Abstract
ABSTRACTObjective: To evaluate exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans.Data source: This is a systematic review based on data from PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), and Physiotherapy Evidence Database (PEDro). We used the following search strategy: “Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six-minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans.” We selected studies that evaluated exercise capacity through maximal/submaximal testing in children and adolescents with post-infectious bronchiolitis obliterans, and no other associated disease. We searched articles in English, Portuguese, and Spanish, without restrictions regarding the period of publication. The methodological quality was assessed by the Agency for Healthcare Research and Quality (AHRQ) protocol.Data synthesis: Out of the 81 articles found, only 4 were included in this review. The studies totaled 135 participants (121 with post-infectious bronchiolitis obliterans and 14 healthy), with sample sizes between 14 and 58 subjects. All patients underwent spirometry to evaluate pulmonary function, indicating an obstructive ventilatory pattern. Among them, 3/4 had their physical performance assessed by the six-minute walk test and 2/4 by the cardiopulmonary exercise testing. These test results were compared to those of a control group (1/4) and presented as percentage of predicted and/or in meters (3/4). Lastly, 3/4 of the studies showed reduced exercise capacity in this population. The studies included were classified as having high methodological quality.Conclusions: Findings of the study demonstrate that children and adolescents with post-infectious bronchiolitis obliterans have reduced exercise capacity.
Highlights
Post-infectious bronchiolitis obliterans (PIBO) is an inflammatory disease of the distal airways, resulting from damage to the lower respiratory tract
The selected articles totaled a sample of 135 participants (121 with PIBO and 14 healthy)
Two studies (50.0%) evaluated exercise capacity with 6MWT; one (25.0%) with cardiopulmonary exercise testing (CPET); and one (25.0%) with both tests
Summary
Post-infectious bronchiolitis obliterans (PIBO) is an inflammatory disease of the distal airways, resulting from damage to the lower respiratory tract. Inflammation and fibrosis of terminal bronchioles causes narrowing and/or complete obliteration of the airway lumen, leading to chronic airflow obstruction.[1,2,3,4,5,6,7] These anatomofunctional changes can result in progressive loss of strength/endurance of ventilatory muscles, directly contributing to the reduction in activities of daily living (ADLs), with a consequent negative impact on exercise tolerance.[8]. Reduction in exercise tolerance for individuals with respiratory diseases has a significant association with quality of life, hospitalizations, medicines, survival time, and clinical prognosis.[8,9,10] In this regard, field/laboratory functional tests are considered essential components in the routine of clinical evaluation of patients, due to their clear and objective way of measuring functional capacity and the reasons for exercise intolerance, and for prescription of an appropriate physical training program.[11,12] Among these tests, we can mention the cardiopulmonary exercise testing (CPET) and the six-minute walk test (6MWT).[13,14]
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