Reduced exercise capacity in non-cystic fibrosis bronchiectasis

Abstract

Abstract.Objective : Bronchiectasis not due to cystic fibrosis is usually a consequence of severe bacterial or tuberculous infection of the lungs, which is commonly seen in children in developing countries. Our aim was to study its functional sequelae and affect on work capacity in children. Methods : Seventeen children (7-17 years of age) with clinical and radiological evidence of bronchiectasis of one or both lungs were studied at the Cardiopulmonaly Unit of the Tuberculosis Research Centre. Pulmonary function tests including spirometry and lung volume measurements were performed. Incremental exercise stress test was done on a treadmill, and ventilatory and cardiac parameters we monitored. Control values were taken from a previous study. Results : Children with bronchiectasis had lower forced vital capacity (FVC) (1.1 + 0.4 L versus 1.5 + 0.4 L, p=0.003) and FEV1 (0.95 ± 0.2 L versus 1.4 ± 0.3 L, p<0.002) compared to age-and sex-matched healthy controls. The patient group had significantly higher residual lung volumes (0.7 ± 0.3 L versus 0.4 + 0.1 L, p<0.02). At maximal exercise, they had lower aerobic capacity (28 ± 6 ml/min/kg versus 38 5 ml/min/kg, p<0.0001) and maximal ventilation (24 ± 8 L/min versus 39 ± 10 L/min, p<0.001). At maximal exercise, while none of the controls desaturated, oxygen saturation fell below 88% in eight of 17 patients. conclusion ;The findings show that children and adolescents with non-cystic fibrosis bronchiectasis have abnormal pulmonary function and reduced exercise capacity. This is likely to interfere with their lie as well as future work capacity. Efforts should be made to minimize lung damage in childhood by ensuring early diagnosis and instituting appropriate treatment of respiratory infections.

HRCT lung abnormalities are not a surrogate for exercise limitation in bronchiectasis

“…The small sample size does mean that statistically significant p-values should be interpreted with caution. It should be noted that the groups are comparable to other exercise studies in this field [25,26]. However, examination of the scatter of the data suggests that the current conclusions are likely to be broadly correct, although ideally requiring confirmation from another larger study.…”

“…There was no comment on the extent of lobar resections and the effect this may have not only on exercise capability but also on how this was accounted for in the novel chest radiograph score. Finally, SWAMINATHAN et al [26] demonstrated impaired pulmonary function and exercise tolerance in children with non-CF bronchiectasis compared to normal controls, but they did not have data on imaging and were not able to compare their findings to a CF control group. There are currently no other studies known that evaluate the exercise capability of children with non-CF bronchiectasis.…”

“…This has been based on evidence of significant limitation of aerobic and anaerobic exercise [23], and that this limitation has a relationship with survival [24]. There is little work that evaluates the exercise capability of children with non-CF bronchiectasis [25,26] and there is only preliminary data in adults [27][28][29][30].…”

British Thoracic Society guideline for non-CFbronchiectasis

“…Children with bronchiectasis can complete detailed exercise testing using an exercise bicycle231 or treadmill364 and this can identify functional limitation that would not be predicted by lung function testing or HRCT scanning 231. No study has examined the role of exercise testing in treatment or follow-up.…”

Distância percorrida no teste de caminhada de seis minutos não se relaciona com qualidade de vida em pacientes com bronquiectasias não fibrocísticas

“…The leading causes of exercise intolerance are associated with reduced lung capacity, reduced ventilatory reserve, loss of peripheral muscle mass, and changes in cardiovascular function. (8) The six-minute walk test (6MWT) has been widely used in clinical practice in order to evaluate exercise limitation in chronic pulmonary disease. The 6MWT is a submaximal exercise test that evaluates exercise tolerance and exercise-related cardiorespiratory changes.…”