Clinical characteristics of initial respiratory insult in children subsequently diagnosed with Post infectious Obliterative Bronchiolitis.

Most acute respiratory infections in children leave no lasting structural or functional deficits. A small minority of children develop post infectious bronchiolitis obliterans (PIBO) which is a lifelong condition. By understanding the clinical characteristics when children initially present with respiratory illnesses, it maybe then possible to delineate the population most at risk of developing BO. These children can then be followed up more closely and antinflammatory treatments considered. <bold>Objectives:</bold> To identify the clinical characteristics of patient’s initial respiratory illness or illnesses that precede the diagnosis of PIBO. <bold>Materials and Methods</bold> This was a retrospective single centre study of patients with PIBO <10 years of age. We investigated the clinical characteristics during their initial respiratory illness which included the symptoms, treatments and investigations carried out. <bold>Results:</bold> Of a total of 13 children, complete data on initial illness was available in only 6. The children with PIBO were likely to have had an ICU admission, needed prolonged oxygen therapy and had an LRTI with adenovirus. Half of those with adenovirus also had a coinfection.4 patients had a single discrete severe illness ,in the other two patients there were multiple respiratory illnesses preceding the diagnosis. Most patients were readmitted several times and there was an approximately 4 month delay between symptoms onset and diagnosis. <bold>Conclusions:</bold> Adenovirus LRTI with a prolonged course suggests the likely development of PIBO. There may be a window of opportunity to intervene in these children with anti-inflammatory therapies to prevent more longer-term morbidity.