Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy

Silvia Onoda Tomikawa, Fabíola Villac Adde, Luiz Vicente Ribeiro Ferreira da Silva Filho, Claudio Leone, Joaquim Carlos Rodrigues

BackgroundBronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. Here we report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy.MethodsForty patients fulfilling the BO diagnosis criteria were treated with methylprednisolone pulse therapy in monthly cycles until clinical improvement. After the pulse therapy began, we analyzed the clinical and laboratory data at intervals. Statistical analyses were performed using non-parametric tests to compare repeated measures (Friedman, Wilcoxon) or paired nominal data (McNemar) (¿¿=¿5%).ResultsThe frequency of wheezing exacerbations and hospitalizations was reduced (p¿=¿0.0042 and p¿<¿0.0001, respectively) and oxygen saturation improved (p¿=¿0.0002) in the pulse therapy-treated patients. Prolonged oral corticosteroid therapy was discontinued in 83% of these patients. The mean Z-score length for age improved from -1.08 to -0.63, and the mean Z-score weight for age improved from -0.91 to -0.59. The adverse effects during the infusion were temporary and none were serious.ConclusionsOur data suggest that pulse corticotherapy could be a safe alternative to prolonged systemic oral corticotherapy in children with BO, thus minimizing the adverse effects of the oral therapy. New prospective controlled studies are required to confirm this proposition.