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Objectives: We describe the clinical spectrum, etiology, and progression of children with post-infectious bronchiolitis obliterans (PIBO) from a low- and middle-income setting for which there is limited literature. Materials and Methods: A cross-sectional, retrospective, and descriptive study between November 2019 and October 2020 of all PIBO patients aged 6 months to 15 years managed at pediatric pulmonology service in Cape Town, South Africa. Results: Fifty-one patients with PIBO were enrolled; 78% were males, median age of 60 months (IQR 33-107). Median age at disease presentation was 6 months (IQR 3-12), 80% presented with cough; 94% required hospital admission, 92% needed supplemental oxygen therapy and 75% needed ventilatory support. Reported cigarette smoke exposure was high (47%). Adenovirus infection was the most common etiology (64%). Chest radiographic findings included lung hyperinflation (43 [84.3%]) and bronchiectasis (23 [45%]). Twenty-seven patients had spirometry and showed mixed (41% [n = 8]) or obstructive (27% [n = 12]) pattern with mean (standard deviation) forced expiratory volume in 1s (FEV1) z-score -3.3 (± 1.4), forced vital capacity (FVC) z-scores -2.4 (± 1.6), and FEV1/FVC z-score -3.1 (± 2.4). Systemic corticosteroids were used during initial presentation in 47 patients (92%). Forty-four patients (86%) required two or more subsequent hospital admissions. Improvement of symptoms was reported in 82% of patients with a mean follow-up period of 5 years. Cough (43% [n = 22]) and wheeze (39% [n = 20)]) were the most common reported current symptoms. Conclusion: PIBO is a recognized cause of pediatric obstructive lung disease in South African settings, with adenovirus pneumonia being the most common preceding illness. Symptoms of airway obstruction persist over time, but improvement was observed with treatment including corticosteroids. [ABSTRACT FROM AUTHOR]

The article discusses the long-term impact of childhood disadvantage on lung function and respiratory health in adulthood. It highlights that many respiratory diseases in adults have their origins in early life, and various preconception, antenatal, and early life exposures can affect healthy lung development. Factors such as preterm birth, respiratory tract infections, familial atopy and asthma, maternal ill-health, social disadvantage, poor nutrition, and exposure to tobacco smoke and unclean air can contribute to impaired lung growth and lifelong disadvantage. The article suggests the use of lung health charts and a lung function tracker app to monitor lung development and intervene early. It emphasizes the importance of prioritizing children in low-income settings, where access to spirometry is lacking, and calls for global efforts to improve access to diagnostic tools for all children. The article also raises the question of whether preschool screening should be considered for high-risk children. Overall, the article emphasizes the need to prioritize children's well-being in decision-making and planning for the future. [Extracted from the article]