Clinical Pulmonary Function Testing for Children with Bronchopulmonary Dysplasia

Abstract

Many more extremely preterm children are now surviving, many of whom develop bronchopulmonary dysplasia (BPD), most commonly defined as continuing supplemental oxygen requirements beyond 36 weeks postmenstrual age. Respiratory symptoms usually diminish with increasing lung growth and development, such that it may be assumed that the child has “outgrown” their breathing problems, with follow-up focusing on neurological problems. However, deficits in lung function may persist into school age and beyond, and such individuals are at increased risk of life-long respiratory problems. Although numerous research studies have utilized pulmonary function tests (PFTs) to investigate respiratory problems from infancy through to adulthood, these tests are less frequently used in the clinical management of individual children. With the exception of the hypoxic fitness-to-fly test, PFTs do not yet have a defined role in clinical management of infants surviving BPD and their applications in preschool children may be limited by the reduced concentration and coordination associated with extremely preterm birth. There is, however, a potentially important role for objective assessments using PFTs in school-age children and adolescents to determine whether there is coexistence of true asthma and exercise-induced bronchoconstriction or bronchomalacia, to evaluate exercise capacity and, in severe cases, to investigate the development of pulmonary hypertension. BPD-associated adult lung disease is likely to be seen with increased frequency as these individuals age.