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Lung structure abnormalities, but normal lung function in pediatric bronchiectasis
Francesca Santamaria1, Silvia Montella, Luigi Camera
1Department of Pediatrics, Federico II University, Naples, Italy.
Insights
Pediatric bronchiectasis is common, but lung function tests do not accurately reflect bronchial damage severity. High-resolution CT scans reveal structural abnormalities, even with normal pulmonary function in children.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Clinical Medicine
Background:
- Pediatric bronchiectasis is increasingly recognized as a significant clinical condition.
- The correlation between pulmonary function and the severity of bronchiectasis in children remains a subject of ongoing research and debate.
Purpose of the Study:
- To evaluate the extent and severity of bronchiectasis using high-resolution computed tomography (HRCT) scan scores.
- To investigate the relationship between HRCT findings and clinical, microbiological, and pulmonary function data in pediatric patients.
Main Methods:
- A cohort of 43 children diagnosed with bronchiectasis via HRCT was studied.
- The Reiff score was employed to assess bronchiectasis extent, bronchial wall thickening, and bronchial wall dilatation.
- Clinical, microbiological, and spirometry data were correlated with HRCT scores.
Main Results:
- The most frequently affected lobes were the right lower lobe (65%), middle lobe (56%), and left lower lobe (51%).
- No significant correlation was found between total HRCT scores (or subscores) and forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC).
- Asthma was present in 74% of patients; early cough onset (<2 years) correlated with atopy, asthma, and positive microbiological findings.
Conclusions:
- Normal lung function can coexist with HRCT-identified bronchial structural damage in pediatric bronchiectasis.
- Pulmonary function testing is not a reliable indicator for assessing the severity of lung disease in children with bronchiectasis.
Background:
Bronchiectasis is not considered to be uncommon in children anymore. The relationship between pulmonary function and severity of bronchiectasis is still controversial.
Study Objectives:
To assess the extent and severity of bronchiectasis through high-resolution CT (HRCT) scan score, and to correlate it with clinical, microbiological, and functional data.
Patients And Methods:
Forty-three white children with HRCT-diagnosed bronchiectasis were studied. Bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were evaluated using the Reiff score. Clinical, microbiological, and spirometry results were related to total HRCT scan score and to subscores as well.
Results:
The percentages of affected lobes were as follows: right lower lobe, 65%; middle lobe, 56%; left lower lobe, 51%; right upper lobe, 37%; lingula, 30%; and left upper lobe, 30% (chi(2) = 18.4; p = 0.002). The mean (+/- SEM) HRCT score was 20 +/- 2.6. Total score or subscores of bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were not significantly related to FEV(1) and FVC. Seventy-four percent of patients had asthma. The age at the onset of cough correlated with age at the time of the HRCT scan (p = 0.004) and with the presence of asthma (p = 0.01). Positive findings of deep throat or sputum cultures were found more frequently in atopic patients (p = 0.02) and asthmatic (p < 0.01) patients, and in children who were < 2 years of age at the onset of cough (p < 0.01).
Conclusions:
Normal lung function may coexist with HRCT scan abnormalities and does not exclude damage to the bronchial structure. Pulmonary function is not an accurate method for assessing the severity of lung disease in children with bronchiectasis.
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