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Infant pulmonary function tests in individuals with Down syndrome
Oded Breuer1, Laurice Boursheh1, Ephraim Bar-Yishay2
1Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Insights
Infants with Down syndrome exhibit fixed airflow obstruction, not restrictive lung disease, with decreased expiratory flows and altered breathing mechanics. This early-life lung disease requires further study for improved respiratory management in Down syndrome.
Area of Science:
- Pediatric Pulmonology
- Genetics and Respiratory Health
- Infant Lung Function
Background:
- Down syndrome is linked to significant respiratory issues.
- Previous studies indicated restrictive lung disease in older individuals with Down syndrome.
- Infant pulmonary function tests (iPFTs) in Down syndrome are not well-characterized.
Purpose of the Study:
- To evaluate infant pulmonary function tests (iPFTs) in infants with Down syndrome.
- To characterize early-life lung disease phenotypes in infants with Down syndrome.
- To compare iPFTs in infants with Down syndrome to a healthy control group.
Main Methods:
- Observational case-control study using registry data (2008-2018).
- Compared iPFTs from 20 infants with Down syndrome to 46 healthy controls.
- Statistical analysis included Mann-Whitney U and Fisher's exact tests.
Main Results:
- Infants with Down syndrome demonstrated an obstructive lung disease phenotype.
- Key findings include mildly increased lung volumes and significantly decreased expiratory flows.
- Airflow limitation was prominent at low lung volumes (V˙max FRC: 48% predicted vs. 100% in controls, p < 0.001).
- Reduced respiratory system compliance and increased airway resistance were observed.
Conclusions:
- Infants with Down syndrome present with a fixed airflow obstruction phenotype.
- This study provides crucial data on early-onset lung disease in Down syndrome.
- Further research is needed to optimize respiratory disease management in this population.
Background And Objective:
Down syndrome is associated with significant respiratory morbidity. The available pulmonary function testing data in school aged children and adults with Down show evidence of restrictive lung disease. We aimed to evaluated infant pulmonary function tests (iPFTs) in individuals with Down.
Methods:
An observational case-control study evaluating iPFTs results from a registry of patients assessed at the Hadassah Hebrew University Medical Center between 2008 and 2018. iPFTs results in Infants with Down were compared to a spirometry control group of infants with normal expiratory airflows, using the Mann-Whitney U and Fisher's exact tests.
Results:
iPFT data from 66 infants (20 Down and 46 control) were evaluated in the study. Most infants with Down showed abnormalities of an obstructive lung disease with mildly increased lung volumes and significantly decreased expiratory flows, mostly unresponsive to bronchodilators. Airflow limitations were most prominent at low lung volumes (median (IQR); maximal expiratory flow at functional residual capacity, V˙max FRC = 48 (26-78) %predicted in Down Vs. V˙max FRC = 100 (93-114) %predicted in controls, p < 0.001). We further observed an alteration in breathing mechanics with significantly decreased respiratory system compliance and increased airway resistance associated with decreased tidal volumes but similar minute ventilation.
Conclusion:
Our study shows that infants with have a fixed airflow obstruction phenotype. These results add comprehensive data to allow better understanding of the lung disease present early in life of infants with Down syndrome. Further studies are required to improve management of respiratory disease in individuals with Down.
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