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EDITORIAL
Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 17

Suppurative lungs, pneumothorax and 6-min walk test in children


Division of Pediatric Pulmonology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Date of Web Publication6-Jul-2018

Correspondence Address:
Aroonwan Preutthipan
Division of Pediatric Pulmonology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/prcm.prcm_8_18

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How to cite this article:
Preutthipan A. Suppurative lungs, pneumothorax and 6-min walk test in children. Pediatr Respirol Crit Care Med 2018;2:17

How to cite this URL:
Preutthipan A. Suppurative lungs, pneumothorax and 6-min walk test in children. Pediatr Respirol Crit Care Med [serial online] 2018 [cited 2018 Jul 20];2:17. Available from: http://www.prccm.org/text.asp?2018/2/2/17/236141

In this issue, Prof. Mark Lloyd Everard has stimulates the awareness of persistent bacterial bronchitis (PBB) and chronic suppurative lung disease (CSLD) in children. As he wrote, “if doctors do not know this disease exists, they will never diagnose it.”[1] PBB and CSLD is a chronic neutrophil-predominated bronchitis. CSLD has been used to describe the clinical features of bronchiectasis when the radiographic features needed to make a diagnosis of bronchiectasis are absent.[2] He also describes the pathophysiology of this disease which is associated with the development of bacterial biofilms in the lungs and airways. Making the diagnosis is somewhat challenging, not straightforward like pneumonia or asthma. Choosing the most appropriate antibiotics and physiotherapy to eliminate bacteria and permit recovery of structure and function in most cases should result in a cure, which could prevent lifelong morbidity from bronchiectasis.[1] Since this disease entity is probably underrecognized, its exact prevalence is unknown. Early diagnosis should be emphasized to minimize long term complications.

Primary spontaneous pneumothorax (PSP) in children may lead to a life threatening condition. In the current issue of Pediatric Respirology and Critical Care Medicine, Ping-Yang Kuo et al. publish an excellent literature review of PSP in children including epidemiology, pathophysiology, clinical features, diagnosis, and management.[3] Unlike adults, the recurrent rate of PSP was much more higher in children after nonsurgical management.[3] Therefore they recommended thorax computed tomography (CT) and subsequent surgical treatment, not only for recurrent PSP but also first episode of large PSP after needle aspiration or chest tube drainage.[4] Video-assisted thoracoscopic surgery (VATS) with either mechanical or chemical pleurodesis to stop air leak is suggested for the affected side. The suggested timing of VATS after failure from tube thoracostomy was ranged from 3 to 7 days.[5],[6],[7] Wedge resection by VATS is recommended if CT scan of the chest shows bullae or blebs.[8] Practice guidelines based on adults may not be applicable to children as the situation may not be the same.

The 6-min walk test (6MWT) is the distance an individual can walk at a constant, uninterrupted, unhurried pace in 6 min. It is now used routinely to assess patients with cardiopulmonary disease in view of its simplicity and cost-effectiveness. Li et al. demonstrated in 2005 that the 6MWT had good correlation with maximum oxygen uptake determined by cardiopulmonary exercise test (CPET) in healthy children.[9] The correlation was confirmed again in children with various cardiopulmonary diseases by Dr. Pik-Fung Wong's study published in this issue.[10] Moreover, if the distance that the child could walk in 6 min was less than 10th percentile of height-matched reference obtained from healthy Chinese children, that child most likely had abnormal CPET. This is another convincing evidence supporting the usefulness of 6MWT, which can be performed easily in children in every parts of the world.

 
  References Top

1.
Everard M. 'Suppurative lung disease' in children. Pediatr Respirol Crit Care Med 2018;2:19-25.  Back to cited text no. 1
    
2.
Redding GJ, Carter ER. Chronic suppurative lung disease in children: Definition and spectrum of disease. Front Pediatr 2017;5:30.  Back to cited text no. 2
[PUBMED]    
3.
Kuo P, Nong B, Huang Y, Chiou Y. Primary spontaneous pneumothorax in children: A literature review. Pediatr Respirol Crit Care Med 2018;2:26-32.  Back to cited text no. 3
    
4.
Soccorso G, Anbarasan R, Singh M, Lindley RM, Marven SS, Parikh DH. Management of large primary spontaneous pneumothorax in children: Radiological guidance, surgical intervention and proposed guideline. Pediatr Surg Int 2015;31:1139-44.  Back to cited text no. 4
[PUBMED]    
5.
Zganjer M, Cizmić A, Pajić A, Cigit I, Zganjer V. Primary spontaneous pneumothorax in pediatric patients: Our 7-year experience. J Laparoendosc Adv Surg Tech A 2010;20:195-8.  Back to cited text no. 5
    
6.
Butterworth SA, Blair GK, LeBlanc JG, Skarsgard ED. An open and shut case for early VATS treatment of primary spontaneous pneumothorax in children. Can J Surg 2007;50:171-4.  Back to cited text no. 6
    
7.
Williams K, Oyetunji TA, Hsuing G, Hendrickson RJ, Lautz TB. Spontaneous pneumothorax in children: National management strategies and outcomes. J Laparoendosc Adv Surg Tech A 2018;28:218-22.  Back to cited text no. 7
    
8.
Noh D, Lee S, Haam SJ, Paik HC, Lee DY. Recurrence of primary spontaneous pneumothorax in young adults and children. Interact Cardiovasc Thorac Surg 2015;21:195-9.  Back to cited text no. 8
    
9.
Li AM, Yin J, Yu CC, Tsang T, So HK, Wong E, et al. The six-minute walk test in healthy children: Reliability and validity. Eur Respir J 2005;25:1057-60.  Back to cited text no. 9
    
10.
Wong P, Chan E, Ng D, Kwok K, Yip A, Leung S. Correlation between 6-min walk test and cardiopulmonary exercise test in Chinese patients. Pediatr Respirol Crit Care Med 2018;2:33-6.  Back to cited text no. 10
    




 

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