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Pulmonary Evaluation in Children with Post-COVID-19 Condition Respiratory Symptoms: A Prospective Cohort Study
Einat Shmueli1,2, Ophir Bar-On1, Ben Amir2
1Pulmonology Institute, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel.
Insights
Pediatric post-COVID-19 condition (PCC) often presents with mild obstructive patterns in pulmonary function tests (PFTs), not diffusion limitations seen in adults. Many children show PFT improvement over time, suggesting potential benefits from inhaler therapy.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Respiratory Medicine
Background:
- Adult post-COVID-19 condition (PCC) studies frequently report pulmonary function test (PFT) abnormalities, particularly diffusion limitation.
- Limited data exists on PFTs in pediatric PCC, necessitating further investigation into respiratory sequelae in children.
- Understanding PFT changes in children with PCC is crucial for accurate diagnosis and management.
Purpose of the Study:
- To characterize pulmonary function test (PFT) abnormalities in children diagnosed with post-COVID-19 condition (PCC).
- To assess the longitudinal changes in PFTs among pediatric PCC patients.
- To identify predictors of abnormal PFTs in children experiencing respiratory symptoms post-COVID-19.
Main Methods:
- Prospective longitudinal study involving 184 children with defined PCC and respiratory complaints.
- Data collected from a multidisciplinary clinic between November 2020 and December 2022.
- Pulmonary function tests (PFTs), including spirometry, exercise challenge tests, bronchodilator reversibility, lung volumes, diffusion capacity, and exhaled nitric oxide, were performed.
Main Results:
- A mild obstructive pattern on PFTs was observed in 11% of children, with most lacking a prior asthma diagnosis.
- Lung volumes and diffusion capacity were largely normal, contrasting with adult findings; elevated exhaled nitric oxide was noted in 22%.
- Follow-up PFTs showed improvement or normalization in 33 children; older age and specific imaging findings predicted obstructive patterns.
Conclusions:
- The primary PFT abnormality in pediatric PCC with respiratory symptoms is a mild obstructive pattern, often without a history of asthma.
- Unlike adults, significant diffusion limitation was not observed in this pediatric cohort.
- Long-term follow-up indicates PFT improvement, and empirical inhaler therapy may be considered for children with risk factors for PFT abnormalities.
Abstract:
Background: Studies on post-COVID-19 condition (PCC) in adults have shown deterioration in pulmonary function tests (PFTs), mainly a diffusion limitation. Among the pediatric population, data are scarce. Aim: To characterize PFTs in children with PCC, including changes over time. Methods: A prospective longitudinal study of children with defined PCC and respiratory complaints who were referred to a designated multidisciplinary clinic from 11/2020 to 12/2022. Results: Altogether, 184 children with a mean age of 12.4 years (SD 4.06) were included. A mild obstructive pattern was demonstrated in 19/170 (11%) at presentation, as indicated by spirometry and/or positive exercise challenge test and/or reversibility post bronchodilators, only three had a previous diagnosis of asthma. Lung volumes and diffusion were normal in all but one patient (1/134, 0.7%). Exhaled nitric oxide levels were elevated in 32/144 (22%). A total of 33 children who had repeated PFTs had normal or near-normal PFTs on follow-up testing, including seven (21.2%) who had mild obstructive PFTs at presentation. Multivariate analysis identified older age [OR 1.36 (95% CI:1.07-1.75)], specific imaging findings (prominent bronchovascular markings (OR 43.28 (95% CI: 4.50-416.49)), and hyperinflation (OR 28.42, 95% CI: 2.18-370.84)] as significant predictors of an obstructive pattern on PFTs. Conclusions: In children with PCC and respiratory symptoms, the most common impairment was a mild obstructive pattern; most were without a history of asthma. Improvement was witnessed in long-term follow-up. In contrast to the adult population, no diffusion limitation was found. Empirical periodic inhaler therapy may be considered in children with factors associated with PFT abnormalities.
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