Bronchiectasis secondary to primary immunodeficiency in children: longitudinal changes in structure and function.
BACKGROUND
Primary immunodeficiency is a common cause of bronchiectasis in children. The term bronchiectasis suggests an irreversible process; however, disease progression following treatment is controversial. The aim of this study was to evaluate the progression of bronchiectasis in children with primary immunodeficiency after institution of treatment.


METHODS
A retrospective review of case notes of children with primary immunodeficiency was undertaken to identify patients with confirmed bronchiectasis. Children who had two high-resolution computed tomography scans of the chest (HRCT chest) with an interval of at least 2 years were identified. The HRCT-chest scans at diagnosis and follow up were scored using a Bhalla score. Spirometry results (FEV1, FVC, and FEV1:FVC ratios) were related to HRCT-chest scores, where available. Statistical analysis was by Wilcoxon signed rank test and Spearman's rank order correlation.


RESULTS
Eighteen subjects were studied. The diagnosis of primary immunodeficiency was established at median (range) age 3.4 (1-13) years, and bronchiectasis at 9.3 (3.1-13.8) years. There was no significant difference between baseline and follow-up median (range) HRCT-chest scores (6 [1-13] and 7.5 [0-15], P = 0.21) respectively. The follow-up FEV1 and FVC percent predicted median (range) were significantly higher than baseline (86% [49-124%] vs. 75% [36-93%], P < 0.005, and 86% [47-112%] vs. 78% [31-96%], P < 0.05), respectively; there was no significant difference between baseline and follow-up FEV(1):FVC ratios. There was no significant correlation between HRCT-chest score changes and FEV1 or FVC changes.


CONCLUSIONS
Bronchiectasis secondary to primary immunodeficiency in childhood is not always a progressive condition, suggesting a potential to slow or prevent disease progression with appropriate treatment.
Haidopoulou
Katerina
K
Fourth Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Calder
Alistair
A
Jones
Alison
A
Jaffe
Adam
A
Sonnappa
Samatha
S
D000293:Adolescent; D001987:Bronchiectasis / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D001995:Bronchography; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007153:Immunologic Deficiency Syndromes / Q000150:complications*; D008137:Longitudinal Studies; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed