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

Table 6 Therapeutic interventions in post-infectious bronchiolitis obliterans children: Comparative efficacy, limitations, and strength of evidence for each strategy

Ref.	Efficacy	Limitations
Systemic corticosteroid pulses (IPMT) (Yoon et al[17], 2015)	Short-term FEV1 gains; better IPMT response with bronchial wall thickening on pre-treatment CT	Small, uncontrolled series; no symptom scores, no pulmonary function test, growth suppression; adverse effects
ICS (Zheng et al[25], 2022) (Zhang et al[26], 2018)	↑ in FEV1, FVC of continuous ICS group over 12 months; improved small-airway flows in toddlers	Retrospective; modest cohorts; adherence bias; durability beyond 1 year unknown
Azithromycin (macrolide) (Li et al[31], 2014)	Clinical stability in 86% when combined with steroids	Uncontrolled; symptom-based outcomes; risk of resistance
Tiotropium (LAMA) (Teixeira et al[28], 2013)	Good acute FEV1 increase	Small cohort; no placebo; unknown long-term impact
Intravenous immunoglobulin (IVIG) (Yilmaz et al[27], 2023)	Improved oxygenation; fewer infections in severe cases	Retrospective; no comparator; high cost; limited availability

Because no randomized, post-infectious bronchiolitis obliterans -specific trials exist, all current treatments for children remain empirical. The following hierarchy ranks interventions by pediatric evidence strength. IPMT: Intravenous pulse methylprednisolone therapy; ICS: Inhaled corticosteroids; CT: Computed tomography; FVC: Forced vital capacity; FEV₁: Forced expiratory volume in one second.