Publish in this journal
Journal Information
Vol. 94. Num. 4.July - August 2018
Pages 337-454
Share
Share
Download PDF
More article options
Visits
160
Vol. 94. Num. 4.July - August 2018
Pages 337-454
Editorial
DOI: 10.1016/j.jped.2018.01.001
Post-infectious bronchiolitis obliterans in children: is general quality of life the right measure?
Bronquiolite obliterante pós-infecciosa em crianças: a qualidade de vida geral é a medida certa?
Visits
160
David Gozal
University of Chicago, Biological Sciences Division, Pritzker School of Medicine, Department of Pediatrics, Sections of Pediatric Pulmonology and Sleep Medicine, Chicago, United States
Related content
J Pediatr (Rio J).2018;94:374-910.1016/j.jped.2017.07.021
Edgar E. Sarria, Eduardo Mundstock, Denise G. Machado, Helena T. Mocelin, Gilberto B. Fischer, Silvana P. Furlan, Ivan C.F. Antonello, Ricardo Stein, Rita Mattiello
This item has received
160
Visits
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text

In recent years, the long-term survival of many chronic progressive pulmonary diseases has improved; with such progress, the attention has also shifted from strictly focusing on physiological measurements of lung function and other physical characteristics to incorporating quality of life (QOL) assessments, with the latter reflecting a degree of interdependency with the severity of the respiratory condition. For example, in patients with cystic fibrosis (CF), factors such as body mass index, a correlate of nutritional status, and FEV1, a reporter of overall expiratory flow limitation and bronchial involvement, have emerged as important factors contributing to QOL.1 Similarly, the frequency of hospital admissions for pulmonary exacerbations, sleep quality, adherence, depression, and physical activity measures are also major contributors to QOL ratings in CF.2–7 As a corollary, reduced QOL is reported by children with non-CF bronchiectatic diseases8 and disease-specific QOL tools have been developed for assessing asthmatic children,9–11 further reinforcing the importance of a comprehensive evaluation that attests to integrative functioning in the context of chronic illness, while also potentially serving as an objective follow-up and longitudinal monitoring instrument.12 In this context, Sarria et al. now report their QOL findings among 34 children suffering from post-infectious bronchiolitis obliterans (PIBO) compared to 34 controls.13 PIBO is a frequently irreversible obstructive lung disease characterized by sub-epithelial inflammation and fibrotic narrowing of the smaller airways following a lower respiratory tract infection during early childhood. Despite its typical history and clinical examination, the diagnosis is characteristically confirmed by bioptic histopathological assessments along with pertinent radiological findings consisting of heterogeneous vascular perfusion alterations along with air trapping with or without bronchiectasis.14,15 Indeed, since lung function tests are either not feasible or require specialized settings in young children, implementation of such approaches for the diagnosis of PIBO is woefully inadequate at best.16–20 As would be anticipated from patients suffering from chronic obstructive respiratory symptoms that are likely to affect their capacity for physical activity, as well as other functions during day and night,21 the overall QOL was reduced in PIBO patients in both the health-related and school-related domains of the well-validated instrument that was used.22 Thus, the findings attest to the significant impact that this relatively rare, yet important diagnostic entity imposes on living conditions. Some limitations to this study deserve comment, to instigate future research. First, it would have been of interest to explore potential associations between available spirometric measurements and QOL measures, Secondly, the inclusion of a physical activity test such as the six-minute walk test (6-MWT) would be highly desirable, as would be the evaluation with overnight polysomnography (PSG); the potential independent contributions of 6-MWT performance and PSG findings to QOL could provide further insights as to the major determinants of QOL. Finally, and as raised by the investigators, future longitudinal periodic and concurrent assessments of clinical, radiological, functional, and QOL measures may shed some light as to the potentially important value of assessing QOL as a readily available, yet easy to obtain score that provides insights into disease severity, response to therapy, and prognostic tracking.

In summary and unsurprisingly, similar to many chronic respiratory diseases, PIBO adversely affects QOL in children. This interesting article should be a reminder to all of us pediatricians that the term “breath of life” is meaningful and should not be taken for granted.

Conflicts of interest

The author declares no conflicts of interest.

References
[1]
Habib A-RR,J. Manji,P.G. Wilcox,A.R. Javer,J.A. Buxton,B.S. Quon
A systematic review of factors associated with health-related quality of life in adolescents and adults with cystic fibrosis
Ann Am Thorac Soc, 12 (2015), pp. 420-428 http://dx.doi.org/10.1513/AnnalsATS.201408-393OC
[2]
H. Hebestreit,S. Kriemler,T. Radtke
Exercise for all cystic fibrosis patients: is the evidence strengthening?
Curr Opin Pulm Med, 21 (2015), pp. 591-595 http://dx.doi.org/10.1097/MCP.0000000000000214
[3]
C.T. Solem,M. Vera-Llonch,S. Liu,M. Botteman,B. Castiglione
Impact of pulmonary exacerbations and lung function on generic health-related quality of life in patients with cystic fibrosis
Health Qual Life Outcomes, 14 (2016), pp. 63 http://dx.doi.org/10.1186/s12955-016-0465-z
[4]
K. Vandekerckhove,M. Keyzer,J. Cornette,I. Coomans,F. Pyl,F. De Baets
Exercise performance and quality of life in children with cystic fibrosis and mildly impaired lung function: relation with antibiotic treatments and hospitalization
Eur J Pediatr, 176 (2017), pp. 1689-1696 http://dx.doi.org/10.1007/s00431-017-3024-7
[5]
M. Vandeleur,L.M. Walter,D.S. Armstrong,P. Robinson,G.M. Nixon,R.S. Horne
Quality of life and mood in children with cystic fibrosis: associations with sleep quality
J Cyst Fibros, (2017),
Dec 24.
[6]
M. van Horck,B. Winkens,G. Wesseling,K. de Winter-de Groot,I. de Vreede,Q. Jöbsis
Factors associated with changes in health-related quality of life in children with cystic fibrosis during 1-year follow-up
Eur J Pediatr, 176 (2017), pp. 1047-1054 http://dx.doi.org/10.1007/s00431-017-2928-6
[7]
K.B. Knudsen,T. Pressler,L.H. Mortensen,M. Jarden,M. Skov,A.L. Quittner
Associations between adherence, depressive symptoms and health-related quality of life in young adults with cystic fibrosis
[8]
A.M. Nathan,J.A. de Bruyne,K.P. Eg,S. Thavagnanam
Review: quality of life in children with non-cystic fibrosis bronchiectasis
Front Pediatr, 5 (2017), pp. 84 http://dx.doi.org/10.3389/fped.2017.00084
[9]
C. Roncada,R. Mattiello,P.M. Pitrez,E.E. Sarria
Specific instruments to assess quality of life in children and adolescents with asthma
J Pediatr (Rio J), 89 (2013), pp. 217-225
[10]
R.S. Everhart,B.H. Fiese
Asthma severity and child quality of life in pediatric asthma: a systematic review
Patient Educ Couns, 75 (2009), pp. 162-168 http://dx.doi.org/10.1016/j.pec.2008.10.001
[11]
C.F. Chiou,M.R. Weaver,M.A. Bell,T.A. Lee,J.W. Krieger
Development of the multi-attribute Pediatric Asthma Health Outcome Measure (PAHOM)
Int J Qual Health Care, 17 (2005), pp. 23-30 http://dx.doi.org/10.1093/intqhc/mzh086
[12]
E.F. Juniper
How important is quality of life in pediatric asthma?
Pediatr Pulmonol Suppl, 15 (1997), pp. 17-21
[13]
E.E. Sarria,E. Mundstock,D.G. Machado,H.T. Mocelin,G.B. Fischer,S.P. Furlan
Health-related quality of life in patients with bronchiolitis obliterans
J Pediatr (Rio J), 94 (2018), pp. 374-379
[14]
L. Zhang,K. Irion,N. da Silva Porto,F. Abreu e Silva
High-resolution computed tomography in pediatric patients with postinfectious bronchiolitis obliterans
J Thorac Imaging, 14 (1999), pp. 85-89
[15]
R. Mattiello,E.E. Sarria,J. Mallol,G.B. Fischer,H. Mocelin,R. Bello
Post-infectious bronchiolitis obliterans: can CT scan findings at early age anticipate lung function?
Pediatr Pulmonol, 45 (2010), pp. 315-319 http://dx.doi.org/10.1002/ppul.21115
[16]
A.J. Colom,A.M. Teper
Clinical prediction rule to diagnose post-infectious bronchiolitis obliterans in children
Pediatr Pulmonol, 44 (2009), pp. 1065-1069 http://dx.doi.org/10.1002/ppul.21080
[17]
R.A. Mosquera,S.S. Hashmi,S.E. Pacheco,A. Reverdin,J. Chevallier,G.N. Colasurdo
Dysanaptic growth of lung and airway in children with post-infectious bronchiolitis obliterans
Clin Respir J, 8 (2014), pp. 63-71 http://dx.doi.org/10.1111/crj.12037
[18]
S. Cazzato,V. Poletti,F. Bernardi,L. Loroni,L. Bertelli,S. Colonna
Airway inflammation and lung function decline in childhood post-infectious bronchiolitis obliterans
Pediatr Pulmonol, 43 (2008), pp. 381-390 http://dx.doi.org/10.1002/ppul.20784
[19]
V. Aguerre,C. Castanos,H.G. Pena,M. Grenoville,P. Murtagh
Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings
Pediatr Pulmonol, 45 (2010), pp. 1180-1185 http://dx.doi.org/10.1002/ppul.21304
[20]
E. Lee,J. Yoon,H.J. Cho,S.J. Hong,J. Yu
Respiratory reactance in children aged three to five years with postinfectious bronchiolitis obliterans is higher than in those with asthma
Acta Paediatr, 106 (2017), pp. 81-86 http://dx.doi.org/10.1111/apa.13632
[21]
R. Mattiello,E.E. Sarria,R. Stein,G.B. Fischer,H.T. Mocelin,S.S. Barreto
Functional capacity assessment in children and adolescents with post-infectious bronchiolitis obliterans
J Pediatr (Rio J), 84 (2008), pp. 337-343
[22]
D.A. Klatchoian,C.A. Len,M.T. Terreri,M. Silva,C. Itamoto,R.M. Ciconelli
Quality of life of children and adolescents from São Paulo: reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory TM version 4.0 Generic Core Scales
J Pediatr (Rio J), 84 (2008), pp. 308-315

Please cite this article as: Gozal D. Post-infectious bronchiolitis obliterans in children: is general quality of life the right measure?. J Pediatr (Rio J). 2018;94:340–1.

See paper by Sarria et al. in pages 374–9.

Copyright © 2018. Sociedade Brasileira de Pediatria
Idiomas
Jornal de Pediatria (English Edition)

Subscribe to our Newsletter

Article options
Tools
en pt
Taxa de publicaçao Publication fee
Os artigos submetidos a partir de 1º de setembro de 2018, que forem aceitos para publicação no Jornal de Pediatria, estarão sujeitos a uma taxa para que tenham sua publicação garantida. O artigo aceito somente será publicado após a comprovação do pagamento da taxa de publicação. Ao submeterem o manuscrito a este jornal, os autores concordam com esses termos. A submissão dos manuscritos continua gratuita. Para mais informações, contate assessoria@jped.com.br. Articles submitted as of September 1, 2018, which are accepted for publication in the Jornal de Pediatria, will be subject to a fee to have their publication guaranteed. The accepted article will only be published after proof of the publication fee payment. By submitting the manuscript to this journal, the authors agree to these terms. Manuscript submission remains free of charge. For more information, contact assessoria@jped.com.br.
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.