Lung function measurements as a clue to aetiological diagnosis

Abstract

A boy was born prematurely in the 31st week of pregnancy, with a birth weight of 1,470 g and length 42 cm. Due to respiratory complications, he was mechanically ventilated for 5 days and, thereafter, he received continuous positive airways pressure (CPAP) for 2 weeks. He needed oxygen supplementation for 10 weeks.At the age of 1 yr he developed pneumonia with a major atelectasis and was mechanically ventilated for 1 day. At the age of 1.5 yrs he suffered bronchiolitis due to respiratory syncytial virus positive (RSV+ve) bronchiolitis. Following this, he was treated with regular daily nebulised budesonide (Pulmicort ) and salbutamol (Ventoline ) until 6 yrs of age. Nebulised treatment was then discontinued. Respiratory symptoms reoccurred and he was then started on regular treatment with inhaled fluticasone (Flutide ) and salmeterol (Serevent ) by Discus .When the patient was able to perform lung function testing, it was noted that he had a reduction in maximum expiratory flow/volume loops. This did not respond to trials of increased doses of inhaled steroids. He did not experience acute exacerbations of his respiratory symptoms, but he had marked limitation of his ability to take part in physical activity, which was attributed to exercise-induced asthma.Due to reduced lung function and exercise-related respiratory symptoms, he was referred to Voksentoppen BKL at the age of 10.5 yrs. Clinical examinationThe patient presented as a moderately overweight 10-yr-old boy, with an increased anterioposterior diameter of thorax and breathing with moderately heightened shoulders. On auscultation, he had slightly symmetrically reduction of respiratory sounds in the posterior lower thorax. Lung function measurements as a clue to aetiological diagnosis