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O'Dea CA, Logie K, Maiorana A, Wilson AC, Pillow JJ, Banton GL, Simpson SJ, Hall GL. Increased prevalence of expiratory flow limitation during exercise in children with bronchopulmonary dysplasia. ERJ Open Res 2018; 4:00048-2018. [PMID: 30320130 PMCID: PMC6174284 DOI: 10.1183/23120541.00048-2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/29/2018] [Indexed: 11/15/2022] Open
Abstract
Evidence regarding the prevalence of expiratory flow limitation (EFL) during exercise and the ventilatory response to exercise in children born preterm is limited. This study aimed to determine the prevalence of EFL as well as contributing factors to EFL and the ventilatory response to exercise in preterm children with and without bronchopulmonary dysplasia (BPD). Preterm children (≤32 weeks gestational age) aged 9–12 years with (n=64) and without (n=42) BPD and term controls (n=43), performed an incremental treadmill exercise test with exercise tidal flow–volume loops. More preterm children with BPD (53%) had EFL compared with preterm children without BPD (26%) or term controls (28%) (p<0.05). The presence of EFL was independently associated with decreased forced expiratory volume in 1 s/forced vital capacity z-score and lower gestational age (p<0.05). There was no difference in peak oxygen uptake between preterm children with BPD and term controls (48.0 versus 48.4 mL·kg−1·min−1; p=0.063); however, children with BPD had a lower tidal volume at peak exercise (mean difference −27 mL·kg−1, 95% CI −49– −5; p<0.05). Children born preterm without BPD had ventilatory responses to exercise similar to term controls. Expiratory flow limitation is more prevalent in children born preterm with BPD and is associated with airway obstruction and a lower gestational age. Children born preterm have an increased prevalence of expiratory limitation during exercise associated with reduced lung function and lower gestational agehttp://ow.ly/jLsk30leOVI
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Affiliation(s)
- Christopher A O'Dea
- Respiratory Medicine, Princess Margaret Hospital, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Karla Logie
- Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Australia.,Division of Paediatrics and Child Health, Medical School, University of Western Australia, Perth, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Allied Health Dept and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia
| | - Andrew C Wilson
- Respiratory Medicine, Princess Margaret Hospital, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - J Jane Pillow
- Centre for Neonatal Research and Education, Division of Paediatrics and Child Health, Medical School, University of Western Australia, Perth, Australia.,School of Human Sciences, University of Western Australia, Perth, Australia
| | | | - Shannon J Simpson
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Australia.,Both authors contributed equally
| | - Graham L Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Australia.,Both authors contributed equally
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Simpson SJ, Logie KM, O'Dea CA, Banton GL, Murray C, Wilson AC, Pillow JJ, Hall GL. Altered lung structure and function in mid-childhood survivors of very preterm birth. Thorax 2017; 72:702-711. [PMID: 28119488 DOI: 10.1136/thoraxjnl-2016-208985] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/19/2016] [Accepted: 01/01/2017] [Indexed: 11/04/2022]
Abstract
RATIONALE Survivors of preterm birth are at risk of chronic and lifelong pulmonary disease. Follow-up data describing lung structure and function are scarce in children born preterm during the surfactant era. OBJECTIVES To obtain comprehensive data on lung structure and function in mid-childhood from survivors of preterm birth. We aimed to explore relationships between lung structure, lung function and respiratory morbidity as well as early life contributors to poorer childhood respiratory outcomes. METHODS Lung function was tested at 9-11 years in children born at term (controls) and at ≤32 weeks gestation. Tests included spirometry, oscillatory mechanics, multiple breath nitrogen washout and diffusing capacity of the lung for carbon monoxide. Preterm children had CT of the chest and completed a respiratory symptoms questionnaire. MAIN RESULTS 58 controls and 163 preterm children (99 with bronchopulmonary dysplasia) participated. Preterm children exhibited pulmonary obstruction and hyperinflation as well as abnormal peripheral lung mechanics compared with term controls. FEV1 was improved by 0.10 z-scores for every additional week of gestation (95% CI 0.028 to 0.182; p=0.008) and by 0.34 z-scores per z-score increase in birth weight (0.124 to 0.548; p=0.002). Structural lung changes were present in 92% of preterm children, with total CT score decreased by 0.64 (-0.99 to -0.29; p<0.001) for each additional week of gestation. Obstruction was associated with increased subpleural opacities, bronchial wall thickening and hypoattenuated lung areas on inspiratory chest CT scans (p<0.05). CONCLUSIONS Abnormal lung structure in mid-childhood resulting from preterm birth in the contemporary era has important functional consequences.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute, Perth, WA, Australia.,Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Karla M Logie
- Telethon Kids Institute, Perth, WA, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Christopher A O'Dea
- Telethon Kids Institute, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | | | - Conor Murray
- Diagnostic Imaging, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Andrew C Wilson
- Telethon Kids Institute, Perth, WA, Australia.,Centre for Child Health Research, University of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - J Jane Pillow
- Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
| | - Graham L Hall
- Telethon Kids Institute, Perth, WA, Australia.,Centre for Child Health Research, University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Banton GL, Hall GL, Tan M, Skoric B, Ranganathan SC, Franklin PJ, Pillow JJ, Schulzke SM, Simpson SJ. Multiple breath washout cannot be used for tidal breath parameter analysis in infants. Pediatr Pulmonol 2016; 51:531-40. [PMID: 26436446 DOI: 10.1002/ppul.23326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 08/27/2015] [Accepted: 09/07/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple breath washout (MBW) testing with SF6 gas mixture is routinely used to assess ventilation distribution in infants. It is currently unknown whether SF6 changes tidal breathing parameters during MBW in infants. We investigated if SF6 does change tidal breathing parameters in infants and whether a separate tidal breathing trace prior to MBW testing is necessary. METHODS Tidal breathing during MBW was compared to standard tidal breathing in room air in healthy infants (n = 38), preterm infants (n = 41), and infants with cystic fibrosis (n = 41). Outcomes included inspiratory and expiratory times (TI and TE ), time to peak tidal inspiratory and expiratory flow (tPTIF and tPTEF), tidal volume (VT ), respiratory rate (f), and minute ventilation (VE ). RESULTS Breath times were all significantly increased for both healthy (TE : -0.0790 [-0.10566, -0.05217]; mean difference [95% confidence intervals]) and CF (-0.109 [-0.15235, -0.06607]) infants during the MBW wash-in (P < 0.001). Healthy infants and those with CF showed decreased f during MBW wash-in (P < 0.001); however, no change in VT, resulting in a decreased VE (0.154 (0.086, 0.222) and 0.128 (0.069, 0.186) for healthy and CF infants, respectively, P < 0.001). Preterm infants experienced a decreased VE during both wash-in (0.134 [0.061, 0.207]; P < 0.001) and wash-out phases of MBW (P < 0.05). CONCLUSION There are differences in tidal breathing parameters during MBW testing with SF6 in infants. It is, therefore, important to measure a separate tidal breathing trace in room air, prior to MBW testing to ensure rigour of tidal breath indices derived from analysis.
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Affiliation(s)
- Georgia L Banton
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Mark Tan
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Billy Skoric
- Respiratory Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | - Peter J Franklin
- School of Population Health, University of Western Australia, Perth, Australia
| | | | - Sven M Schulzke
- Department of Neonatology, University Children's Hospital Basel, Basel, Switzerland
| | - Shannon J Simpson
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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Simpson SJ, Ranganathan S, Park J, Turkovic L, Robins-Browne RM, Skoric B, Ramsey KA, Rosenow T, Banton GL, Berry L, Stick SM, Hall GL. Progressive ventilation inhomogeneity in infants with cystic fibrosis after pulmonary infection. Eur Respir J 2015; 46:1680-90. [PMID: 26381521 DOI: 10.1183/13993003.00622-2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 06/28/2015] [Indexed: 12/28/2022]
Abstract
Measures of ventilation distribution are promising for monitoring early lung disease in cystic fibrosis (CF). This study describes the cross-sectional and longitudinal impacts of pulmonary inflammation and infection on ventilation homogeneity in infants with CF.Infants diagnosed with CF underwent multiple breath washout (MBW) testing and bronchoalveolar lavage at three time points during the first 2 years of life.Measures were obtained for 108 infants on 156 occasions. Infants with a significant pulmonary infection at the time of MBW showed increases in lung clearance index (LCI) of 0.400 units (95% CI 0.150-0.648; p=0.002). The impact was long lasting, with previous pulmonary infection leading to increased ventilation inhomogeneity over time compared to those who remained free of infection (p<0.05). Infection with Haemophilus influenzae was particularly detrimental to the longitudinal lung function in young children with CF where LCI was increased by 1.069 units for each year of life (95% CI 0.484-1.612; p<0.001).Pulmonary infection during the first year of life is detrimental to later lung function. Therefore, strategies aimed at prevention, surveillance and eradication of pulmonary pathogens are paramount to preserve lung function in infants with CF.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Judy Park
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Roy M Robins-Browne
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Billy Skoric
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Kathryn A Ramsey
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Tim Rosenow
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Georgia L Banton
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Luke Berry
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, Australia School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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