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Lung clearance index and diffusion capacity for CO to detect early functional pulmonary impairment in children with
Julia Hildebrandt1, Anja Rahn1, Anja Kessler1
1Department of Pediatrics, Rostock University Medical Centre, Ernst-Heydemann Strasse 8, DE 18057, Rostock, Germany.
Insights
The lung clearance index (LCI) is more sensitive than diffusion capacity for carbon monoxide (DLCO) in detecting early lung impairment in children with rheumatic diseases. LCI is a feasible, non-invasive tool for routine follow-up.
Area of Science:
- Pediatric Rheumatology
- Pulmonary Medicine
- Diagnostic Imaging
Background:
- Pulmonary complications significantly impact morbidity and mortality in adults with rheumatic diseases.
- Early pulmonary impairment, undetectable by spirometry or clinical signs, is suspected in children with rheumatic diseases.
- Diffusion capacity for carbon monoxide (DLCO) is an established but cooperation-dependent method for detecting lung impairment.
Purpose of the Study:
- To compare the efficacy of lung clearance index (LCI) versus DLCO in detecting early functional pulmonary impairment in children with rheumatic diseases.
- To evaluate LCI as a non-invasive, less cooperation-dependent alternative to DLCO for pediatric pulmonary function testing.
Main Methods:
- Nineteen pediatric patients (ages 9-17) with rheumatic disease and no clinical pulmonary signs underwent both LCI and DLCO testing.
- Testing was conducted during routine annual check-ups.
- LCI was assessed using tidal breathing, while DLCO involved forced breathing and breath-holding maneuvers.
Main Results:
- LCI demonstrated higher sensitivity than DLCO in detecting early functional pulmonary impairment (p=0.0128).
- Eight patients showed elevated LCI with normal DLCO, indicating subclinical impairment.
- Nine patients exhibited abnormal findings in both LCI and DLCO tests.
Conclusions:
- Early functional pulmonary impairment is prevalent in children with rheumatic diseases.
- LCI is a sensitive, feasible, and non-invasive method for early detection of pulmonary changes in this population.
- Integration of LCI into routine follow-up for pediatric rheumatic diseases is recommended due to its advantages over DLCO.
Background:
In adults with rheumatic diseases pulmonary complications are relevant contributors to morbidity and mortality. In these patients diffusion capacity for CO (DLCO) is an established method to detect early pulmonary impairment. Pilot studies using DLCO indicate that early functional pulmonary impairment is present even in children with rheumatic disease albeit not detectable by spirometry and without clinical signs of pulmonary disease. Since the lung clearance index (LCI) is also a non-invasive, feasible and established method to detect early functional pulmonary impairment especially in children and because it requires less cooperation (tidal breathing), we compared LCI versus DLCO (forced breathing and breath-holding manoeuvre) in children with rheumatic diseases.
Findings:
Nineteen patients (age 9-17 years) with rheumatic disease and no clinical signs of pulmonary disease successfully completed LCI and DLCO during annual check-up. In 2 patients LCI and DLCO were within physiological limits. By contrast, elevated LCI combined with physiological results for DLCO were seen in 8 patients and in 9 patients both, the LCI and DLCO indicate early functional pulmonary changes. Overall, LCI was more sensitive than DLCO to detect early functional pulmonary impairment (p = 0.0128).
Conclusions:
Our findings suggest that early functional pulmonary impairment is already present in children with rheumatic diseases. LCI is a very feasible and non-invasive alternative for detection of early functional pulmonary impairment in children. It is more sensitive and less cooperation dependent than DLCO. Therefore, we suggest to integrate LCI in routine follow-up of rheumatic diseases in children.
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