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Lung Clearance Index to Detect Early Pulmonary Changes in Children with Sickle Cell Disease

Received: 24 December 2021     Accepted: 23 March 2022     Published: 14 April 2022
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Abstract

Objective: Pulmonary complications including acute chest syndrome, are leading causes of sickle cell disease (SCD) related morbidity and mortality. Prior studies have shown that patients with pulmonary complications have evidence of pulmonary involvement reflected in lung functions trends as early as childhood. Spirometry is the current standard for measuring lung function. Growing evidence suggests that lung clearance index (LCI) which is a commonly reported parameter of multiple breath washout (MBW) tests, is more sensitive than spirometry measurements in the early identification of pulmonary changes in pediatric patients. The aim of our study was to determine if this relationship between LCI and spirometry existed within the pediatric sickle cell population. Study Design: This is a cross-sectional, retrospective study to compare LCI to spirometry measurements in children with SCD. Charts were reviewed of clinic encounters at Phoenix Children’s Hospital from March 1, 2013 – June 30, 2017. Spirometry and MBW measurements were collected from 23 patients between the ages of 5 years – 22 years. The MBW utilized sulfur hexafluoride (SF6) as the tracer gas. Demographics and SCD variant (e.g. HbSS, HbSC, etc.) for each encounter were also collected. Results: Our results show that LCI correlates to FEV1% predicted (Spearman’s coefficient -0.44, p = 0.003) and FEF25-75% (Spearman’s coefficient -0.49, p <0.001) over time. Based on demographics, LCI is affected by weight (p = 0.046) but not age or height. When comparing LCI and FEV1% predicted, abnormal LCI results were noted to occur even in the presence of normal FEV1% predicted measurements. Conclusions: Our data support LCI correlating with spirometry measurements, but more studies are necessary to explore whether LCI can be used as a screening test to detect pulmonary changes in young children with SCD. Earlier monitoring of lung function will allow for preventative therapies and delayed progression of pulmonary dysfunction.

Published in American Journal of Pediatrics (Volume 8, Issue 2)
DOI 10.11648/j.ajp.20220802.12
Page(s) 56-62
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Spirometry, Pediatrics, Sickle Cell, Pulmonary Function Tests

References
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  • APA Style

    Sophia Williams, Monica Chaung, Paul Kang. (2022). Lung Clearance Index to Detect Early Pulmonary Changes in Children with Sickle Cell Disease. American Journal of Pediatrics, 8(2), 56-62. https://doi.org/10.11648/j.ajp.20220802.12

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    ACS Style

    Sophia Williams; Monica Chaung; Paul Kang. Lung Clearance Index to Detect Early Pulmonary Changes in Children with Sickle Cell Disease. Am. J. Pediatr. 2022, 8(2), 56-62. doi: 10.11648/j.ajp.20220802.12

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    AMA Style

    Sophia Williams, Monica Chaung, Paul Kang. Lung Clearance Index to Detect Early Pulmonary Changes in Children with Sickle Cell Disease. Am J Pediatr. 2022;8(2):56-62. doi: 10.11648/j.ajp.20220802.12

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  • @article{10.11648/j.ajp.20220802.12,
      author = {Sophia Williams and Monica Chaung and Paul Kang},
      title = {Lung Clearance Index to Detect Early Pulmonary Changes in Children with Sickle Cell Disease},
      journal = {American Journal of Pediatrics},
      volume = {8},
      number = {2},
      pages = {56-62},
      doi = {10.11648/j.ajp.20220802.12},
      url = {https://doi.org/10.11648/j.ajp.20220802.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220802.12},
      abstract = {Objective: Pulmonary complications including acute chest syndrome, are leading causes of sickle cell disease (SCD) related morbidity and mortality. Prior studies have shown that patients with pulmonary complications have evidence of pulmonary involvement reflected in lung functions trends as early as childhood. Spirometry is the current standard for measuring lung function. Growing evidence suggests that lung clearance index (LCI) which is a commonly reported parameter of multiple breath washout (MBW) tests, is more sensitive than spirometry measurements in the early identification of pulmonary changes in pediatric patients. The aim of our study was to determine if this relationship between LCI and spirometry existed within the pediatric sickle cell population. Study Design: This is a cross-sectional, retrospective study to compare LCI to spirometry measurements in children with SCD. Charts were reviewed of clinic encounters at Phoenix Children’s Hospital from March 1, 2013 – June 30, 2017. Spirometry and MBW measurements were collected from 23 patients between the ages of 5 years – 22 years. The MBW utilized sulfur hexafluoride (SF6) as the tracer gas. Demographics and SCD variant (e.g. HbSS, HbSC, etc.) for each encounter were also collected. Results: Our results show that LCI correlates to FEV1% predicted (Spearman’s coefficient -0.44, p = 0.003) and FEF25-75% (Spearman’s coefficient -0.49, p 1% predicted, abnormal LCI results were noted to occur even in the presence of normal FEV1% predicted measurements. Conclusions: Our data support LCI correlating with spirometry measurements, but more studies are necessary to explore whether LCI can be used as a screening test to detect pulmonary changes in young children with SCD. Earlier monitoring of lung function will allow for preventative therapies and delayed progression of pulmonary dysfunction.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Lung Clearance Index to Detect Early Pulmonary Changes in Children with Sickle Cell Disease
    AU  - Sophia Williams
    AU  - Monica Chaung
    AU  - Paul Kang
    Y1  - 2022/04/14
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ajp.20220802.12
    DO  - 10.11648/j.ajp.20220802.12
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 56
    EP  - 62
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20220802.12
    AB  - Objective: Pulmonary complications including acute chest syndrome, are leading causes of sickle cell disease (SCD) related morbidity and mortality. Prior studies have shown that patients with pulmonary complications have evidence of pulmonary involvement reflected in lung functions trends as early as childhood. Spirometry is the current standard for measuring lung function. Growing evidence suggests that lung clearance index (LCI) which is a commonly reported parameter of multiple breath washout (MBW) tests, is more sensitive than spirometry measurements in the early identification of pulmonary changes in pediatric patients. The aim of our study was to determine if this relationship between LCI and spirometry existed within the pediatric sickle cell population. Study Design: This is a cross-sectional, retrospective study to compare LCI to spirometry measurements in children with SCD. Charts were reviewed of clinic encounters at Phoenix Children’s Hospital from March 1, 2013 – June 30, 2017. Spirometry and MBW measurements were collected from 23 patients between the ages of 5 years – 22 years. The MBW utilized sulfur hexafluoride (SF6) as the tracer gas. Demographics and SCD variant (e.g. HbSS, HbSC, etc.) for each encounter were also collected. Results: Our results show that LCI correlates to FEV1% predicted (Spearman’s coefficient -0.44, p = 0.003) and FEF25-75% (Spearman’s coefficient -0.49, p 1% predicted, abnormal LCI results were noted to occur even in the presence of normal FEV1% predicted measurements. Conclusions: Our data support LCI correlating with spirometry measurements, but more studies are necessary to explore whether LCI can be used as a screening test to detect pulmonary changes in young children with SCD. Earlier monitoring of lung function will allow for preventative therapies and delayed progression of pulmonary dysfunction.
    VL  - 8
    IS  - 2
    ER  - 

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Author Information
  • Department of Pediatrics, Division of Pulmonary, Phoenix Children’s Hospital, Phoenix, USA

  • Academic Department, University of Arizona College of Medicine, Phoenix, USA

  • Department of Epidemiology and Biostatistics, University of Arizona College of Medicine, Phoenix, USA

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