Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Key Features ++ Essentials of Diagnosis ++ Persistent symptoms of airway obstruction 8 weeks after the resolution of a lower respiratory tract infection Chest CT shows a mosaic pattern of hyperinflation and vascular attenuation ++ General Considerations ++ Rare chronic obstructive lung disease Characterized by complete obliteration of the small airways following a severe insult Most common form in children is postinfectious, following a lower airway tract infection with adenovirus; influenza, rubeola, Bordetella, and Mycoplasma are also implicated Other causes include Connective tissue diseases Chronic aspiration Stevens-Johnson syndrome Posttransplantation (lung or bone marrow) Inhalational injury Many cases of bronchiolitis obliterans are idiopathic Mechanical ventilation for severe adenoviral respiratory infection is a strong risk factor ++ Clinical Findings ++ Symptoms and Signs ++ Dyspnea Cough Exercise intolerance ++ Differential Diagnosis ++ Poorly treated asthma Cystic fibrosis Bronchopulmonary dysplasia ++ Diagnosis ++ Chest radiograph abnormalities include evidence of heterogeneous air trapping and airway wall thickening Classic findings on high-resolution chest CT include Mosaic perfusion pattern Vascular attenuation Central bronchiectasis Ventilation-perfusion scans May show pattern of mismatch Not typically required for diagnosis Pulmonary angiograms reveal decreased vasculature in involved lung Bronchograms show marked pruning of the bronchial tree ++ Treatment ++ Supportive care Supplemental oxygen for hypoxemia Routine vaccination Avoidance of environmental irritant exposure Exercise Nutritional support Inhaled bronchodilators (β-agonists and anticholinergic) may reverse airway obstruction if the disease has a reactive component Systemic corticosteroids May help reverse the obstruction or prevent ongoing damage Monthly pulse-dose corticosteroids will reduce the risk of adverse effects associated with long-term corticosteroids. Antibiotics should be used as indicated for pneumonia Azithromycin has been shown to have therapeutic benefit in bronchiolitis obliterans syndrome after lung transplantation Lung transplant may be an option for patients with severe, progressive disease ++ Outcome ++ Complications ++ Persistent airway obstruction Recurrent wheezing Bronchiectasis Chronic atelectasis Recurrent pneumonia Unilateral hyperlucent lung syndrome ++ Prognosis ++ Depends in part on the underlying cause as well as the age of onset Postinfectious bronchiolitis obliterans tends to be nonprogressive with low mortality and the possibility of slow improvement Bronchiolitis obliterans resulting from transplantation or Stevens-Johnson syndrome may have a rapidly progressive course leading to death or need for lung transplantation ++ References + +Colom AJ et al: Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. Thorax 2015 Feb;70(2):169–174 [PubMed: 25388479] .CrossRef+ +Li YN et al: Post-infectious bronchiolitis obliterans in children: a review of 42 cases. BMC Pediatr 2014 Sep 25;14:238 [PubMed: 25252824] .CrossRef+ +Teixeira MF et al: Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children. Chest 2013 Sep;144(3):974–980 ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPediatrics 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPediatrics Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options