Persistent Abnormal Lung Function After Childhood Empyema
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Am J Respir Med 2002; 1 (6): 441-445 1175-6365/02/0006-0441/$25.00/0 © Adis International Limited. All rights reserved.
Persistent Abnormal Lung Function After Childhood Empyema Gary L. Kohn,1 Cathy Walston,1 Julie Feldstein,1 Brad W. Warner,2 Paul Succop3 and William D. Hardie1 1 Division of Pulmonary Medicine, Children’s Hospital Medical Center, Cincinnati, Ohio, USA 2 Division of Pediatric Surgery, Children’s Hospital Medical Center, Cincinnati, Ohio, USA 3 Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, USA
Abstract
Objective: The purpose of this study was to examine pulmonary function tests in children at various time points in their recovery from empyema. Design: Cross-sectional study. Setting: Academic Children’s Hospital. Patients: Pediatric patients with a diagnosis of empyema between 1992–2000. Results: A total of 45 pulmonary function tests were carried out in 36 study participants. Within 3 months of hospital discharge, 91% of pulmonary function tests demonstrated a restrictive pattern with a mean forced vital capacity (FVC) of 69.2 ± 4% and a mean total lung capacity (TLC) of 74.9 ± 4% of predicted. The incidence of restriction in pulmonary function significantly decreased over time and for patients tested >1 year from hospital discharge the mean FVC was 87.1 ± 2% and the mean TLC 95.0 ± 2% of predicted. However, 19% of the patients tested >1 year from discharge demonstrated a mild restrictive pattern and 16% demonstrated mild obstructive changes. Patients with abnormal lung function >1 year from hospital discharge did not demonstrate any signs or symptoms of respiratory insufficiency. Conclusion: There is a high incidence of restrictive patterns in lung function for children tested within 3 months from hospital discharge for empyema. The incidence of restrictive patterns decreased significantly over time and most patients tested >1 year from hospital discharge demonstrated normal lung function.
Lower respiratory tract infections (LRIs) are a common cause of morbidity and mortality in children. In North America, one-third of children will develop an LRI in the first year of life and each year an estimated four million children, primarily in developing countries, die from pneumonia.[1-3] There is increasing evidence that childhood LRIs are associated with the development of reduced lung function. Kjellman[4] found a significant decrease in vital capacity in children with pneumonia caused by Mycoplasma pneumoniae, several weeks after their recovery from the illness. A cohort of children with bronchiolitis in infancy demonstrated significant reductions in the forced expiratory volume in 1 second (FEV1) and in midexpiratory flow rates, compared with matched controls, 9 years after their illness.[5] There are also data supporting the fact that childhood pneumonia is associated with reduced lung function persisting into adulthood. Johnston et al.[6] demonstrated that adults with a history of pneumonia in childhood had significant
deficits in their forced vital capacity (F
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