Should there be a management plan of children with post-infectious bronchiolitis obliterans and bronchiectasis?

Guidelines on follow-up of children with post-infectious bronchiolitis obliterans(PIBO) and/or bronchiectasis(BE) are scarce. Orientations are derived from other chronic lung diseases and adult studies. Aim: describe the management plan of children with PIBO and/or BE and analyse if it varies with lung function(LF). Methods: Retrospective review of medical records of children with PIBO and BE followed in a tertiary hospital for 2consecutive years(2018-9). Diagnosis based on history, LF and HRCT findings. Frequency of physician visits, spirometries and respiratory microbiology surveillance/year were recorded, as best LF parameters and nutritional status/year.Descriptive and regression analysis was done. Results: During the study period, 28 children [20 boys, median age 13.5yrs (7.1, 18.2), median duration of follow-up 9.6yrs(2.5, 15.4)], 16 with BOPI (plus BE 6; average z-score BMI -0.7, FEV1 -3.2, FEV1/FVC -2.6) and 12 with BE (average z-score BMI 0.4, FEV1 -0.5, FEV1/FVC -0.1) were regularly observed, on average, 2.7times/year (1 to 7) and performed 1.8spirometries/year (1 to 4) but only 4 had respiratory samples collected. 14 had been prescribed mucus clearance devices or educated on respiratory rehabilitation. No association between clinic visits and FEV1 was found. During this period,3 non-residents in Portugal were also observed,7 initiated follow-up and 10 were transferred/lost to follow-up. Method: Respiratory microbiology surveillance was low. In this small sample, LF alone did not instruct on follow-up. In the absence of guidelines, management is tailored to patients. Future directions should dictate minimal follow-up requirements for children with BOPI and BE.