Detection of pulmonary complications in common variable immunodeficiency

Touw CML, van de Ven AA, de Jong PA, Terheggen-Lagro S, Beek E, Sanders EAM, van Montfrans JM. Detection of pulmonary complications in common variable immunodeficiency. Pediatr Allergy Immunol 2010: 21: 793-805. (c) 2009 John Wiley & Sons A/S Pulmonary complications are frequently observed in common variable immunodeficiency (CVID). We reviewed the literature related to radiologic imaging techniques and pulmonary function tests (PFT) for diagnosing pulmonary complications in CVID. Scientific publications related to CVID (or primary hypogammaglobulinemia), pulmonary complications, PFT, chest X-ray (CXR), and high-resolution computed tomography scan (HRCT) were detected in PubMed, Embase and in reference lists of selected articles. Twenty-six articles including 1047 patients (587 patients with CVID) were reviewed. Up to 73% of CVID patients develop chronic structural pulmonary complications, of which bronchiectasis and bronchial wall thickening are most frequently detected. HRCT is the most sensitive method for identification of structural abnormalities, detecting pulmonary complications that were missed on CXR and PFT in 2-59% of patients. On PFT, obstructive flow-volume curves were most commonly found, eventually occurring in 50-94% of patients. HRCT is an important diagnostic tool for pulmonary complications in CVID at the time of diagnosis and at regular time-points during follow-up, with the proper follow-up interval yet to be determined.