Post-Infectious Bronchiolitis Obliterans in Pediatric Populations
Summary
Post-infectious bronchiolitis obliterans (PIBO) is a rare, irreversible obstructive lung disease that develops in a subset of children following severe lower respiratory tract infection. Injury to bronchiolar epithelium triggers persistent neutrophil-driven inflammation, fibrotic remodelling and fixed airway obliteration. Clinically, affected children present with chronic cough, wheezing, tachypnoea and impaired exercise tolerance. Standard diagnosis combines clinical history with pulmonary function tests and high-resolution computed tomography (HRCT) showing mosaic attenuation and air-trapping. Prognosis varies according to disease severity, with some patients stabilising under long-term anti-inflammatory therapy and others progressing to chronic respiratory insufficiency. Globally, PIBO remains under-recognised, emphasising the need for early risk stratification, standardised diagnostic pathways and targeted interventions to mitigate long-term morbidity.
Research from Nature Portfolio
A foundational investigation evaluated lung clearance index (LCI) and quantitative air-trapping measurements from chest computed tomography in infants with post-infectious bronchiolitis obliterans. In a cohort of patients younger than one year, mean attenuation thresholds were established to delineate trapped lung volume, and multiple-breath washout tests produced LCI and moment-ratio indices. Both LCI and first-moment ratio correlated significantly with the proportion of air-trapping derived from CT, indicating their feasibility as complementary, non-invasive tools when conventional spirometry is impractical. The study demonstrated that functional residual capacity measurements align with quantitative imaging, supporting integrated functional–structural monitoring in early disease management.
Post-Infectious Bronchiolitis Obliterans in Pediatric Populations publication trend
The graph below shows the total number of articles in post-infectious bronchiolitis obliterans in pediatric populations across all publications each year (not limited to Nature Index journals).
Technical terms
Bronchiolitis obliterans: A chronic obstructive lung disease characterised by bronchiolar epithelial injury, inflammation and fibrotic airway obliteration.
Post-infectious bronchiolitis obliterans (PIBO): A form of bronchiolitis obliterans arising after severe respiratory infection, leading to fixed airflow obstruction in children.
Lung clearance index (LCI): A measure from multiple-breath washout testing reflecting ventilation inhomogeneity and small-airway function.
Air-trapping: Retention of inhaled air in lung regions due to airway obstruction, visible on expiratory CT scans as areas of low attenuation.
Mosaic attenuation: A pattern on HRCT in which patches of differing lung density reflect regional perfusion or ventilation abnormalities.
Forced expiratory volume in one second (FEV1): The volume of air expelled in the first second of a forced exhalation, used to assess airway obstruction.
High-resolution computed tomography (HRCT): An imaging modality providing detailed lung parenchyma and airway visualisation, essential for diagnosing small-airway diseases.
References
- Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report. Canadian Respiratory Journal (2020).
- Risk Factors for the Development of Post-Infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis. Pathogens (2022).
- Lung Clearance Index and Quantitative Computed Tomography of Post-Infectious Bronchiolitis Obliterans in Infants. Scientific Reports (2017).
- Pulmonary Function in Post-Infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis. Pathogens (2022).
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