PULMONARY FUNCTION TESTING IN CHILDREN WITH CHRONIC LIVER DISEASE
El-Shabrawi MHF1, El-Karaksy HM1, Okasha S1, Kotb MA1,
Mohsen NA1, El-Koofy N1, El-Sayed HM1, Isa
MA1, Hassan AM1 and Ibrahim A2
1 Department of Pediatrics, Faculty of
Medicine, Cairo University, Cairo, Egypt
2 Department of Physiology, Faculty of
Medicine, Cairo University, Cairo, Egypt
Objective: Arterial hypoxemia due to intrapulmonary
shunting is a rare but severe complication in children with chronic liver
disease (CLD) that may necessitate “urgent” liver
transplantation. We aimed at studying the feasibility and usefulness of
pulmonary function testing (PFT) in diagnosis of lung affection(s) in
children with CLD.
Methods: Twenty-five children (14 males) aged
10-16 (median 12.4) years were investigated; 12 had frank cirrhosis and 13
non-cirrhotic and none was ascitic. All had arterial blood gas
determination at rest in 21% oxygen (O2) and after breathing 100% O2 for 15
minutes. PFT was performed using a dry-seal spirometer in the sitting
position with nose clips taking the largest of 3 consecutive readings for
each child. Carbon monoxide (CO) diffusion capacity (DLco) was estimated by
the single breath method using a spirometer containing a gas mixture of
nitrogen, 21% O2,10% helium and 0.3% CO .Pulmonary artery pressure was also
measured at rest and after maximal exercise by a bicycle ergometer.
Results: Arterial hyoxemia (PaO2 <80 mmHg) was
present in 10 patients.Forced expiratory volume in 1 minute(FEV 1)was <
80% predicted in 15 patients, forced vital capacity(FVC) was< 80%
predicted in15 and a ratio FEV 1/ FVC was< 65% predicted in 20 patients.
DLco was < 80% predicted in 15 patients. These results indicate
obstrucive airway as well as a diffusion defect.
Conclusion: Arterial hypoxemia is not uncommon in
childern with CLD.PFT is a tedious but non-invasive investigation in
children with CLD; it does demonstrate both obstructive airway as well as
diffusion defects in these children. Therefore; we may recommend PFT in the
work-up of children with CLD in order to detect pulmonary affections early;
particularly if liver transplantation is contemplated.