Nordlund Björn, James Anna, Ebersjö Christina, Hedlin Gunilla, Broström Eva B
Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Pediatr Pulmonol. 2017 Sep;52(9):1179-1186. doi: 10.1002/ppul.23741. Epub 2017 Jun 21.
The long-term respiratory characteristics of ex-preterm children with bronchopulmonary dysplasia (BPD) are not established. The objective of this study was to describe hallmarks of BPD at school age in comparison to children with atopic asthma.
This study was a cross-sectional descriptive comparative study in a hospital-based setting. Thirty schoolchildren diagnosed with BPD (10.4 years/born at 26.6 weeks' gestation) and 30 age- and sex-matched children with asthma and sensitized to airborne allergens (IgE >0.35 kU /L) were analyzed. Measurements included fraction of exhaled nitric oxide (FENO, ppb), dynamic and static lung function, and bronchial provocation with methacholine (PD:20) and mannitol (PD:15), as well as an evaluation of respiratory symptoms using the asthma control test (C-ACT).
Lung function measures (FEV1% 77 vs 84, FEV1/FVC% 85 vs 91, FEF50% 61 vs 80) and carbon monoxide diffusion capacity (DLCO%, 81 vs 88) were all reduced in children with BPD compared to asthma (P values <0.042). FENO values were also significantly lower in children with BPD (12 vs 23, P = 0.019). The proportion of positive methacholine tests (74% vs 93%, P = 0.14) was comparable between BPD and asthma. However, less responsiveness towards mannitol (19% vs 61%, P = 0.007) and fewer self-reported symptoms (C-ACT, median 26 vs 24, P = 0.003) were found in the BPD group.
Respiratory hallmarks of BPD at school-age were reduced lung function, limited responsiveness towards indirectly acting mannitol but hyper-responsiveness towards direct acting methacholine and impairment in diffusion capacity. Children with BPD displayed less evidence of airway inflammation compared with atopic asthma.
支气管肺发育不良（BPD）早产儿童的长期呼吸特征尚未明确。本研究的目的是描述BPD学龄儿童与特应性哮喘儿童相比的特征。
本研究是一项在医院环境中进行的横断面描述性比较研究。分析了30名被诊断为BPD的学龄儿童（10.4岁/孕26.6周出生）和30名年龄及性别匹配的对空气传播过敏原致敏（IgE>0.35 kU/L）的哮喘儿童。测量指标包括呼出一氧化氮分数（FENO，ppb）、动态和静态肺功能、乙酰甲胆碱支气管激发试验（PD:20）和甘露醇支气管激发试验（PD:15），以及使用哮喘控制测试（C-ACT）评估呼吸症状。
与哮喘儿童相比，BPD儿童的肺功能指标（FEV1% 77 vs 84，FEV1/FVC% 85 vs 91，FEF50% 61 vs 80）和一氧化碳弥散能力（DLCO%，81 vs 88）均降低（P值<0.042）。BPD儿童的FENO值也显著较低（12 vs 23，P = 0.019）。BPD组和哮喘组乙酰甲胆碱试验阳性比例相当（74% vs 93%，P = 0.14）。然而，BPD组对甘露醇的反应性较低（19% vs 61%，P = 0.007），自我报告的症状较少（C-ACT，中位数26 vs 24，P = 0.003）。
BPD学龄儿童的呼吸特征为肺功能降低、对间接作用的甘露醇反应性有限但对直接作用的乙酰甲胆碱反应性过高以及弥散能力受损。与特应性哮喘相比，BPD儿童气道炎症的证据较少。
