Comparison of pulmonary diseases in common variable immunodeficiency and X-linked agammaglobulinaemia.
Patients with CVID are at greater risk of developing lung complications than patients with XLA because of delayed diagnosis and possible immune dysregulation. Early diagnosis and appropriate treatment reduces the incidence of pulmonary infections in both groups of patients. However, CVID patients are prone to progressive lung disease despite optimal immunoglobulin therapy.


OBJECTIVE
Pulmonary disease is the most common complication in patients with common variable immunodeficiency (CVID) or X-linked agammaglobulinaemia (XLA). Pulmonary disease may progress despite immunoglobulin replacement therapy. In this study pulmonary complications were compared in patients with CVID or XLA.


METHODS
Pulmonary complications were evaluated in 115 patients (76 with CVID and 39 with XLA) by reviewing hospital records of chest infections, pulmonary function tests and high-resolution CT scans.


RESULTS
Thirty-two patients with XLA (82%) presented with 59 episodes of pneumonia before diagnosis, whereas 15 patients (38.4%) experienced pneumonia after immunoglobulin replacement therapy (1.67 vs 0.45 episodes per patient per year). Among the CVID patients, 196 episodes of pneumonia were documented in 59 patients (77.6%) before diagnosis, while 36 patients (47.3%) experienced pneumonia after therapy (1.11 vs 0.58 episodes of pneumonia per patient per year). Forty-seven (41%) patients (38 with CVID and 9 with XLA) developed chronic lung disease. The CVID patients developed more complications, including bronchiectasis and lymphoid interstitial pneumonitis, than the XLA patients.


CONCLUSIONS
Patients with CVID had a greater likelihood of developing lung disease, possibly due to delayed diagnosis and immune dysregulation, as compared with XLA patients. Early diagnosis of patients with primary antibody deficiencies and adequate i.v. immunoglobulin replacement therapy substantially reduces the number of pulmonary infections. However, CVID patients are prone to progression of lung disease despite optimal immunoglobulin therapy because of the nature of the disease. This important issue should be addressed in further studies.
Aghamohammadi
Asghar
A
Department of Pediatrics, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. aghamohammadi@sina.tums.ac.ir
Allahverdi
Abdolreza
A
Abolhassani
Hassan
H
Moazzami
Kasra
K
Alizadeh
Hooman
H
Gharagozlou
Mohammad
M
Kalantari
Najmoddin
N
Sajedi
Vahid
V
Shafiei
Alireza
A
Parvaneh
Nima
N
Mohammadpour
Masoud
M
Karimi
Nasser
N
Sadaghiani
Mohammad Salehi
MS
Rezaei
Nima
N
D000293:Adolescent; D000328:Adult; D000361:Agammaglobulinemia / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D001987:Bronchiectasis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017074:Common Variable Immunodeficiency / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D040181:Genetic Diseases, X-Linked / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007116:Immunization, Passive; D008171:Lung Diseases / Q000453:epidemiology*; D017563:Lung Diseases, Interstitial / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D015995:Prevalence; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult