Pulmonary Function Test Abnormalities in Pediatric Inflammatory Bowel Disease

Abstract

Background: Pulmonary involvement in adult patients with inflammatory bowel disease (IBD) seems more common than previously appreciated. Its prevalence and development over time in pediatric IBD patients are largely unknown. Objectives: The aim was to study lung function including fraction of exhaled nitric oxide (FeNO) and transfer capacity for carbon monoxide (TLCO) in pediatric IBD patients and to describe the longitudinal development in a subset of patients with lung function abnormalities. Methods: Sixty-six measurements were made in 48 IBD patients (30 patients with Crohn's disease and 18 with ulcerative colitis) and 108 matched controls. Patients with abnormal TLCO or elevated residual volume/total lung capacity (RV/TLC) ratios were invited for a follow-up. Statistical comparisons were made by nonparametric tests and ANOVA. Results: TLCO was decreased in IBD patients [median: 88% predicted (interquartile range, IQR, 22) vs. 99% predicted (IQR 19) in controls]. RV/TLC ratios were mildly elevated in patients with ulcerative colitis [32% (IQR 9) vs. 27% (IQR 8) in controls], and maximum expiratory flows at 50 and 25% of vital capacity were mildly reduced in patients with Crohn's disease. FeNO and disease activity did not correlate with lung function abnormalities. Abnormalities did not consistently persist over a median follow-up period of 34 months. Conclusions: This study supports evidence that variable and fluctuating pulmonary involvement also occurs in pediatric IBD patients. Its clinical significance is unclear.

Pathophysiological Concepts and Management of Pulmonary Manifestation of Pediatric Inflammatory Bowel Disease

“…A recent study showed alterations in certain parameters of PFT (forced expiratory volume in 1 s (FEV1), forced vital capacity and diffusion capacity of lung for carbon monoxide (DLCO)) between the day of IBD diagnosis and three years after [128]. Contradictory to other studies, Furlano et al showed that pediatric CD patients have significantly decreased mid-and end-expiratory flow values, but the number of patients with flow values under the norm was generally low [98].…”

“…In most of the published cases of children with IBD and pulmonary symptomatic PM, X-rays showed alterations (Tables 1 and 2). If the airway system is affected in children with IBD, the inflammation concentrates on smaller airway compartments, leading to purulent bronchitis [18,86,98]. Adult IBD patients with small airway involvement tend to be younger and the proportion of PM, which occurs before intestinal symptoms, is higher than in those patients with large airway involvement [96].…”

Inflammatory bowel disease and the lung in paediatric patients

“…Most studies on respiratory manifestations of IBD in children include lung function testing. To date, there are six studies that assessed lung function in 294 children with IBD [14,48,[54][55][56][57]. Pulmonary function abnormalities were generally inconsistent and mild.…”

“…Another hypothesis is that late pulmonary involvement reflects the reduction of immunosuppression after surgery allowing pulmonary disease to flare up [ 36 , 47 ]. It could also be speculated that disease activity is not necessarily synchronous among the involved organs, as reflect by abnormal pulmonary findings among IBD patients in clinical intestinal remission [ 48 ].…”

Psoriasis and Respiratory Comorbidities: The Added Value of Fraction of Exhaled Nitric Oxide as a New Method to Detect, Evaluate, and Monitor Psoriatic Systemic Involvement and Therapeutic Efficacy

“…FeNO could provide a quantitative and qualitative indicator of respiratory airway inflammation [ 29 ], as it is routinely used to screen and manage asthmatic patients [ 30 ]. Pilot studies have highlighted the possible use of FeNO in systemic inflammatory nonpulmonary diseases [ Table 1 ] [ 31 – 34 ], such as psoriasis. In this review, we describe the rationale and possible applications of FeNO in the management of PS.…”