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Jornal de Pediatria
On-line version ISSN 1678-4782
TEPER, Alejandro; FISCHER, Gilberto Bueno and JONES, Marcus Herbert. Respiratory sequelae of viral diseases: from diagnosis to treatment. J. Pediatr. (Rio J.) [online]. 2002, vol.78, suppl.2, pp. 187-194. ISSN 1678-4782. http://dx.doi.org/10.1590/S0021-75572002000800009.
Objective: the objective of the present article is to present a review of the main clinical issues faced by pediatricians while defining the diagnosis, management and prognosis of postinfectious bronchiolitis obliterans. Sources: data from national and international scientific journals selected from the Lilacs and Medline databases. Summary of the findings: with the purpose of establishing the diagnosis, a radiological investigation shows high levels of pulmonary insufflation, thickened bronchovascular bundles and, less often, bronchiectasis, atelectasis and pulmonary hyperlucency. The CT exam allows the visualization of structural and functional findings, such as air trapping, bronchiectasis and mosaic pattern. Lung function tests in children and infants always reveal significant reduction of expiratory flows. Pulmonary biopsy is not mandatory in order to confirm bronchiolitis obliterans. Diagnosis can be established through the combination of history of bronchiolitis, chronic obstructive pulmonary disease and typical tomographic findings. The treatment used by most services includes oral and inhaled corticosteroids and bronchodilators for long periods. The management of exacerbated conditions often requires antibiotics and physical therapy. Conclusions: most patients present a favorable outcome with slow improvement of the pulmonary function and reduced necessity for supplementary oxygen. Some patients present progressive worsening of hypoxemia and CO2 retention, which leads to pulmonary hypertension and cor pulmonale. Postinfectious bronchiolitis obliterans is mild and moderate in most patients, with consequent good prognosis and low mortality.
Keywords : bronchiolitis obliterans; children; tomography; viral bronchiolitis; spirometry.