Çoksüer Fevziye, Öztürk Gökçen Kartal, Ocak Ece, Barlık Meral, Özaslan Mehmet Mustafa, Dindar Bahar Girgin, Halis Ece, Öğütcü Şükrü Atacan, Demir Esen, Gülen Figen
Department of Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey.
Eur J Pediatr. 2025 Aug 7;184(9):536. doi: 10.1007/s00431-025-06378-0.
Postinfectious bronchiolitis obliterans (PIBO) is a severe chronic pulmonary disorder in children, characterized by irreversible airway obstruction following acute lower respiratory tract infections. Currently, there is no consensus on the treatment protocol for PIBO. This study aimed to evaluate the safety and effectiveness of combining intravenous pulse methylprednisolone (IVPM) with intravenous immunoglobulin (IVIG) in pediatric patients with PIBO. We conducted a retrospective single-center cohort study that included 18 children diagnosed with PIBO at a tertiary pediatric pulmonology center. Patients received monthly cycles of IVPM (10 mg/kg/day for 3 days) and IVIG (1 g/kg for 2 days) over a six-month period. After the first three cycles, the IVPM/IVIG therapy was evaluated for side effects and clinical improvement. Treatment continued for all patients since no complications were observed. Clinical, radiological, and laboratory parameters were compared before and after treatment. Following therapy, 83.3% of patients experienced symptomatic and clinical improvement. Annual wheezing episodes (3.12 ± 0.83 vs. 1.25 ± 0.70; p = 0.014) and hospitalization rates (2.12 ± 0.64 vs. 0.50 ± 0.75; p < 0.001) decreased significantly compared to baseline. Oxygen therapy was discontinued for all patients. The median weight and height z-scores at sixth month of therapy showed improvement, although no significant difference was noted. No serious adverse events were reported; transient hyperglycemia and mild rash were the only side effects observed. Conclusion: This is the first study to evaluate the combination of IVPM/IVIG therapy in pediatric PIBO patients. Our findings suggest that early initiation of this regimen may provide a safe alternative for these patients, with no serious side effects observed. What is Known: • There is no standardized treatment protocol for postinfectious bronchiolitis obliterans (PIBO), and current therapies depend on expert opinion and small case series What is New: • This study evaluates the safety and efficacy of combining intravenous pulse methylprednisolone (IVPM) with intravenous immunoglobulin (IVIG) in pediatric PIBO patients • The study demonstrates that IVPM/IVIG therapy initiated at a younger age and in earlier stages of the disease may improve clinical outcomes while decreasing hospitalization and episodes of wheezing.
感染后闭塞性细支气管炎（PIBO）是一种儿童严重慢性肺部疾病，其特征为急性下呼吸道感染后出现不可逆的气道阻塞。目前，对于PIBO的治疗方案尚无共识。本研究旨在评估静脉注射脉冲甲基强的松龙（IVPM）联合静脉注射免疫球蛋白（IVIG）治疗儿童PIBO患者的安全性和有效性。我们进行了一项回顾性单中心队列研究，纳入了一家三级儿童肺病中心诊断为PIBO的18名儿童。患者在六个月内每月接受一个周期的IVPM（10mg/kg/天，共3天）和IVIG（1g/kg，共2天）治疗。在前三个周期后，对IVPM/IVIG治疗的副作用和临床改善情况进行评估。由于未观察到并发症，所有患者均继续治疗。比较治疗前后的临床、影像学和实验室参数。治疗后，83.3%的患者症状和临床情况得到改善。与基线相比，年度喘息发作次数（3.12±0.83对1.25±0.70；p=0.014）和住院率（2.12±0.64对0.50±0.75；p<0.001）显著降低。所有患者均停止了氧疗。治疗第六个月时的体重和身高z评分中位数有所改善，尽管未观察到显著差异。未报告严重不良事件；仅观察到短暂性高血糖和轻度皮疹。结论：这是第一项评估IVPM/IVIG联合治疗儿童PIBO患者的研究。我们的研究结果表明，早期启动该治疗方案可能为这些患者提供一种安全的替代方案，且未观察到严重副作用。已知信息：• 感染后闭塞性细支气管炎（PIBO）没有标准化的治疗方案，目前的治疗依赖专家意见和小病例系列。新发现：• 本研究评估了静脉注射脉冲甲基强的松龙（IVPM）联合静脉注射免疫球蛋白（IVIG）治疗儿童PIBO患者的安全性和疗效。• 该研究表明，在疾病较年轻和早期阶段启动IVPM/IVIG治疗可能改善临床结局，同时降低住院率和喘息发作次数。
