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Long-Term Lung Function and Exercise Capacity in Postinfectious chILD.
Pediatric Allergy, Immunology, and Pulmonology ( IF 0.9 ) Pub Date : 2019-04-30 , DOI: 10.1089/ped.2018.0973
Yagmur Sisman 1 , Frederik F Buchvald 1 , Astrid Madsen Ring 1 , Katharina Wassilew 2 , Kim Gjerum Nielsen 1
Affiliation  

Background: Severe postinfectious diffuse pulmonary disease may clinically mimic other entities of children's interstitial lung disease and is clinically challenging comprising various disease severities despite treatment. Long-term lung function trend and physical capacity in children with postinfectious diffuse pulmonary disease are rarely reported. We investigated trends in pulmonary function by long-term follow-up and assessed physical capacity in such patients. Methods: We performed a descriptive, single-center follow-up study in children with biopsy-verified postinfectious diffuse pulmonary disease. Patients with completed primary treatment course were eligible for follow-up, including pulmonary function and exercise (VO2peak) testing. Results: Thirty patients with postinfectious diffuse pulmonary disease were identified and included. Median (range) age at diagnose was 27.5 (2-172) months after a mean lag time of 23 months. H. influenzae and rhinovirus were the most frequent pathogens. Fifteen patients were available for follow-up after mean (range) 7.6 (2-15) years of treatment completion. Lung clearance index (LCI2.5), forced expiratory volume in 1 second (FEV1), and bronchodilator responsiveness were abnormal in 80%, 53%, and 44%, respectively. Diffusion capacity for monoxide was abnormal in 7% and total lung capacity in 33%. Only 8% demonstrated low VO2peak, while 40% reported difficulties during physical exertion. Longitudinal data on spirometry (n = 14) remained unchanged from end of treatment throughout follow-up. A significant association was found between zLCI2.5 and zFEV1 (multiple linear regression; r 2 = 0.61; P = 0.0003). Conclusion: Postinfectious diffuse pulmonary disease in children carries a varying degree of chronic pulmonary impairment with onset of symptoms in the first months of life and a typical considerable lag time before diagnosis. Follow-up several years after the initial injury demonstrated moderate-to-severe peripheral airway impairment although no further lung function decline was found years after completion of treatment. Despite acceptable VO2peak, a considerable proportion struggled during heavy exercise.

中文翻译:

感染后儿童的长期肺功能和运动能力。

背景:严重的感染后弥漫性肺部疾病可能在临床上模仿儿童间质性肺部疾病的其他实体,并且尽管具有治疗效果,但在临床上仍具有挑战性,包括各种疾病的严重程度。感染后弥漫性肺病患儿的长期肺功能趋势和身体机能很少报道。我们通过长期随访研究了肺功能的趋势,并评估了此类患者的身体能力。方法:我们对经活检证实为感染后弥漫性肺病的儿童进行了描述性,单中心随访研究。完成基本治疗过程的患者符合随访条件,包括肺功能和运动(VO2peak)测试。结果:确定并纳入了30例感染后弥漫性肺部疾病的患者。平均滞后时间为23个月后,诊断时的中位(范围)年龄为27.5(2-172)个月。流感嗜血杆菌和鼻病毒是最常见的病原体。在平均(范围)7.6(2-15)年的治疗完成后,有15位患者可以进行随访。肺清除指数(LCI2.5),1秒强迫呼气量(FEV1)和支气管扩张药反应率分别为80%,53%和44%。一氧化氮的扩散能力异常为7%,总肺容量为33%。只有8%的人表现出较低的VO2peak,而40%的人则表现出体力消耗困难。从治疗结束到整个随访期间,肺活量测定的纵向数据(n = 14)保持不变。在zLCI2.5和zFEV1之间发现了显着关联(多重线性回归; r 2 = 0.61; P = 0.0003)。结论:儿童感染后的弥漫性肺部疾病在生命的最初几个月中会出现不同程度的慢性肺功能不全,出现症状,诊断之前通常会有相当长的滞后时间。初始损伤数年后的随访显示中度至重度外周气道受损,尽管在完成治疗后数年未发现肺功能进一步下降。尽管VO2peak可以接受,但仍有很大一部分人在剧烈运动中挣扎。初始损伤数年后的随访显示中度至重度外周气道受损,尽管在完成治疗后数年未发现肺功能进一步下降。尽管VO2peak可以接受,但仍有很大一部分人在剧烈运动中挣扎。初始损伤数年后的随访显示中度至重度外周气道受损,尽管在完成治疗后数年未发现肺功能进一步下降。尽管VO2peak可以接受,但仍有很大一部分人在剧烈运动中挣扎。
更新日期:2019-11-01
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