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Childhood sequelae of infant lung disease: exercise and pulmonary function abnormalities after bronchopulmonary
Insights
Children surviving bronchopulmonary dysplasia (BPD) show long-term airway obstruction and hyperinflation. While aerobic fitness is maintained, it comes at the cost of reduced oxygen levels during exercise.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Exercise Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- Long-term outcomes and exercise tolerance in BPD survivors are not fully understood.
Purpose of the Study:
- To assess long-term pulmonary sequelae in BPD survivors.
- To evaluate the effect of BPD on exercise tolerance.
Main Methods:
- Studied 10 children with BPD history and 8 age-matched controls.
- Performed pulmonary function tests and graded exercise stress tests.
- Measured gas exchange (SaO2, tcPCO2) and oxygen consumption during exercise.
Main Results:
- BPD survivors exhibited abnormal lung function, including airway obstruction and hyperinflation.
- Exercise led to decreased SaO2 and increased tcPCO2 in the BPD group.
- 50% of BPD survivors experienced exercise-induced bronchospasm; maximal oxygen consumption was similar between groups.
Conclusions:
- Long-term BPD survivors have persistent airway obstruction and hyperreactivity.
- Aerobic fitness is achieved but with significant gas exchange impairment during exertion.
- BPD sequelae impact respiratory function during physical activity.
Abstract:
To determine the long-term pulmonary sequelae and effect on exercise tolerance of bronchopulmonary dysplasia (BPD), we studied 10 children at a mean age of 10.4 years, who had been born prematurely, survived respiratory distress syndrome, and subsequently developed BPD, and compared them with eight age-matched normal children born at term. Pulmonary function tests and graded exercise stress tests were performed. Residual volume, the ratio between residual volume and total lung capacity, vital capacity, forced expiratory volume in 1 second, forced expiratory flow between 25% and 75% of vital capacity, and maximal expiratory flows at 80%, 70%, and 60% of total lung capacity were all abnormal (P less than 0.02) in the children with BPD, compared with control values. Pre-exercise transcutaneous CO2 tension was higher (P less than 0.05) in the BPD group than in the control group. At maximal workload, tcPCO2 remained high in patients with BPD compared with control values (P less than 0.05). Arterial oxygen saturation at maximal workload fell below pre-exercise levels in the BPD group (P less than 0.05) but not in control children. There were no differences in maximal oxygen consumption between the BPD group and control children. Exercise-induced bronchospasm occurred in 50% of the BPD group, but not in the control group. We conclude that long-term survivors of BPD have evidence of airway obstruction, hyperinflation, and airway hyperreactivity, compared with a control group. Aerobic fitness was not significantly different in the BPD and control groups, but was achieved in the BPD group at the expense of a fall in SaO2 and a rise in tcPCO2.