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Differences and similarities between bronchopulmonary dysplasia and asthma in schoolchildren
Björn Nordlund1,2, Anna James3, Christina Ebersjö4,5
1Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.
Insights
Children with bronchopulmonary dysplasia (BPD) show reduced lung function and diffusion capacity by school age compared to asthma. BPD patients exhibit less airway inflammation but distinct airway hyperresponsiveness patterns.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Neonatology
Background:
- Long-term respiratory outcomes for ex-preterm children with bronchopulmonary dysplasia (BPD) remain unclear.
- This study investigates the school-age respiratory characteristics of BPD survivors.
Purpose of the Study:
- To characterize the respiratory profile of school-aged children with BPD.
- To compare these findings with those of children with atopic asthma.
Main Methods:
- A cross-sectional, comparative study involving 30 schoolchildren with BPD and 30 age/sex-matched children with asthma.
- Measurements included lung function, exhaled nitric oxide (FENO), bronchial provocation tests (methacholine and mannitol), and symptom assessment (C-ACT).
Main Results:
- Children with BPD had significantly reduced lung function (FEV1, FEV1/FVC, FEF50) and carbon monoxide diffusion capacity (DLCO%) compared to the asthma group.
- FENO levels were lower in the BPD group, suggesting less airway inflammation.
- While methacholine responsiveness was similar, BPD patients showed less mannitol responsiveness and fewer reported symptoms.
Conclusions:
- School-aged children with BPD exhibit impaired lung function and diffusion capacity.
- BPD is associated with distinct airway hyperresponsiveness patterns (hyper-responsive to direct stimuli, hypo-responsive to indirect stimuli) and reduced airway inflammation compared to atopic asthma.
Background:
The long-term respiratory characteristics of ex-preterm children with bronchopulmonary dysplasia (BPD) are not established. The objective of this study was to describe hallmarks of BPD at school age in comparison to children with atopic asthma.
Methods:
This study was a cross-sectional descriptive comparative study in a hospital-based setting. Thirty schoolchildren diagnosed with BPD (10.4 years/born at 26.6 weeks' gestation) and 30 age- and sex-matched children with asthma and sensitized to airborne allergens (IgE >0.35 kUA /L) were analyzed. Measurements included fraction of exhaled nitric oxide (FENO, ppb), dynamic and static lung function, and bronchial provocation with methacholine (PD:20) and mannitol (PD:15), as well as an evaluation of respiratory symptoms using the asthma control test (C-ACT).
Results:
Lung function measures (FEV1% 77 vs 84, FEV1/FVC% 85 vs 91, FEF50% 61 vs 80) and carbon monoxide diffusion capacity (DLCO%, 81 vs 88) were all reduced in children with BPD compared to asthma (P values <0.042). FENO values were also significantly lower in children with BPD (12 vs 23, P = 0.019). The proportion of positive methacholine tests (74% vs 93%, P = 0.14) was comparable between BPD and asthma. However, less responsiveness towards mannitol (19% vs 61%, P = 0.007) and fewer self-reported symptoms (C-ACT, median 26 vs 24, P = 0.003) were found in the BPD group.
Conclusion:
Respiratory hallmarks of BPD at school-age were reduced lung function, limited responsiveness towards indirectly acting mannitol but hyper-responsiveness towards direct acting methacholine and impairment in diffusion capacity. Children with BPD displayed less evidence of airway inflammation compared with atopic asthma.
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