulmonol. 2019;54:212-219.
Kurland G, Michelson P. Bronchiolitis obliterans in children. Pediatr Pulmonol. 2005;39:193-208.
Onay ZR, Ramasli Gursoy T, Aslan AT, et al. Postinfectious bronchiolitis obliterans masked by misdiagnosis as asthma. Pediatr Pulmonol. 2020;55:1007-1011.
Moonnumakal SP, Fan LL. Bronchiolitis obliterans in children. Curr Opin Pediatr. 2008;20:272-278.
Jerkic SP, Brinkmann F, Calder A, et al. Postinfectious bronchiolitis obliterans in children: diagnostic workup and therapeutic options: a workshop report. Can Respir J. 2020;2020:1-16.
Norman BC, Jacobsohn DA, Williams KM, et al. Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients. Bone Marrow Transplant. 2011;46:1369-1373.
Gökturk B. Successful Therapy with intravenous gamma globulin in two children with postinfectious bronchiolitis obliterans. J Pulmonol Respir Res. 2017;1:009-012.
Teufel M, Ketelsen D, Fleischer S, et al. Comparison between high-resolution CT and MRI using a very short echo time in patients with cystic fibrosis with extra focus on mosaic attenuation. Respiration. 2013;86:302-311.
Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324-1343.
Fuchs HJ, Borowitz DS, Christiansen DH, et al. Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. N Engl J Med. 1994;331:637-642.
Barker AF, Bergeron A, Rom WN, Hertz MI. Obliterative bronchiolitis. N Engl J Med. 2014;370:1820-1828.
Champs NS, Lasmar LM, Camargos PA, Marguet C, Fischer GB, Mocelin HT. Post-infectious bronchiolitis obliterans in children. J Pediatr. 2011;87(3):187-198.
Lee E, Park S, Kim K, Yang HJ. Risk factors for the development of post-infectious bronchiolitis obliterans in children: a systematic review and meta-analysis. Pathogens. 2022;11(11):1268.
Nakagiri T, Inoue M, Morii E, et al. Local IL-17 production and a decrease in peripheral blood regulatory T cells in an animal model of bronchiolitis obliterans. Transplantation. 2010;89:1312-1319.
Cazzato S, Poletti V, Bernardi F, et al. Airway inflammation and lung function decline in childhood post-infectious bronchiolitis obliterans. Pediatr Pulmonol. 2008;43:381-390.
Colom AJ, Maffey A, Garcia Bournissen F, Teper A. Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. Thorax. 2015;70(2):169-174.
Fischer GB, Sarria EE, Mattiello R, Mocelin HT, Castro-Rodriguez JA. Post-infectious bronchiolitis obliterans in children. Paediatr Respir Rev. 2010;11:233-239.
Rosewich M, Zissler UM, Kheiri T, et al. Airway inflammation in children and adolescents with bronchiolitis obliterans. Cytokine. 2015;73(1):156-162.
Kingah PL, Muma G, Soubani A. Azithromycin improves lung function in patients with post-lung transplant bronchiolitis obliterans syndrome: a meta-analysis. Clin Transplant. 2014;28:906-910.
Hayes Jr. D. A review of bronchiolitis obliterans syndrome and therapeutic strategies. J Cardiothorac Surg. 2011;6:92.
Kim CK, Kim SW, Kim JS, et al. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest. 2001;120:1101-1106.
Todd JL, Palmer SM. Bronchiolitis obliterans syndrome: the final frontier for lung transplantation. Chest. 2011;140:502-508.
Liu X, Cao W, Li T. High-dose intravenous immunoglobulins in the treatment of severe acute viral pneumonia: the known mechanisms and clinical effects. Front Immunol. 2020;11:1660.
Ibáñez C, Suñé P, Fierro A, et al. Modulating effects of intravenous immunoglobulins on serum cytokine levels in patients with primary hypogammaglobulinemia. BioDrugs. 2005;19:59-65.
Williams KM, Cheng GS, Pusic I, et al. Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22:710-716.
Verleden GM, Verleden SE, Vos R, et al. Montelukast for bronchiolitis obliterans syndrome after lung transplantation: a pilot study. Transpl Int. 2011;24:651-656.