Childhood Interstitial Lung Disease

Clinical profile of interstitial lung disease in Indian children

OBJECTIVE

To describe the clinical spectrum and factors associated with poor short-term outcomes in children with interstitial lung disease (ILD).

DESIGN

Retrospective chart review

SETTING

Pediatric Chest Clinic of a tertiary care hospital

METHODOLOGY

We retrieved information regarding clinical course and laboratory features of all children diagnosed as ILD between January 1999 and February 2010. Disease severity was assessed using ILD score based on clinical features and SpO2 at the time of initial evaluation. Outcome was assessed after 3 months of initial diagnosis as improved or death/no improvement in symptoms.

RESULTS

90 children (median age, 6.8 years; 62% boys) were diagnosed to have ILD during this period. 46 children were classified as having definite ILD while 44 had possible ILD. The commonest clinical features at presentation were cough (82.2%), dyspnea (80%), pallor (50%), and crackles (45.6%). 3 children (3.3%) died while 21 (23%) showed no improvement in clinical status on follow-up at 3 months. A higher ILD score (RR 3.72, 95% CI 1.4, 9.9) and lower alkaline phosphatase levels (median [IQR]: 205 [175.2] vs. 360 [245.7]; P=0.006) were found to be significantly associated with worse outcomes.

CONCLUSION

The common clinical features of ILD in our study included breathlessness, cough and hypoxemia. A working diagnosis of ILD can be made with the help of imaging, bronchoscopy, or lung biopsy. A simple score based on clinical findings and pulse-oximetry might predict those children with poor short-term outcome.

Computed tomography of diffuse interstitial lung disease in children

Unlike diseases of the airways, interstitial lung diseases in childhood are exceedingly rare and are usually associated with significant morbidity and mortality. Interstitial lung disease in the paediatric age group is a particular diagnostic challenge because the clinical presentation and radiographic features are so non-specific. High resolution computed tomography (HRCT) has proved its worth in adults with interstitial lung disease and has a role, albeit more limited, in the non-invasive evaluation of paediatric interstitial lung disease.

Factors influencing survival in children with chronic interstitial lung disease

To investigate factors influencing survival in children with chronic interstitial lung disease (ILD), we extracted specific clinical information from a data base of 99 children with ILD who met entry criteria for our study. The effects of a weight below the fifth percentile for the patient's age, crackles, clubbing, family history of ILD, symptom duration, and severity-of-illness score on survival were examined with univariate and multivariate statistical analyses. There were 15 recorded deaths in the group, with a probability that a patient would survive to 24 mo, 48 mo, and 60 mo after onset of symptoms of 83%, 72%, and 64%, respectively. Of the clinical features, only increasing severity-of-illness score was significantly associated with a higher probability of decreased survival. Children with ILD have decreased survival probabilities that can be predicted with a severity-of-illness score.

Clinical spectrum of chronic interstitial lung disease in children

To describe the clinical spectrum of interstitial lung disease in children, we reviewed our experience with 48 patients during a 12-year period. Most patients initially had typical findings of restrictive lung disease and hypoxemia. Growth failure or pulmonary hypertension or both were found in more than one third. Specific diagnosis, made in 35 patients (70%), most often required invasive studies, particularly open lung biopsy. Although the diagnostic yield from open lung biopsy was high, the diagnosis of many patients remained uncertain. Many different disorders were encountered. The response to corticosteroids, bronchodilators, and chloroquine was inconsistent. Six patients died, five within 1 year after the initial evaluation. The spectrum of pediatric interstitial lung disease includes a large, heterogeneous group of rare disorders associated with high morbidity and mortality rates.