Abstract Ref Number = APCP109
Chronic Lung Disease in Children and Adolescence
Department of Child Health, Faculty of Medicine, University of Indonesia
The respiratory system shows significant growth and development during the third trimester of fetal life and the first year of life. The epidemiological studies showing associations between insults to the developing lung during prenatal and early postnatal life and adult respiratory morbidity or reduced lung function. Chronic lung disease (CLD) is a broad term in pediatric pulmonology representing a broad category of chronic lung disorders in children and represents a heterogeneous group of many distinct clinicopathological entities. Chronic lung diseases in children are classified as primary and secondary lung disease. Secondary lung disease may develop due to several systemic disorders including primary ciliary dyskinesia, cystic fibrosis, due to oesophagus atresia and tracheo-oesophagal fistula, neuromuscular disease and immunodeficiencies.
The prevalence of CLD has increased in the past decade because of the more advanced and intensive respiratory support provided for compromised children and additionally the overall improved survival of preterm babies. Chronic lung disease in infancy (also known as bronchopulmonary dysplasia/BPD) was strongly associated with continued bronchodilator use up to age 2 years, with persistent wheezing between ages 2 and 5 years, and with an asthma diagnosis later in childhood.
Children also are at risk of developing CLD when they have a congenital lung disorder. Some common congenital disorders include agenesis, hypoplasia, bronchogenic cyst, congenital lobar emphysema and many others. Interstitial lung disease (ILD) in children usually has an underlying cause. However, in about 19% to 27% of cases, there is an undetermined cause. This fibrotic process is mostly responsible for the morbidity and mortality of ILD.
In developing countires, the most common clinical suppurative lung conditions in children are empyema, lung abscess, and bronchiectasis, and to a less often necrotizing pneumonia. Until recently, bronchiectasis was the most common form of persistent suppurative lung disease in children. Protracted bacterial bronchitis is a newly described chronic suppurative condition in children, which is less persistent but more common than bronchiectasis.
Treatment of CLD is based on the underlying specific cause of CLD. The supportive treatment may include optimization of nutrition, prophylactic immunizations, treatment of secondary infections, bronchodilator therapy, oxygen (both for comfort and prevention of hypoxia, pulmonary hypertension, and cor pulmonale), smoke-free environmental control, and additional medication therapies, such as steroids, cytotoxic agents, immunosuppressants, IV immunoglobulin, antioxidants, and cytokine inhibitors. Many of patients will lead to the dependence on oxygen and tracheostomy, and some who have poor prognosis have to face the end of life in childhood so that the collaboration with other specialists is needed to maintain the patients in comfortable condition.