title: Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy.
abstract: BACKGROUND
  Bronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. Here we report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy.
  
  
  METHODS
  Forty patients fulfilling the BO diagnosis criteria were treated with methylprednisolone pulse therapy in monthly cycles until clinical improvement. After the pulse therapy began, we analyzed the clinical and laboratory data at intervals. Statistical analyses were performed using non-parametric tests to compare repeated measures (Friedman, Wilcoxon) or paired nominal data (McNemar) (α = 5%).
  
  
  RESULTS
  The frequency of wheezing exacerbations and hospitalizations was reduced (p = 0.0042 and p < 0.0001, respectively) and oxygen saturation improved (p = 0.0002) in the pulse therapy-treated patients. Prolonged oral corticosteroid therapy was discontinued in 83% of these patients. The mean Z-score length for age improved from -1.08 to -0.63, and the mean Z-score weight for age improved from -0.91 to -0.59. The adverse effects during the infusion were temporary and none were serious.
  
  
  CONCLUSIONS
  Our data suggest that pulse corticotherapy could be a safe alternative to prolonged systemic oral corticotherapy in children with BO, thus minimizing the adverse effects of the oral therapy. New prospective controlled studies are required to confirm this proposition.
authors.affiliation: Pediatric Pulmonology Division, Instituto da Criança, Hospital das Clínicas, University of São Paulo, Avenida Dr Enéas de Carvalho Aguiar, 647, São Paulo, CEP 05403-000, SP, Brazil. silviatomi@yahoo.com.br.
authors.forename: Silvia Onoda
authors.initials: SO
authors.lastname: Tomikawa
authors.forename: Fabíola Villac
authors.initials: FV
authors.lastname: Adde
authors.forename: Luiz Vicente Ribeiro Ferreira
authors.initials: LV
authors.lastname: da Silva Filho
authors.forename: Claudio
authors.initials: C
authors.lastname: Leone
authors.forename: Joaquim Carlos
authors.initials: JC
authors.lastname: Rodrigues
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D000305:Adrenal Cortex Hormones