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Clinical Pulmonary Function Testing for Children with Bronchopulmonary Dysplasia
Sooky Lum1, Andrew Bush2, Janet Stocks1
1Portex Respiratory Unit, UCL, Institute of Child Health, London, United Kingdom.
Insights
Children surviving extreme prematurity often develop bronchopulmonary dysplasia (BPD). Lung function deficits can persist, increasing lifelong respiratory risks, necessitating ongoing pulmonary function testing (PFTs).
Area of Science:
- Pediatrics
- Pulmonology
- Neonatology
Background:
- Bronchopulmonary dysplasia (BPD) affects many extremely preterm survivors, often defined by oxygen needs past 36 weeks postmenstrual age.
- While respiratory symptoms may seem to resolve, persistent lung function deficits pose lifelong risks.
- Current follow-up often prioritizes neurological issues, potentially overlooking long-term respiratory sequelae.
Purpose of the Study:
- To highlight the persistent respiratory risks in extremely preterm children with BPD.
- To emphasize the underutilization of pulmonary function tests (PFTs) in clinical management.
- To explore the potential role of PFTs in assessing school-aged children and adolescents with BPD history.
Main Methods:
- Review of existing research on PFTs in BPD survivors from infancy to adulthood.
- Analysis of the current clinical application and limitations of PFTs in managing BPD.
- Identification of specific PFT applications for school-aged and adolescent BPD survivors.
Main Results:
- PFTs are underused in clinical settings despite their research utility.
- PFTs have limited application in infants and preschoolers due to developmental factors.
- PFTs show potential for diagnosing asthma, exercise-induced bronchoconstriction, and pulmonary hypertension in older children.
Conclusions:
- Extremely preterm survivors with BPD face enduring lung function deficits and increased risk of adult lung disease.
- Objective PFT assessments are crucial for school-aged and adolescent BPD survivors to guide management and predict long-term outcomes.
- Integrating PFTs into clinical practice is essential for comprehensive care of BPD survivors.
Abstract:
Many more extremely preterm children are now surviving, many of whom develop bronchopulmonary dysplasia (BPD), most commonly defined as continuing supplemental oxygen requirements beyond 36 weeks postmenstrual age. Respiratory symptoms usually diminish with increasing lung growth and development, such that it may be assumed that the child has "outgrown" their breathing problems, with follow-up focusing on neurological problems. However, deficits in lung function may persist into school age and beyond, and such individuals are at increased risk of life-long respiratory problems. Although numerous research studies have utilized pulmonary function tests (PFTs) to investigate respiratory problems from infancy through to adulthood, these tests are less frequently used in the clinical management of individual children. With the exception of the hypoxic fitness-to-fly test, PFTs do not yet have a defined role in clinical management of infants surviving BPD and their applications in preschool children may be limited by the reduced concentration and coordination associated with extremely preterm birth. There is, however, a potentially important role for objective assessments using PFTs in school-age children and adolescents to determine whether there is coexistence of true asthma and exercise-induced bronchoconstriction or bronchomalacia, to evaluate exercise capacity and, in severe cases, to investigate the development of pulmonary hypertension. BPD-associated adult lung disease is likely to be seen with increased frequency as these individuals age.
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