Response to letter regarding ‘risk factors for bronchiolitis obliterans in children with community-acquired pneumonia and analysis of CT findings and clinical manifestations of pneumonia after the diagnosis of bronchiolitis obliterans’

I respond Ahmet Kağan Özkaya et al. for their recent letter, ‘Letter to the editor regarding: ‘Risk factors for bronchiolitis obliterans in children with community-acquired pneumonia,’ which provides valuable insights into the predictors of this serious condition [1,2]. This commentary acknowledges the value of our research whilst highlighting four limitations: the failure to analyse associations between pathogens and risk factors; the advisability of combining scores for specific clinical symptoms; the presence of selection bias in bronchoscopy procedures; and the lack of data on the impact of treatment on risk. It recommends improvements in future studies.

First, we fully concur with the reviewer’s perspective that specific pathogens, particularly adenoviruses, are closely associated with the development of post-infectious bronchiolitis obliterans (PIBO). In the preliminary descriptive analysis of this study, we present the pathogen distribution among two groups of patients. However, owing to incomplete pathogenetic test results in some cases, the sample size may prove insufficient to support multivariate regression analysis following further stratification. In future studies, we shall expand our sample size and incorporate pathogen type as a stratification factor for analysis, thereby exploring the heterogeneity of risk factors across different infectious agents.

Second, the reviewers rightly pointed out that indicators such as dyspnea, shortness of breath, and the three depressions sign often manifest clinically as a continuum reflecting the severity of respiratory distress. We concur that integrating these relevant indicators into a composite score may facilitate a more holistic reflection of disease severity while mitigating multicollinearity issues. This approach offers valuable insights for subsequent development of clinical predictive models.

Third, we acknowledge the issue of selection bias in bronchoscopy highlighted by the reviewers. Indeed, bronchoscopy is typically employed in paediatric patients presenting with more severe clinical manifestations or poor response to treatment, which may result in the endoscopic finding of ‘endobronchitis’ being highly correlated with disease severity. Future prospective studies may endeavour to conduct bronchoscopy examinations under more standardised protocols to mitigate such biases.

Finally, reviewers recommend incorporating information on acute-phase treatments (such as the use of corticosteroids, intravenous immunoglobulin, or specific antimicrobial regimens.), which is crucial for exploring the relationship between early intervention measures and the risk of developing PIBO. This study employed a retrospective design, and certain treatment records were incomplete and thus excluded from analysis. We shall systematically collect treatment data in subsequent prospective studies to evaluate the impact of early intervention on long-term outcomes.

We extend our gratitude once more to Ahmet Kağan Özkaya and colleagues for their meticulous and insightful commentary. These suggestions have not only enriched the depth of discussion in this paper but also charted a course for our subsequent research. We look forward to conducting more rigorous and in-depth investigations in this field, with the aim of providing more robust evidence for the clinical prevention and treatment of PIBO.

Funding Statement

This work received no financial support

Disclosure statement

No potential conflict of interest was reported by the author.

Data availability statement

Data sharing is not applicable to this article as no datasets were generated during current study.