Impact of Surgery on Growth, Pulmonary Functions, and Acute Pulmonary Exacerbations in Children with Non-Cystic Fibrosis BronchiectasisFunding Source There is no financial source.
01 June 2017
25 October 2017
12 December 2017 (online)
Background Treatment decisions for the management of bronchiectasis include medical treatment, such as antibiotics, chest physiotherapy, and surgical procedures. Here, we aimed to review the effect of lung resection on longitudinal growth, clinical course of patients depending on annual exacerbation rates, and pulmonary function tests (PFTs) and compare them with the results of only medically treated children with non-cystic fibrosis (non-CF) bronchiectasis.
Methods The medical records of patients with non-CF bronchiectasis were retrospectively analyzed. Patients who underwent lobectomy/segmentectomy/pneumonectomy were categorized as “surgery group” (n = 29). Age- and gender-matched patients who were only medically treated were selected as “medical group” (n = 33). Annual data of patients were included till the end of postoperative second year in the surgery group and third year of medical treatment in the medical group.
Results Mean baseline height z-score was lower in the surgery group, and mean baseline PFT values were all lower in the surgery group than those in the medical group (p < 0.05). In the surgery group, mean values of height z-score were –1.68 ± 0.92 at the time of surgery and improved to –1.42 ± 1.22 and –1.34 ± 1.05 in the first and second postoperative years, respectively, and annual intravenous antibiotic requirements decreased significantly (p < 0.05); however, mean body mass index (BMI) z-score values and PFT parameters did not change significantly. In the medical group, height z-score mean values and PFT parameters showed nonsignificant improvement but annual exacerbation frequency, annual intravenous, and oral antibiotic requirements decreased significantly.
Conclusion Surgical management of non-CF bronchiectasis has no significant effect on BMI z-scores, annual exacerbation frequencies, oral antibiotic requirements and lung function tests; but can lead to significant improvement on height z-scores and decrease need of annual intravenous antibiotic requirements for acute severe exacerbations despite small number of patients in this study.
- 1 Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016; 51 (05) 450-469
- 2 Boren EJ, Teuber SS, Gershwin ME. A review of non-cystic fibrosis pediatric bronchiectasis. Clin Rev Allergy Immunol 2008; 34 (02) 260-273
- 3 Eastham KM, Fall AJ, Mitchell L, Spencer DA. The need to redefine non-cystic fibrosis bronchiectasis in childhood. Thorax 2004; 59 (04) 324-327
- 4 Callahan CW, Redding GJ. Bronchiectasis in children: orphan disease or persistent problem?. Pediatr Pulmonol 2002; 33 (06) 492-496
- 5 Stafler P, Carr SB. Non-cystic fibrosis bronchiectasis: its diagnosis and management. Arch Dis Child Educ Pract Ed 2010; 95 (03) 73-82
- 6 Brower KS, Del Vecchio MT, Aronoff SC. The etiologies of non-CF bronchiectasis in childhood: a systematic review of 989 subjects. BMC Pediatr 2014; 14: 4
- 7 Martínez-García MA, Soler-Cataluña JJ, Perpiñá-Tordera M, Román-Sánchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 2007; 132 (05) 1565-1572
- 8 Chang AB, Bell SC, Torzillo PJ. , et al; extended voting group. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines. Med J Aust 2015; 202 (01) 21-23
- 9 Pasteur MC, Bilton D, Hill AT. ; British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010; 65 (Suppl. 01) i1-i58
- 10 WHO AnthroPlus for personal computers manual: software for assessing growth of the world's children and adolescents. Geneva: WHO; 2009
- 11 American Thoracic Society. Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med 1995; 152 (03) 1107-1136
- 12 McShane PJ, Naureckas ET, Tino G, Strek ME. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2013; 188 (06) 647-656
- 13 Qi Q, Li T, Li JC, Li Y. Association of body mass index with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis. Braz J Med Biol Res 2015; 48 (08) 715-724
- 14 Onen ZP, Gulbay BE, Sen E. , et al. Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med 2007; 101 (07) 1390-1397
- 15 Stark LJ, Opipari-Arrigan L, Quittner AL, Bean J, Powers SW. The effects of an intensive behavior and nutrition intervention compared to standard of care on weight outcomes in CF. Pediatr Pulmonol 2011; 46 (01) 31-35
- 16 Ramírez I, Filbrun A, Hasan A, Kidwell KM, Nasr SZ. Improving nutritional status in a pediatric cystic fibrosis center. Pediatr Pulmonol 2015; 50 (06) 544-551
- 17 Fan LC, Liang S, Lu HW, Fei K, Xu JF. Efficiency and safety of surgical intervention to patients with Non-Cystic Fibrosis bronchiectasis: a meta-analysis. Sci Rep 2015; 5: 17382
- 18 Haciibrahimoglu G, Fazlioglu M, Olcmen A, Gurses A, Bedirhan MA. Surgical management of childhood bronchiectasis due to infectious disease. J Thorac Cardiovasc Surg 2004; 127 (05) 1361-1365
- 19 Sirmali M, Karasu S, Türüt H. , et al. Surgical management of bronchiectasis in childhood. Eur J Cardiothorac Surg 2007; 31 (01) 120-123
- 20 Karadag B, Karakoc F, Ersu R, Kut A, Bakac S, Dagli E. Non-cystic-fibrosis bronchiectasis in children: a persisting problem in developing countries. Respiration 2005; 72 (03) 233-238
- 21 Bastardo CM, Sonnappa S, Stanojevic S. , et al. Non-cystic fibrosis bronchiectasis in childhood: longitudinal growth and lung function. Thorax 2009; 64 (03) 246-251
- 22 Kapur N, Masters IB, Chang AB. Longitudinal growth and lung function in pediatric non-cystic fibrosis bronchiectasis: what influences lung function stability?. Chest 2010; 138 (01) 158-164
- 23 Twiss J, Stewart AW, Byrnes CA. Longitudinal pulmonary function of childhood bronchiectasis and comparison with cystic fibrosis. Thorax 2006; 61 (05) 414-418
- 24 Coutinho D, Fernandes P, Guerra M, Miranda J, Vouga L. Surgical treatment of bronchiectasis: A review of 20 years of experience. Rev Port Pneumol (2006) 2016; 22 (02) 82-85
- 25 Guerra MS, Miranda JA, Leal F, Vouga L. Surgical treatment of bronchiectasis. Rev Port Pneumol 2007; 13 (05) 691-701
- 26 Agasthian T, Deschamps C, Trastek VF, Allen MS, Pairolero PC. Surgical management of bronchiectasis. Ann Thorac Surg 1996; 62 (04) 976-978 , discussion 979–980
- 27 Stephen T, Thankachen R, Madhu AP, Neelakantan N, Shukla V, Korula RJ. Surgical results in bronchiectasis: analysis of 149 patients. Asian Cardiovasc Thorac Ann 2007; 15 (04) 290-296