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      Pulmonary and extrapulmonary features in bronchopulmonary dysplasia: a comparison with healthy children

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          Abstract

          [Purpose] The aim of this study was to compare functional capacity and peripheral muscle strength in preterm children with bronchopulmonary dysplasia (BPD) with those of age-matched full-term healthy controls. [Subjects and Methods] Eighteen BPD subjects and 20 healthy subjects were enrolled in the study. Pulmonary function testing was performed. Body composition was determined using the skinfold method. An analysis of posture was scored. Muscle strength was evaluated using a dynamometer. Functional capacity was assessed using the six-minute walking test (6MWT). [Results] Pulmonary function testing parameters, 6MWT distance, and quadriceps strength of the children with BPD were significantly lower than those of healthy peers. The scores of posture analysis of the children with BPD were significantly higher than those of healthy subjects. Exercise heart rate was significantly higher in the children with BPD compared to healthy children. The 6MWT distance correlated with height, fat-free mass, exercise dyspnea perception, and hand grip strength in BPD children. [Conclusion] The study showed that preterm children with BPD had disturbed pulmonary and extrapulmonary characteristics. BPD had lower fat free mass, reduced lung function, worsen postural function, a shorter 6MWT distance, and lower quadriceps strength than healthy children. These features may provide insights into the choice of outcome measures for pulmonary rehabilitation for BPD.

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          Most cited references16

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          Six-minute walk test in children and adolescents.

          To evaluate the 6-minute walking distance (6MWD) for healthy Caucasian children and adolescents of a population-based sample from the age of 3 to 18 years. Two hundred and eighty boys and 248 girls completed a modified test, using a measuring wheel as incentive device. Median 6MWD increased from the age of 3 to 11 years in boys and girls alike and increased further with increasing age in boys (from 667.3 m to 727.6 m), whereas it essentially plateaued in girls (655.8 m to 660.9 m). After adjusting for age, height (P = .001 in boys and P < .001 in girls) remained independently correlated with the 6MWD. In the best fitting and most efficient linear and quadratic regression models, the variables age and height explained about 49% of the variability of the 6MWD in boys and 50% in girls. This modified 6-minute walk test (6MWT) proved to be safe, easy to perform, and highly acceptable to children. It provides a simple and inexpensive means to measure functional exercise capacity in children, even of young age, and might be of value when conducting comparable studies.
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            Lung function and exercise capacity in young adults born prematurely.

            Limited information is available about the long-term outcome of lung function and exercise capacity in young adults born prematurely. To determine long-term effects of prematurity on lung function (volumes, diffusing capacity) and exercise capacity in ex-preterms compared with healthy peers. In a prospective cohort study, children born with a gestational age of less than 32 wk and/or a birth weight under 1,500 g were followed up for 19 yr. Participants (n=42; mean gestational age, 30 wk, and mean birth weight, 1,246 g) and healthy term control subjects (n=48) were recruited for lung function and exercise tests. Spirometry, bodybox (TLC(box)), diffusing capacity (Dl(CO)), bicycle ergometer test. Preterm birth was associated with lower FEV(1) (preterms, 95% predicted, vs. controls, 110% predicted; p<0.001), DL(CO)sb (88% predicted vs. 96% predicted, p=0.003), and exercise capacity (load, 185 vs. 216 W; p<0.001; anaerobic threshold: mean, 1,546 vs. 1,839 ml/min; p<0.001) compared with control subjects at follow-up. No differences between the groups were found in TLC(box), peak oxygen consumption (Vo(2)), and breathing reserve. No significant differences in lung function and exercise parameters were found between preterms with and without bronchopulmonary dysplasia. Long-term effects of prematurity were airway obstruction and a lower CO diffusing capacity compared with control subjects, although mean lung function parameters were within the normal range. Ex-preterms had a lower exercise level, which could not be explained by impaired lung function or smoking habits, but might be due to impaired physical fitness.
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              Long-term pulmonary outcomes of patients with bronchopulmonary dysplasia.

              Bronchopulmonary dysplasia (BPD) is the commonest cause of chronic lung disease in infancy. The incidence of BPD has remained unchanged despite many advances in neonatal care. BPD starts in the neonatal period but its effects can persist long term. Premature infants with BPD have a greater incidence of hospitalization, and continue to have a greater respiratory morbidity and need for respiratory medications, compared to those without BPD. Lung function abnormalites, especially small airway abnormalities, often persist. Even in the absence of clinical symptoms, BPD survivors have persistent radiological abnormalities and presence of emphysema has been reported on chest computed tomography scans. Concern regarding their exercise tolerance remains. Long-term effects of BPD are still unknown, but given reports of a more rapid decline in lung function and their suspectibility to develop chronic obstructive pulmonary disease phenotype with aging, it is imperative that lung function of survivors of BPD be closely monitored. Copyright © 2013 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                30 June 2015
                June 2015
                : 27
                : 6
                : 1761-1765
                Affiliations
                [1) ] Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Turkey
                [2) ] School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Turkey
                [3) ] Department of Pediatric Chest Medicine, Faculty of Medicine, Hacettepe University, Turkey
                Author notes
                [* ]Corresponding author. Naciye Vardar Yagli, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University: 06100 Samanpazari, Ankara, Turkey. (E-mail: naciyevardar@ 123456yahoo.com )
                Article
                jpts-2015-038
                10.1589/jpts.27.1761
                4499978
                26180315
                e9a98435-086f-45a0-860f-5ea7c595357e
                2015©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                : 19 January 2015
                : 14 February 2015
                Categories
                Original Article

                bronhopulmonary dysplasia,functional capacity,lung function

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