Therapeutic interventions and pulmonary function in pediatric patients with post-infectious bronchiolitis obliterans

Table 3 Proposed combination therapies for post-infectious bronchiolitis obliterans

Ref.	Therapies	Pulmonary function outcomes	Key points/notes
Zheng et al[25] retrospective (2022) — 34 children, age > 5 years (n = 20); ≤ 5 years (n = 14)	Continuous vs intermittent ICS (budesonide ± terbutaline)	After 1-year, continuous ICS showed improvements in FVC, FEV1, MMEF 25%-75%, tidal flow ratios; intermittent ICS did not	Continuous ICS significantly improved airway obstruction; > 50% had positive bronchodilator tests
Zhang et al[26] (2018) Clinical cohort, China (2014-2017) — 30 children, median age 17 months	Long-term nebulized budesonide + terbutaline + ipratropium	Significant increase in TPEF%/TE and VPEF%/VE; HRCT improved in 82% of patients; symptoms greatly improved (P < 0.01)	Triple nebulization well tolerated, effective in young children, with both functional and radiologic improvements
Li et al[31] workshop report — 42 children	Oral prednisone (1.5 mg/kg/day taper over 6-9 months) + azithromycin (5-10 mg/kg, 3 days/week × 6 months)	Defined “effective”: Stable lung function (as < 10% decline); > 50% responded with reduced wheezing; effective in 86% of cases. No HRCT improvement	Combined steroids + azithromycin frequently effective; no control groups, but high subjective + functional response rates
Jerkic et al[1] Workshop report (BOS studies)	FAM regimen: Fluticasone + azithromycin + montelukast + steroid pulse	In BOS, poor pulmonary decline halted: Treatment failure (≥ 10% FEV1 drop) was only 6% at 3 months vs 40% historical controls	While untested in PIBO, single-center use suggested safety; efficacy needs formal trials
Yilmaz et al[27] (2023) IVIG study (2010-2021) — 11 severe PIBO patients	Regular IVIG infusions (weekly/monthly)	Reduced infections and hospital visits; all patients weaned off oxygen; radiological scores improved; BMI increased	Retrospective uncontrolled but showed clinical and radiologic gains in severe PIBO
Teixeira et al[28] (2013) randomized control trial — 30 patients	Tiotropium (LAMA) ± short-acting β2 agonists	Improvement in acute FEV1, FVC and FEF25%-75%; bronchodilator reversibility seen in approximately 25% of PIBO patients in related studies	Suggests LAMAs may be useful in PIBO—especially those with some reversibility

ICS: Inhaled corticosteroids; FVC: Forced vital capacity; HRCT: High-resolution computed tomography; FAM: Fluticasone, azithromycin, and montelukast; BMI: Body mass index; PIBO: Post-infectious bronchiolitis obliterans; LAMAs: Long-acting muscarinic antagonists.