Lung Function In Survivors Research Articles

An Update on Lung Function of Extremely and Very Preterm Infants in Later Life: The Role of Early Nutritional Interventions.

Birth occurring at ≤32 weeks' gestation ("very preterm") or at ≤28 weeks' gestation ("extremely preterm") potentially poses considerable health problems for the neonate, including respiratory sequelae, not only during the immediate newborn period, but throughout childhood and into adulthood. With the progressive improvements in neonatal care, the survival of extremely preterm and very preterm neonates has improved substantially. However, a considerable percentage of these infants suffer dysfunctions that may trigger, at some stage later in life, the onset of respiratory morbidities. The interruption of the normal development of the respiratory tract caused by preterm birth, in combination with postnatal lung injury caused by various interventions, e.g., mechanical ventilation and oxygen therapy, increases the risk ofthe development of long-term respiratory deficits in survivors. Those infants that are most affected are those who develop chronic lung disease of prematurity (also called bronchopulmonary dysplasia, BPD), but impaired lung function can develop irrespective of BPD diagnosis. Apart from indicating abnormal lung function in survivors of extreme prematurity, recent long-term follow-up studies also emphasize the crucial role of early nutritional intake as an effective strategy, which promotes lung growth and repair. This article will update the associations between extremely/very preterm birth with long-term respiratory outcomes. It will also discuss the protective effect of nutritional interventions, focusing on recently published follow-up data.

Longitudinal Analysis of Pulmonary Function in Survivors of Congenital Diaphragmatic Hernia

Background: Due to studies with small sample size and short follow-up duration, there is limited information on the natural history of lung function in survivors of congenital diaphragmatic hernia (CDH). In this study, we determined the trends over time of pulmonary function test (PFT) in CDH patients followed at our multidisciplinary clinic. Methods: This is a retrospective cohort study of CDH patients born between 1991 and 2013. Demographic and baseline variables were compared between those who had only one …

Quality of Life and Lung Function in Survivors of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

Survivors of acute respiratory distress syndrome (ARDS) have long-term impairment of pulmonary function and health-related quality of life, but little is known of outcomes of ARDS survivors treated with extracorporeal membrane oxygenation. The aim of this study was to compare long-term outcomes of ARDS patients treated with or without extracorporeal membrane oxygenation. A prospective, observational study of adults with ARDS (January 2013 to December 2015) was conducted at a single center. One year after discharge, survivors underwent pulmonary function tests, computed tomography of the chest, and health-related quality-of-life questionnaires. Eighty-four patients (34 extracorporeal membrane oxygenation, 50 non-extracorporeal membrane oxygenation) were studied; both groups had similar characteristics at baseline, but comorbidity was more common in non-extracorporeal membrane oxygenation (23 of 50 vs. 4 of 34, 46% vs. 12%, P < 0.001), and severity of hypoxemia was greater in extracorporeal membrane oxygenation (median PaO2/FIO2 72 [interquartile range, 50 to 103] vs. 114 [87 to 133] mm Hg, P < 0.001) and respiratory compliance worse. At 1 yr, survival was similar (22/33 vs. 28/47, 66% vs. 59%; P = 0.52), and pulmonary function and computed tomography were almost normal in both groups. Non-extracorporeal membrane oxygenation patients had lower health-related quality-of-life scores and higher rates of posttraumatic stress disorder. Despite more severe respiratory failure at admission, 1-yr survival of extracorporeal membrane oxygenation patients was not different from that of non-extracorporeal membrane oxygenation patients; each group had almost full recovery of lung function, but non-extracorporeal membrane oxygenation patients had greater impairment of health-related quality of life.

Altered lung function at mid-adulthood in mice following neonatal exposure to hyperoxia

Infants born very preterm are usually exposed to high oxygen concentrations but this may impair lung function in survivors in later life. However, the precise changes involved are poorly understood. We determined how neonatal hyperoxia alters lung function at mid-adulthood in mice. Neonatal C57BL/6J mice inhaled 65% oxygen (HE group) from birth for 7 days. They then breathed room air until 11 months of age (P11mo); these mice experienced growth restriction. Controls breathed only room air. To exclude the effects of growth restriction, a group of dams was rotated between hyperoxia and normoxia during the exposure period (HE+DR group). Lung function was measured at P11mo. HE mice had increased inspiratory capacity, work of breathing and tissue damping. HE+DR mice had further increases in inspiratory capacity and work of breathing, and reduced FEV100/FVC. Total lung capacity was increased in HE+DR males. HE males had elevated responses to methacholine. Neonatal hyperoxia alters lung function at mid-adulthood, especially in males.

Bleomycin-associated lung toxicity in childhood cancer survivors.

9591 Background: Bleomycin has been established as a pulmonary toxin, but the risk for toxicity in survivors of childhood cancer is poorly characterized. Methods: We conducted a cross-sectional study of lung function in survivors of childhood Hodgkin lymphoma and germ cell tumor treated with bleomycin at our institution between 1997 and 2010. We assessed their most recent post-therapy pulmonary function test (PFT). Spirometry and lung volumes were categorized as normal, restrictive, obstructive or mixed. Diffusing capacity of carbon monoxide (DLCO) was categorized as normal or abnormal. Results: 195 patients were treated with bleomycin. Ten died of non-pulmonary causes. Of 185 survivors, 143 (77%) had complete data available for analysis. Median cumulative bleomycin dose was 60U/m2 (IQR 30-60). Three patients (2%) had a history of acute bleomycin toxicity. PFTs were performed a median of 2.3 years (IQR 1.4-4.9) from completion of therapy. Spirometry was abnormal in 58 patients (41%); of whom 5 (9%) had respiratory symptoms. 42 (70%) had obstructive, 11 (18%) restrictive and 5 (9%) mixed ventilatory defects. Abnormalities were mild in 53 (91%), moderate in 3 (5%) and severe in 2 (4%). DLCO was abnormal in 27 patients, 26 (96%) of whom had mildly reduced DLCO and were asymptomatic. Univariate analysis did not demonstrate a significant association between gender, smoking, lung metastases, lung radiation, chemotherapy regimen, or autologous transplant and abnormal lung function. Disease relapse was associated with abnormal lung function (p=0.01). Smoking (p=0.04) and relapse (p=0.03) were associated with abnormal DLCO. The odds ratio of developing abnormal spirometry for each 1unit/m2 increase in bleomycin was 1.01 (95% CI 1.00-1.02, p=0.07). Conclusions: Childhood cancer survivors treated with bleomycin frequently have evidence of asymptomatic abnormalities on PFT. The current recommendation for pulmonary function testing in childhood cancer survivors appears justified.

Childhood Course of Lung Function in Survivors of Bronchopulmonary Dysplasia

Childhood Course of Lung Function in Survivors of Bronchopulmonary Dysplasia

Long-term Assessment of Lung Function in Survivors of Severe ARDS

To investigate the long-term outcome of lung function in survivors of severe ARDS after modern treatment strategies including lung protective mechanical ventilation and prone positioning maneuvers. Follow-up cohort study. University hospital pulmonary division and level 1 trauma center. Sixteen survivors of severe ARDS (from 1992 to 1994) with a lung injury score > or = 2.5. The follow-up study (from 1995 to 1996) included interview, physical examination, chest radiographs, static and dynamic lung volumes, diffusion capacity of the lung for carbon monoxide (DLCO), blood gas analysis, and cardiopulmonary exercise testing (CPET). The mean +/- SD interval between hospital discharge and functional assessment was 29.5 +/- 8.7 months (range, 15.0 to 40.7 months). In approximately one half of the patients, mild abnormalities in static and dynamic lung volumes were found. In 25% (4 of 16 patients), lung function was obstructive; in 25% (4 of 16 patients), lung function was restrictive; and in 6.3% (1 of 16 patients), a combined obstructive-restrictive pattern was revealed. DLCO was impaired in 12.5% (2 of 16 patients); gas exchange during exercise was impaired in 45.5% (5 of 11 patients). Residual obstructive and restrictive defects as well as impaired pulmonary gas exchange remain common after severe ARDS. CPET is a very sensitive measure to evaluate residual impairment of lung function after ARDS. Using CPET, reduced pulmonary gas exchange can be detected in many patients with normal DLCO.

Malignant disease and the lung.

Primary lung tumours in childhood are rare. However, cancer in a child may have an impact on the lung in a number of ways. Chemotherapy and radiotherapy may be directly toxic to the lung. Young children are particularly sensitive to the effects of radiotherapy, which can cause impairment of growth of muscle, skin and bone, in addition to its direct toxic effect on the underlying lung. The lung is vulnerable to infection - particularly protozoal, viral and fungal organisms, as well as bacterial. Children undergoing bone marrow transplantation are at greater risk of lung damage, as they are profoundly immunosuppressed and have received intensive cytotoxic chemotherapy or radiotherapy. The underlying cause of lung damage may be difficult to determine because of the complexity of treatment and the additional risk of infectious complications. In a small number of children, pulmonary complications may be fatal. However, for the many survivors, although abnormalities of lung function are frequently detected, these are rarely clinically significant and, with notable exceptions, do not appear to deteriorate with time. However, data remain scanty; there is a real need for ongoing prospective studies of lung function in survivors of childhood cancer.

A long-term follow-up of lung function in survivors of paraquat poisoning.

1. Respiratory failure is a frequent cause of death in moderate to severe paraquat poisoning, and a transient fall in the gas transfer factor may be seen in mild poisoning. 2. The objectives of this study were to detect long-term changes in lung function in survivors of paraquat poisoning. 3. We analyzed 12 survivors retrospectively for age, sex, signs and symptoms, laboratory findings, chest X-ray findings, serum paraquat level, and lung function test. The first and the follow-up lung tests were performed at 3.7+/-1.4 weeks and 3.4+/-1.4 years, respectively. 4. Serum paraquat levels were assayed in all patients and 3/12 were above the Proudfoot's predictive line. Liver dysfunction (GOT > 50) and renal dysfunction (BUN > 30) were noted in 5/12 and 8/12, respectively. D(L)/V(A) was lower than the normal limit in the first study (3.9+/-0.6 L), but increased significantly and returned to the normal range in the follow-up study (4.5+/-0.6 L). %VC was within the normal range in either examination, but significantly decreased in the follow-up. %TLC was within the normal range in the first study (87+/-13%), but significantly decreased below the normal limit in the follow-up (81+/-13%). 5. These results indicate that survivors of paraquat poisoning may be left with a restrictive type of pulmonary dysfunction and suggest that a long-term follow-up of lung function may be necessary for survivors of paraquat poisoning.

Recovery From Blast Lung Injury: One-Year Follow-up

Blast injury to the lung is one of the devastating threats facing victims of an explosion. Although the pathogenesis of blast injury has been studied, little is known about the long-term effects on lung function in survivors. To examine the pulmonary function of survivors 1 year after sustaining a blast injury. Prospective study. Pulmonary function test laboratory at Hadassah Medical Center, Jerusalem. Eleven surviving victims of a blast injury sustained during a bus terrorist explosion. Twelve months after the injury, physical examinations, lung function tests, and progressive cardiopulmonary exercise examinations were conducted, and chest radiographs were obtained. The average age was 28 +/- 9.8 years. Most of the victims had multiple injuries in addition to the lung injury. Ten patients received mechanical ventilation, and 6 patients required chest drainage. All patients were treated in the ICU, with an average stay of 11.8 +/- 9 days. The patients were discharged to their homes or to a rehabilitation center 32.4 +/- 27. 3 days after the explosion. One year later, none had any pulmonary-related complaints. Physical examination of the lungs was normal. Most of the patients demonstrated normal lung function tests and complete resolution of the chest radiograph findings. Most patients who survive lung blast injury will regain good lung function within a year.

Lung Function in Survivors of Childhood Acute Lymphoblastic Leukemia

To evaluate lung function in patients cured from childhood acute lymphoblastic leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary toxicity is a well-recognized side effect of many ALL treatments. Cross-sectional study conducted at least 3 years after cessation of therapy. Outpatient pneumology department of the University Hospital. Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23 treated with chemotherapy plus BMT (group B). A detailed history of smoking habit, respiratory symptoms, and diseases was recorded directly from the patients with the aid of their parents. A complete physical examination and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were performed in all subjects. No patient reported acute or chronic respiratory symptoms or diseases. In group A patients, lung function was in the normal range, except for three subjects in whom there was an isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with more than half the patients having an abnormal DLCO. A statistically significant difference was found between the two groups for FVC (p = 0.022) and DLCO (p = 0.004). Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function and counseling about avoiding additional lung risk factors is recommended.

Prematurity as a risk factor for asthma in preadolescent children

Information on long-term respiratory symptoms in prematurely born children is scanty. We studied an unselected population of 9- to 11-year-old schoolchildren. A self-administered questionnaire was distributed to the parents. Children underwent lung function testing, cold air challenge, and skin prick tests. A gestational age < 37 weeks in children with a birth weight < or = 2500 gm was reported by 5% of the parents. Premature girls had significantly more current asthma (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.4, 4.7; p < 0.05), recurrent wheezing (OR 1.7; 95% CI 1.1, 2.7; p < 0.001), recurrent shortness of breath (OR 2.4; 95% CI 1.5, 3.9; p < 0.001), and frequent cough with exercise (OR 1.8; 95% CI 1.1, 2.9; p < 0.05) than term girls, especially if they required mechanical ventilation after birth. No such differences could be shown in boys. More prematurely born children who required mechanical ventilation (OR 3.7; 95% CI 2.2, 6.4; p < 0.0001) had a family history of asthma than children born at term. Significant decrements could be demonstrated for different measurements of lung function in premature girls. These results remained significant after control for confounders in a multivariate regression analysis. No difference was found between groups for bronchial hyperresponsiveness to cold, dry air or for atopic sensitization. We conclude that a family history of asthma may predispose premature children to more severe respiratory disease. Respiratory symptoms and decrements in lung function seen in girls may reflect abnormalities of lung function in survivors of severe neonatal respiratory disease.