a Respiratory Unit , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK.
b Respiratory Critical Care and Anaesthesia Section , Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health , London , UK.
Expert Rev Respir Med. 2019 May;13(5):481-488. doi: 10.1080/17476348.2019.1586537. Epub 2019 Mar 8.
Bronchiolitis obliterans (BO) is a chronic and irreversible obstructive lung disease leading to the obstruction and/or obliteration of the small airways. Three main BO entities are distinguished: post-infectious BO (PIBO); BO post lung transplantation; and BO after bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT). All three entities are separate, however, there are similarities in histopathological characteristics and possibly in aspects of the development pathway. Areas covered: We review current evidence of bronchiolitis obliterans diagnosis and management in children. The diagnosis of BO is usually based on a combination of history, clinical and radiological findings, although lung biopsy and histopathology remain the gold standard approaches to confirm BO. Expert opinion: At present, we do not have a clear understanding of the mechanisms of the development of BO and lack strong evidence for treatment. Although most BO in children is post-infectious, most of the current evidence for treatment originates from studies analyzing BO in adult lung transplant and HSCT patients. BO management requires multidisciplinary approach and care in specialized centers.
闭塞性细支气管炎（BO）是一种慢性且不可逆转的阻塞性肺疾病，可导致小气道阻塞和/或闭塞。主要有三种 BO 实体：感染后 BO（PIBO）；肺移植后的 BO；骨髓移植（BMT）或造血干细胞移植（HSCT）后的 BO。尽管这三种实体是独立的，但它们在组织病理学特征上存在相似之处，并且在发展途径的某些方面可能也存在相似之处。
我们回顾了儿童闭塞性细支气管炎的诊断和管理的最新证据。BO 的诊断通常基于病史、临床和影像学发现的综合评估，尽管肺活检和组织病理学仍然是确认 BO 的金标准方法。
目前，我们对 BO 发展机制的认识尚不清楚，治疗方法也缺乏有力的证据。尽管大多数儿童的 BO 是感染后，但大多数针对 BO 的治疗证据都来自于分析成人肺移植和 HSCT 患者的 BO 的研究。BO 的管理需要多学科方法，并在专门的中心进行护理。
