Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Department Clinical & Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska.
Pediatr Pulmonol. 2020 Apr;55(4):975-985. doi: 10.1002/ppul.24696. Epub 2020 Feb 25.
The sole prospective longitudinal study of children with either chronic suppurative lung disease (CSLD) or bronchiectasis published in the current era was limited to a single center. We sought to extend this study by evaluating the longer-term clinical and lung function outcomes and their associated risk factors in Indigenous children of adolescents from Australia, Alaska, and New Zealand who participated in our previous CSLD or bronchiectasis studies during 2004-2010.
Between 2015 and 2018, we evaluated 131 out of 180 (72.8%) children of adolescents from the original studies at a single follow-up visit. We administered standardized questionnaires, reviewed medical records, undertook clinical examinations, performed spirometry, and scored available chest computed tomography scans.
Participants were seen at a mean age of 12.3 years (standard deviation: 2.6) and a median of 9.0 years (range: 5.0-13.0) after their original recruitment. With increasing age, rates of acute lower respiratory infections (ALRI) declined, while lung function was mostly within population norms (median forced expiry volume in one-second = 90% predicted, interquartile range [IQR]: 81-105; forced vital capacity [FVC] = 98% predicted, IQR: 85-114). However, 43 out of 111 (38.7%) reported chronic cough episodes. Their overall global rating judged by symptoms, including ALRI frequency, examination findings, and spirometry was well (20.3%), stable (43.9%), or improved (35.8%). Multivariable regression identified household tobacco exposure and age at first ALRI-episode as independent risk factors associated with lower FVC% predicted values.
Under our clinical care, the respiratory outcomes in late childhood or early adolescence are encouraging for these patient populations at high-risk of premature mortality. Prospective studies to further inform management throughout the life course into adulthood are now needed.
目前发表的唯一一项关于慢性化脓性肺部疾病（CSLD）或支气管扩张症的前瞻性纵向研究仅限于单一中心。我们试图通过评估来自澳大利亚、阿拉斯加和新西兰的儿童和青少年患者的长期临床和肺功能结果及其相关风险因素来扩展该研究，这些患者在 2004-2010 年期间参加了我们之前的 CSLD 或支气管扩张症研究。
在 2015 年至 2018 年期间，我们在单次随访中评估了来自原始研究的 180 名儿童和青少年中的 131 名（72.8%）。我们使用标准化问卷、回顾医疗记录、进行临床检查、进行肺活量测定和评分现有的胸部计算机断层扫描。
参与者的平均年龄为 12.3 岁（标准差：2.6），中位数为 9.0 岁（范围：5.0-13.0），从最初招募到随访。随着年龄的增长，急性下呼吸道感染（ALRI）的发生率下降，而肺功能大多在人群正常范围内（中位一秒用力呼气量[FEV1]占预计值的 90%，四分位间距[IQR]：81-105；用力肺活量[FVC]占预计值的 98%，IQR：85-114）。然而，111 名中有 43 名（38.7%）报告有慢性咳嗽发作。他们的整体全球评分（根据症状、包括 ALRI 频率、检查结果和肺活量测定）为良好（20.3%）、稳定（43.9%）或改善（35.8%）。多变量回归确定家庭烟草暴露和首次 ALRI 发作年龄是与较低 FVC%预测值相关的独立危险因素。
在我们的临床护理下，这些高死亡率风险的患者群体在儿童后期或青春期的呼吸道结局令人鼓舞。现在需要进行前瞻性研究，以进一步为成年期的整个生命周期提供管理信息。
