Longitudinal Pulmonary Evaluation in Children with Post- COVID-19
Condition and Respiratory Symptoms: A Prospective Cohort Study
Abstract
Background: Studies on post-COVID-19 condition (PCC) in adults
have shown deterioration in pulmonary function tests (PFTs), mainly a
diffusion limitation. Among pediatric population data are scarce.
Aim: To characterize PFTs of children with PCC, including
changes over time. Methods: A prospective longitudinal study of
children with defined PCC and respiratory complaints referred to a
designated multidisciplinary clinic from 11/2020 to 12/2022.
Results: 184 children at a mean age of 12.4 years (SD 4.06)
were included. A mild obstructive pattern was demonstrated in 19/170
(11%) at presentation, as indicated by spirometry and/or positive
exercise challenge test and/or reversibility post bronchodilators- only
3 with a previous diagnosis of asthma. Lung volumes and diffusion were
normal in all but one patient (1/134, 0.7%). [Exhaled nitric
oxide](https://erj.ersjournals.com/content/21/1/43) levels were
elevated in 32/144 (22%). All 33 children who had repeated PFTs had
normal or near-normal PFTs on following testing, including 7 (21.2%)
who had mild obstructive PFTs at presentation. Multivariate analysis
identified older age [OR 1.36 (95% CI:1.07-1.75)] and specific
imaging findings [prominent bronchovascular markings (OR 43.28 (95%
CI: 4.50-416.49)[ and hyperinflation ](OR 28.42, 95% CI:
2.18-370.84)] as significant predictors of an obstructive pattern on
PFTs. Conclusion: In children with PCC and respiratory
symptoms, the most common impairment was mild obstructive pattern; most
of them without a history of asthma. Improvement was witnessed in
long-term follow-up. As opposed to the adult population, no diffusion
limitation was found. Empirical periodic inhaler therapy may be
considered in children with factors associated with PFTs abnormalities.