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.