Postinfectious Bronchiolitis Obliterans: Knowledge, Attitude, and Practice Survey

Abstract Objective: The objective of the study was to outline what is commonly understood, perceived, and followed at individual institutions across the country on the subject of postinfectious bronchiolitis obliterans (PIBO). Methodology: A 64-item web-based questionnaire with three sections addressing key domains in PIBO was employed. The questionnaire assessed knowledge points, attitudes, and practice essentials which were consolidated and analyzed. Results: The questionnaire was completed by 40 pediatricians/subspecialists across 15 cities in India, and 88% of them were pediatric pulmonologists. Adenovirus was the most commonly known virus to cause PIBO. Age at initial lower respiratory infection, need for prolonged oxygen support, requirement of mechanical ventilation, need for systemic steroids, and longer duration of hospital stay were perceived to be risk factors for PIBO by >75% of respondents. The prognosis was thought to be favorable by 75% of respondents. Corticosteroids, either as daily oral (50%) or monthly intravenous (70%), were the most preferred treatment option. Inhaled corticosteroids and azithromycin were employed as add-on therapies by >80% of consultants. While 61.5% were aware of combination therapies such as fluticasone, azithromycin, and montelukast (FAM)/budesonide, azithromycin, and montelukast (BAM) therapies, only 48.7% used them. Up to 10% of children were observed to need second-line treatment by our respondents, but the choice of drug and time of institution exhibited discrepancies. Conclusions: There is a sizeable ambiguity in practices concerning PIBO. This uncertainty calls for a review and consensus among Indian practitioners.