Dataset Information

Follow-up on the therapeutic effects of a budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in children with post-infectious bronchiolitis obliterans.

ABSTRACT:

Background

Post-infectious bronchiolitis obliterans (PIBO) is a rare, severe chronic lung disease without optimal treatment. Currently, treatment in children mainly relies on systemic corticosteroids, but long-term use of these drugs may lead to adverse reactions. This study aimed to evaluate the short-term efficacy of the budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in paediatric PIBO patients and whether it can reduce systemic corticosteroid use.

Methods

This was a prospective study. From June 2017 to July 2020, patients diagnosed with PIBO at Yuying Children's Hospital of Wenzhou Medical University were treated with the BAMA regimen for 3 months. Methylprednisolone was added only when the clinical manifestations did not improve or deteriorated. All patients were followed up every 2 to 4 weeks, and changes in clinical symptoms were recorded. Pulmonary function tests and high-resolution computed tomography (HRCT) were performed, and systemic corticosteroid use was recorded after the 3-month follow-up.

Results

A total of 75 patients with PIBO were included; overall, 54 patients completed the course of treatment. After treatment, the respiratory manifestations were improved in 37 patients (68.5%), but 4 patients (7.4%) showed decreased exercise tolerance, and 2 patients (3.7%) were readmitted to the hospital. Additionally, 17 (56.7%) of the 30 patients whose pulmonary function was re-examined showed improvement, and 28 (77.8%) of the 36 patients who underwent HRCT showed marked improvement. Importantly, 20 patients (54.1%) received systemic corticosteroids for 2 weeks or less, while 31.5% of patients used no corticosteroids.

Conclusions

The BAMA regimen effectively relieved clinical symptoms and signs of PIBO in children, improved pulmonary function and HRCT manifestations, and reduced the use of systemic corticosteroids.

SUBMITTER: Weng T

PROVIDER: S-EPMC8411176 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Publications

Follow-up on the therapeutic effects of a budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in children with post-infectious bronchiolitis obliterans.

Weng Tingting T Lin Xixi X Wang Leying L Lv Jiamei J Dong Lin L

Journal of thoracic disease 20210801 8

<h4>Background</h4>Post-infectious bronchiolitis obliterans (PIBO) is a rare, severe chronic lung disease without optimal treatment. Currently, treatment in children mainly relies on systemic corticosteroids, but long-term use of these drugs may lead to adverse reactions. This study aimed to evaluate the short-term efficacy of the budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in paediatric PIBO patients and whether it can reduce systemic corticosteroid use.<h4>Methods< ...[more]

PMID: 34527318

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Project description:Bronchiolitis obliterans syndrome (BOS) remains the major problem which precludes long-term survival after lung transplantation. Previously, an open label pilot study from our group demonstrated a possible beneficial effect of montelukast in progressive BOS patients with low airway neutrophilia (<15%), and already on azithromycin treatment, in whom the further decline in pulmonary function was attenuated. This was, however, a non-randomized and non-placebo controlled trial. The study design is a single center, prospective, interventional, randomized, double blind, placebo-controlled trial, with a two arm parallel group design and an allocation ratio of 1:1. Randomization to additional montelukast (10 mg/day, n = 15) or placebo (n = 15) was performed from 2010 to 2014 at the University Hospitals Leuven (Leuven, Belgium) in all consecutive patients with late-onset (>2years posttransplant) BOS ≥1. Primary end-point was freedom from graft loss 1 year after randomization; secondary end-points were acute rejection, lymphocytic bronchiolitis, respiratory infection rate; and change in FEV1, airway and systemic inflammation during the study period. Graft loss at 1 y and 2y was similar in both groups (respectively p = 0. 981 and p = 0.230). Montelukast had no effect on lung function decline in the overall cohort. However, in a post-hoc subanalysis of BOS stage 1 patients, montelukast attenuated further decline of FEV1 during the study period, both in absolute (L) (p = 0.008) and % predicted value (p = 0.0180). A linear mixed model confirmed this association. Acute rejection, lymphocytic bronchiolitis, respiratory infections, systemic and airway inflammation were comparable between groups over the study period. This randomized controlled trial showed no additional survival benefit with montelukast compared to placebo, although the study was underpowered. The administration of montelukast was associated with an attenuation of the rate of FEV1 decline, however, only in recipients with late-onset BOS stage 1.

Project description:BackgroundPost-infectious bronchiolitis obliterans (PIBO) is a severe form of chronic obstructive lung disease secondary to severe respiratory tract infections. Knowledge of pediatric PIBO development-associated risk factors may improve selection of appropriate early therapeutic interventions.ObjectiveThe aim of this study was to describe the clinical characteristics of children diagnosed with PIBO, and identify the risk factors for development of PIBO after adenovirus pneumonia.MethodsFirst, a retrospective observational study was performed of 308 pediatric patients with PIBO (ages < 5 years) that revealed high frequencies of non-invasive/invasive ventilation, co-infection, and atopic conditions. Subsequently, we retrospectively reviewed 131 patients (ages < 5 years) with adenovirus pneumonia who developed BO (included among the 308 children) or not. Logistic regression analysis revealed PIBO development-associated risk factors.ResultsRespiratory symptoms of 308 patients (median age of 18 months, range: 12-54 months; male predominance of 3.7:1) included wheezing (71%), dyspnea (66%), tachypnea (23%), and hypoxemia (18%). Etiologic agents (predominantly adenovirus, Mycoplasma pneumoniae) were detected in 236 patients, of whom 137 had co-infections. Notably, atopic disease history (of patients and/or family members) was associated with 78% of patients, and 15% of patients diagnosed with asthma before, at the time of PIBO diagnosis. In a subsequent study of 131 adenovirus pneumonia patients, multivariate analysis showed that co-infection (OR 4.20, 95% CI 1.29 to 13.63), atopic conditions (OR 29.67, 95% CI 12.16 to 81.67), and duration of fever (OR 1.42, 95% CI 1.10 to 1.83) were independent risk factors for PIBO development following adenovirus pneumonia.ConclusionsAtopic conditions, co-infections, and duration of fever were identified as risk factors for pediatric post-infectious BO development following adenovirus pneumonia, and PIBO may overlap with asthma, warranting early aggressive treatment and further research to elucidate roles of atopic conditions in BO development.

Dataset Information

Follow-up on the therapeutic effects of a budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in children with post-infectious bronchiolitis obliterans.

Background

Methods

Results

Conclusions

Publications

Follow-up on the therapeutic effects of a budesonide, azithromycin, montelukast, and acetylcysteine (BAMA) regimen in children with post-infectious bronchiolitis obliterans.

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