Chest
Volume 109, Issue 6, June 1996, Pages 1532-1535
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Clinical Investigations: Airways
Evidence of Airway Obstruction in Children With Idiopathic Scoliosis

https://doi.org/10.1378/chest.109.6.1532Get rights and content

Restrictive pulmonary function abnormalities are reported in children and adolescents with idiopathic scoliosis. We hypothesized that spirometry alone, without more extensive testing, including the measurement of lung volumes, is inadequate in characterizing lung function in these children and may miss obstructive abnormalities including significant gas trapping. To examine this hypothesis, we reviewed the pulmonary function tests of 44 children (36 female, 8 male) between the ages of 10 and 18 years with idiopathic scoliosis prior to surgical correction. Spirometry, measurements of lung volumes with both plethysmographic and helium dilution techniques, and bronchodilator response were analyzed for evidence of reversible airway obstruction and gas trapping. Eighteen of 44 (41%) subjects had significant restriction. Only 3 (7%) subjects met standard criteria for airflow obstruction. However, 20 (46%) subjects had an elevated total gas volume by plethysmography-functional residual capacity by helium dilution ratio indicative of moderate or severe gas trapping, 10 (23%) subjects showed mild gas trapping, 8 (18%) subjects had a ratio suggestive of gas trapping, and only 6 (14%) subjects were normal. Additionally, significant improvement in airway mechanics was noted after bronchodilator administration. Specific conductance improved in all subjects, with a mean increase of 62%±8.0 (p<0.001). The residual volume-total lung capacity ratio and total gas volume by plethysmography also decreased significantly (mean decrease, 22.5%±3.0 and 15%±1.0, respectively, p<0.001) in response to inhaled bronehodilators. In conclusion, although restrictive defects are commonly present in children with idiopathic scoliosis, significant gas trapping and responses to bronchodilators also commonly occur. These abnormalities may be missed without extensive pulmonary function testing.

Section snippets

Clinical Data

We performed pulmonary function tests on 59 children scheduled to have surgical correction of idiopathic scoliosis between January 1988 and December 1994. Forty-four subjects (36 females, 8 males) who had a thoracic curve greater than 35 degrees as measured by the method of Cobb6 and who did not have secondary scoliosis due to neuromuscular disease, metabolic disease, or trauma were included in the study.

All pulmonary function tests were done in a pediatric pulmonary function lab by the same

RESULTS

The mean age of the subjects was 13.6±0.33 years (range, 10 to 18 years) and the mean thoracic angle was 47±1.62 degrees (range, 35 to 90 degrees).

Based on ATS14 criteria, 26 (59%) subjects had no restrictive defects, 4 (9%) subjects had mild defects, 7 (16%) subjects had moderate defects, and 7 (16%) subjects had moderately severe defects (Fig 1).

The mean percent predicted FEV1 was 67%±2.5, with an FVC of 68%±2.6. The difference between the predicted and measured FEV1/FVC did not meet ITS13

DISCUSSION

It is generally accepted that alveolar hypoventilation and respiratory dysfunction leading to pulmonary hypertension and cor pulmonale is encountered with scoliosis patients whose curvature is greater than 90 degrees. However, pulmonary function defects may be seen with lesser degrees of scoliosis.15 The mean angle of our subjects was 47 degrees, a moderate, class 2 deformity based on the classification by Gozioglu et al.1 Even though 45% of our subjects had restrictive defects, none had a

ACKNOWLEDGMENT

The authors are grateful to Richard Griffin, MS, for technical support.

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