The improved clinical course of persistent tachypnea of infancy with inhaled bronchodilators and corticosteroids

Abstract

Background: Persistent tachypnea of infancy (PTI) is the most common interstitial lung disease in young children. As no standardized therapeutic guidelines exist, different pharmaceuticals are used to treat PTI; inhaled corticosteroids (ICS) and bronchodilators being mostly used. This observation assessed the effectiveness of bronchodilators and ICS in children with PTI enrolled in the children's interstitial lung diseases (chILD)-EU Register.Methods: Symptomatic children with PTI were observed according to a predetermined stepwise protocol including bronchodilators as the first choice treatment (6 weeks). In patients with incomplete response, additionally, ICS was given (12 weeks). Signs, symptoms, and pulmonary function were evaluated at three time points: at baseline, 6 (±1) weeks after initiation of bronchodilators, and 12 (±1) weeks after bronchodilators/ICS.Results: Thirty-one children (median age: 44 months, interquartile range [IQR]: 15-67) were included. The therapy was associated with a significant reduction of tachypnea (53.3% of patients, p = 0.02), exercise intolerance (52.2% of patients, p < 0.001), chest retractions (43.8% of patients, p = 0.04), and crackles (29.2% of patients, p = 0.02). Also, a significant improvement in forced expiratory volume in 1 s (FEV 1 ) (median z score: −2.21 vs. −0.47, p = 0.03), residual volume (RV) (median z score 5.28 vs. 1.07, p = 0.007), RV% total lung capacity (TLC) (median z score: 6.05 vs. 1.48, p = 0.01), sRaw (median z score: 6.6 vs. 4.64, p = 0.01), R5 (median z score:1.27 vs. 0.31, p = 0.009), and R5-R20 (median: 0.58 vs. 0.26 kPa/(l/s), p = 0.002) was demonstrated.Conclusions: Inhaled bronchodilators and ICS may exert a positive effect on the severity of symptoms and pulmonary function test (PFT) in symptomatic children with PTI. However, a randomized control trial should be conducted to confirm their effectiveness.

Pulmonary function in children with persistent tachypnea of infancy

“…The vast majority of published data refer to children with asthma and cystic fibrosis. 33 IOS is particularly useful in young children because it requires minimal cooperation. 34 Our study showed that all IOS indexes reflecting small airway function (i.e., R5, R5-R20, F res , and AX) were significantly higher in PTI patients when compared with healthy controls.…”

“…Also, new techniques such as IOS and N2MBW have not yet been used in the assessment of lung function in children with PTI despite the fact that there is a growing number of studies demonstrating the usefulness of IOS for evaluating peripheral airways. The vast majority of published data refer to children with asthma and cystic fibrosis 33 . IOS is particularly useful in young children because it requires minimal cooperation 34 .…”

Taquipnea Persistente De La Infancia: Hiperplasia De Células Neuroendocrinas, Una Revisión

“…Existe un único estudio observacional y prospectivo, que se realizó en 31 pacientes, reportó mejoría en la gravedad de los síntomas y de la función pulmonar tras la administración de broncodilatadores y corticoides inhalados (19).…”