6533b859fe1ef96bd12b6e8b

RESEARCH PRODUCT

Impact of long-term treatment with inhaled corticosteroids and bronchodilators on lung function in a patient with post-infectious bronchiolitis obliterans

subject

description

Post-infectious bronchiolitis obliterans (PIBO) is a small airways disease characterized by fixed airflow limitation. Therefore, inhaled bronchodilators and corticosteroids are not recommended as maintenance therapy options. The management of PIBO currently consists only of close monitoring of affected patients, aimed at the prevention and early treatment of pulmonary infections. In recent years, there has been an increase in the incidence of PIBO in the pediatric population. Patients with PIBO are characterized by a progressive decline in lung function, accompanied by a decrease in overall functional capacity. Here, we report the case of a relatively young man diagnosed with PIBO and followed for three years. After short- and long-term therapy with an inhaled corticosteroid/long-acting 2 agonist combination, together with an inhaled long-acting antimuscarinic, the patient showed relevant improvement of airway obstruction that had been irreversible at the time of the bronchodilator test. The lung function of the patient worsened when he interrupted the triple inhaled therapy. In addition, a 3-week pulmonary rehabilitation program markedly improved his physical performance. RESUMO A bronquiolite obliterante pos-infecciosa (BOPI) e uma doenca das pequenas vias aereas caracterizada por limitacao fixa do fluxo aereo. Portanto, os broncodilatadores e os corticosteroides inalatorios nao sao recomendados como opcoes de terapia de manutencao. Atualmente, o manejo da BOPI consiste apenas de um acompanhamento rigoroso dos pacientes afetados, visando a prevencao e ao tratamento precoce de infeccoes pulmonares. A incidencia de BOPI tem aumentado na populacao pediatrica nos ultimos anos. Os pacientes com BOPI caracterizam-se por um declinio progressivo da funcao pulmonar, associado a uma diminuicao da capacidade funcional global. Relatamos aqui o caso de um homem relativamente jovem diagnosticado com BOPI, acompanhado por tres anos. Apos terapia de curto e de longo prazo com uma combinacao de corticosteroide/2-agonista de longa duracao inalatorios, associada a um agente antimuscarinico de longa duracao inalatorio, o paciente apresentou uma melhora relevante da obstrucao das vias aereas, a qual fora irreversivel durante o teste de broncodilatacao. A funcao pulmonar do paciente piorou quando ele interrompeu a terapia inalatoria tripla. Alem disso, um programa de reabilitacao pulmonar de tres semanas significativamente melhorou seu desempenho fisico.