Younger Age and Viral Triggers Were Associated With Post-Infectious Bronchiolitis Obliterans in French Children

Julie Mazenq^{1

2}, Marine Crebassa^{1

2}, Alice Hadchouel^{1

3}, Souad Ghattas^{1

3}, Philippe Reix^{1

4}, Laurianne Coutier^{1

4}, Christophe Marguet^{1

5}, Nadia Nathan^{1

6}, Lisa Giovannini-Chami^{1

7}, Caroline Thumerelle^{1

8}, François Galode^{1

9}, Marie-Catherine Renoux^{1

10}, Léa Roditis^{1

11}, Eglantine Hullo^{1

12}, Pierrick Cros^{1

13}, Laurence Weiss^{1

14}, Sébastien Kiefer^{1

15}, Marie Tochon^{1

16}, Brahim Allali^{1

17}, Katia Bessaci Kabouya^{1

18}, Céline Delestrain^{1

19}, Louisa Goumidi²⁰, Hortense Petat^{1

5}, Véronique Houdouin^{1

21}, Jean-Christophe Dubus^{1

2}

Affiliations

¹ French Reference Centre of Rare Lung Diseases (RespiRare), Paris, France.
² APHM-Paediatric Pulmonology Department, INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France.
³ AP-HP, Hôpital universitaire Necker-Enfants Malades, service de pneumologie pédiatrique, Université de Paris Cité, Paris, France.
⁴ Paediatric Pulmonology Department, UMR CNRS 5558, Equipe EMET, University Hospital, Lyon, France.
⁵ Department of Paediatrics and Adolescent Medicine, Inserm U1311 Dynamycure, FHU RESPIRE, Rouen-Univ Rouen Normandie, University Hospital, Paris, France.
⁶ Paediatric Pulmonology Department, AP-HP, Armand Trousseau Hospital, Sorbonne University, Paris, France.
⁷ Paediatric Pulmonology Department, University Hospital Lenval, Nice, France.
⁸ Paediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Univ. Lille, CHU Lille, Lille, France.
⁹ Paediatric Pulmonology Department, Clinical Investigation Centre (CIC 1401), Cardio-Thoracic Research Centre of Bordeaux, Inserm, University Hospital, Bordeaux University, Bordeaux, France.
¹⁰ Paediatric Pulmonology Department, University Hospital, Montpellier, France.
¹¹ Paediatric Pulmonology Department, University Hospital, Toulouse, France.
¹² Paediatric Pulmonology Department, University Hospital, Grenoble, France.
¹³ Paediatric Pulmonology Department, University Hospital, Brest, France.
¹⁴ Paediatric Pulmonology Department, University Hospital, Strasbourg, France.
¹⁵ Children's Hospital, University Hospital, Nancy, France.
¹⁶ Paediatric and Neonatal Department, Villefranche sur Saône Hospital, Gleizé, France.
¹⁷ Paediatric Pulmonology Department, University Hospital, Clermont Ferrand, France.
¹⁸ Paediatric Department, University Hospital, Reims, France.
¹⁹ Paediatric Department, Centre Hospitalier Intercommunal of Créteil, INSERM, IMRB, University Paris Est Créteil, Créteil, France.
²⁰ INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France.
²¹ Paediatric Pulmonology Department, AP-HP, Robert Debré Hospital, Paris University, Paris, France.

PMID: 40548825
PMCID: PMC12520280
DOI: 10.1111/apa.70188

Observational Study

Younger Age and Viral Triggers Were Associated With Post-Infectious Bronchiolitis Obliterans in French Children

Julie Mazenq et al. Acta Paediatr. 2025 Nov.

. 2025 Nov;114(11):2900-2908.

doi: 10.1111/apa.70188. Epub 2025 Jun 23.

Authors

Affiliations

¹ French Reference Centre of Rare Lung Diseases (RespiRare), Paris, France.
² APHM-Paediatric Pulmonology Department, INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France.
³ AP-HP, Hôpital universitaire Necker-Enfants Malades, service de pneumologie pédiatrique, Université de Paris Cité, Paris, France.
⁴ Paediatric Pulmonology Department, UMR CNRS 5558, Equipe EMET, University Hospital, Lyon, France.
⁵ Department of Paediatrics and Adolescent Medicine, Inserm U1311 Dynamycure, FHU RESPIRE, Rouen-Univ Rouen Normandie, University Hospital, Paris, France.
⁶ Paediatric Pulmonology Department, AP-HP, Armand Trousseau Hospital, Sorbonne University, Paris, France.
⁷ Paediatric Pulmonology Department, University Hospital Lenval, Nice, France.
⁸ Paediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Univ. Lille, CHU Lille, Lille, France.
⁹ Paediatric Pulmonology Department, Clinical Investigation Centre (CIC 1401), Cardio-Thoracic Research Centre of Bordeaux, Inserm, University Hospital, Bordeaux University, Bordeaux, France.
¹⁰ Paediatric Pulmonology Department, University Hospital, Montpellier, France.
¹¹ Paediatric Pulmonology Department, University Hospital, Toulouse, France.
¹² Paediatric Pulmonology Department, University Hospital, Grenoble, France.
¹³ Paediatric Pulmonology Department, University Hospital, Brest, France.
¹⁴ Paediatric Pulmonology Department, University Hospital, Strasbourg, France.
¹⁵ Children's Hospital, University Hospital, Nancy, France.
¹⁶ Paediatric and Neonatal Department, Villefranche sur Saône Hospital, Gleizé, France.
¹⁷ Paediatric Pulmonology Department, University Hospital, Clermont Ferrand, France.
¹⁸ Paediatric Department, University Hospital, Reims, France.
¹⁹ Paediatric Department, Centre Hospitalier Intercommunal of Créteil, INSERM, IMRB, University Paris Est Créteil, Créteil, France.
²⁰ INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France.
²¹ Paediatric Pulmonology Department, AP-HP, Robert Debré Hospital, Paris University, Paris, France.

PMID: 40548825
PMCID: PMC12520280
DOI: 10.1111/apa.70188

Abstract

Aim: Post-infectious bronchiolitis obliterans (PIBO) is a rare but severe chronic paediatric obstructive lung disease, characterised by the obliteration of small airways following severe lower respiratory tract infections. Epidemiological data in Europe remain limited.

Methods: This multicentre retrospective study examined the characteristics of paediatric patients diagnosed with PIBO from 2017 to 2023. Carried out by the French Reference Centre of Rare Lung Diseases network, it was based on clinical and radiological criteria and included age at diagnosis, medical history, symptoms, initial triggers, treatment, and outcomes.

Results: The study comprised 147 patients (58.5% male) diagnosed by 18 tertiary centres at a median age of 22 months. Most (83.7%) were hospitalised for the suspected initial infection: 36.7% in intensive care units and 47.0% in acute care wards. A younger age at diagnosis was associated with higher hospitalisation rates (p = 0.01). Microbiological triggers were identified in 66.0%, mostly adenoviruses (28.5%) and the respiratory syncytial virus (26.4%), often as co-infections. Lung function tests were performed on 23.1% of patients and bronchoscopies on 66.9%. Treatment included inhaled corticosteroids (90.5%), azithromycin (59.2%) and intravenous corticosteroid pulses (40.8%).

Conclusion: Age and causative agents were key factors in the initial severity of the infection that led to paediatric PIBO in our study.

Keywords: adenoviruses; post‐infectious bronchiolitis obliterans; rare diseases; respiratory syncytial virus.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**FIGURE 1**
Primary symptoms at the time of diagnosis among 147 French paediatric patients followed up for post‐infectious bronchiolitis obliterans.

**FIGURE 2**
The severity of the initial suspected infection was classified according to three age groups in French paediatric patients and followed up for post‐infectious bronchiolitis obliterans. Severity was based on no admission to hospital, acute care admission, or intensive care unit admission.

**FIGURE 3**
Microbiological agent linked to the initial suspected infection according to three age groups in French paediatric patients followed up for post‐infectious bronchiolitis obliterans. Expressed as absolute values.

See this image and copyright information in PMC

References

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Younger Age and Viral Triggers Were Associated With Post-Infectious Bronchiolitis Obliterans in French Children

Affiliations

Younger Age and Viral Triggers Were Associated With Post-Infectious Bronchiolitis Obliterans in French Children

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources