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What are the best pulmonary function test parameters for early detection of post‐lung transplant bronchiolitis obliterans syndrome in children?
Author(s) -
Sritippayawan Suchada,
Keens Thomas G.,
Horn Monica V.,
Starnes Vaughn A.,
Woo Marlyn S.
Publication year - 2003
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1034/j.1399-3046.2003.00069.x
Subject(s) - medicine , bronchiolitis obliterans , lung transplantation , pulmonary function testing , lung , vital capacity , abnormality , bronchiolitis , lung volumes , cardiology , pediatrics , gastroenterology , lung function , respiratory system , diffusing capacity , psychiatry
Post‐lung transplant bronchiolitis obliterans syndrome (BOS) is defined as an unexplained fall in forced expiratory volume in 1 s (FEV 1 ) ≥20% of baseline (B). There have been reports in adults that FEF 25−75% (>30% decline from B) is more sensitive than FEV 1 for the early diagnosis of BOS. Yet, it is not known if other pulmonary function test (PFT) parameters – forced expiratory flow rates at 25–75% of vital capacity (FEF 25−75% ) and maximal expiratory flow rate at 80% ( V max80% ), 70% ( V max70% ) and 60% ( V max60% ) – are more sensitive indicators for early diagnosis of BOS than FEV 1 in post‐lung transplant children. We reviewed serial PFTs of 18 patients (ages 14.1 ± 3.7 yr, 50% female) who had lung transplantation at our institution from 1993 to 1999, and who met the criteria for BOS diagnosis. There was no significant difference in post‐transplant days when decline in FEV 1 ≥20% of B, FEF 25−75% >30% of B, and V max 80% , V max70% and V max60% from normal occurred (635 ± 431, 551 ± 422 and 454 ± 287 days, respectively; p = 0.4). However, a decline in FEV 1 was the first abnormality in only 39% of the patients, while a decline in FEF 25−75% and V max at specific lung volume were the first abnormality in 78% and 56% of the patients, respectively. The earliest signs of BOS would be missed in 61% of patients if FEV 1 was the primary parameter used for the diagnosis. In order to improve the sensitivity of the diagnosis of post‐lung transplant BOS; we speculate that the diagnosis should be based on decreases in FEF 25−75% rather than on FEV 1 .