Gerald L. Strope

Risk Factors Associated With the Development of Chronic Lung Disease in Children

By better understanding the intrinsic and extrinsic factors that predispose children to chronic lung disease, strategies to prevent its development can be proposed. This article addresses conditions, such as bronchiolitis, croup, hyaline membrane disease, hydrocarbon ingestion, and near-drowning, that have been found to result in long-term changes in lung physiology. Also considered are the possible relationships of common respiratory infection, asthma, smoking, and air pollution to the development of chronic respiratory infection.

575 CHILDHOOD SARCOIDOSIS

A wide range of clinical and laboratory manifestations have been reported in childhood sarcoidosis. We are presenting the findings from a review of the largest series reported to date. Sixty patients were diagnosed with sarcoidosis by biopsy (47) or chest x-ray (CXR) and clinical course (13). Fifty-four percent were male, 72% black, 88% lived on the coastal plain of N.C., 75% presented in the winter or spring, and the average age was 13.3 yrs. Common symptoms were weight loss (54%), cough (53%), and fatigue (48%). Common physical findings included peripheral lymphadenopathy (58%), eye changes (54%), and skin changes (42%). All but 1 had an abnormal CXR. Frequently abnormal laboratory tests included an elevated ESR (74%), eosinophilia (45%), increased gamma-globulins (88%), hypercalcemia (31%), hypercalciuria (67%), and pulmonary function tests (50% with restrictive changes). Distinctive features not emphasized fully in the past were the prominence of eye involvement, hypercalcemia/hypercalciuria, skin involvement and the multisystem involvement. After an average of 4.7 yrs, of follow-up, there was considerable improvement in clinical manifestations, CXR findings, and pulmonary function; however, there was 1 death, 35% had continued physical abnormalities, and 47% had CXR findings. Because children treated with adrenocorticosteroids had more severe disease, evaluation of therapy could not be done. Due to the larger number of children in this series, the clinical manifestations are clarified and knowledge of the distinctive features should improve the management of childhood sarcoidosis.

THE EFFECTS OF THE OCCURRENCE OF MILD BRONCHIOLITIS ON LUNG FUNCTION

Bronchiolitis requiring hospitalization during infancy is reported to result in decrements of lung function suggestive of small airways dysfunction. The purpose of this study was to evaluate the effects of a history of mild bronchiolitis not requiring hospitalization in a group of children enrolled in day care and followed longitudinally from early infancy. Fifty-six black children (30 girls, 26 boys) had all illnesses documented clinically and etiologically, then were trained to perform spirometry at 2 1/2 years of age. Regression analyses were performed on MEFV parameters over the height range 90-130 cm using these measurements as dependent and height as independent variables. The FEF25-75% and Vmax50% in children who ever had bronchiolitis (n=27) were significantly reduced and about 300 ml/sec below the flows for children who had never had bronchiolitis but the slopes of the regressions were not different for the 2 groups; there were no differences in mean values or slopes for the regressions of FVC or FEV1 nor between girls and boys. These data demonstrate that black children who have had mild bronchiolitis have decrements in flow rates at low lung volumes as early as 3 years of age and that this change persists during early childhood. Since the flow rate decreases were constant over the height range studied, they may represent a fixed effect of acute injury or constitutional differences.