儿童支气管扩张症172例临床研究

目的 探讨儿童支气管扩张症临床表现、 影像学及肺功能方面特点, 分析病因构成, 了解疾病预后。方法 回顾性总结 172 例支气管扩张症患儿的临床表现、 影像学、 肺功能特点及病因, 对部分患儿进行随访。结果 支气管扩张症患儿临床主要表现为咳嗽、咯痰、生长发育受限、杵状指等。胸部X线诊断支气管扩张症的检出阳性率（4.42%）显著低于高分辨率CT（HRCT）的100%。存在免疫缺陷、闭塞性细支气管炎及原发性纤毛运动障碍的患儿在HRCT中弥漫性支气管扩张较其他病因更显著（P＜0.05）。76.92%的患儿肺功能异常。65.70%的患儿可以发现潜在病因,以肺部感染（31.40%）为主。门诊随访患儿FEV1%随病程的延长以每年1.28%的速度下降。其中1例临床症状、HRCT、肺功能均有好转。结论 儿童支气管扩张症临床表现没有明显特异性。大部分患儿可以发现潜在病因,以肺部感染最为常见。对于临床怀疑支气管扩张症的患儿应尽早进行HRCT检查,积极寻找潜在病因。支气管扩张症患儿的肺功能可随着病程的进展缓慢下降。部分患儿在临床症状、HRCT及肺功能上可有好转。     

78例儿童支气管扩张症的临床特征分析

目的总结支气管扩张症患儿的临床特征, 提高诊疗水平, 改善预后。方法回顾性分析2010年1月至2020年1月在青岛大学附属妇女儿童医院诊断治疗的78例支气管扩张症患儿的临床资料, 对其年龄及区域分布、病因、临床表现、肺部高分辨率CT检查结果、肺功能特点、支气管镜检查结果以及治疗预后进行分析。结果 78例支气管扩张症患儿中, 男35例(44.9%), 女43例(55.1%), 中位年龄8.7(6.1, 9.0)岁;农村患儿51例(65.4%), 城市患儿27例(34.6%), 农村儿童发病率高于城市儿童。引起支气管扩张症的前3位病因为:感染后40例(51.3%), 原发性免疫缺陷病9例(11.5%), 吸入因素7例(9.0%)。主要临床表现为湿性咳嗽、咳脓痰、喘息、反复呼吸道感染。肺部高分辨率CT显示弥漫性支气管扩张症36例(46.2%), 局限性支气管扩张37例(47.4%)。49例(62.8%)存在肺通气功能异常。接受支气管镜检查61例(78.2%), 其中49例(80.3%)镜下存在"鱼骨样"改变。经治疗原发病、抗感染、支气管镜检查及肺泡灌洗、祛痰及物理治疗, 67例好转出院并接受...     

儿童支气管扩张症22例临床分析

目的探讨儿童支气管扩张症的病因、临床表现、影像学改变、实验室检查以及治疗方法。方法对临床诊断为支气管扩张症的22例患儿的资料进行分析。结果患儿临床表现为进行性慢性持续性或间歇性咳嗽、咳痰、咯血、杵状指等;入院前多被诊断为支气管肺炎、哮喘或肺结核等;体液免疫异常16例(72.7%),细胞免疫异常15例(68.2%),普通X线胸片显示无异常4例(18.2%),高分辨率CT表现为单纯柱状即表现有双轨征3例(13.6%)、囊状葡萄串状阴影4例(18.2%)、蜂窝状2例(9.1%)、曲张形囊柱状即支气管呈粗细不均的改变6例(27.3%)、棒状或结节状2例(9.1%);病变累及左、右下叶12例(54.5%),右中叶8例(36.4%)。结论支气管扩张症的病因主要是肺部感染,病程迁延而危重,症状多持续或反复,易误诊或漏诊,依据临床表现和实验室以及必要的影像学检查是早期诊断的关键,治疗较困难,须采用综合治疗。     

儿童闭塞性细支气管炎42例临床分析

目的 探讨儿童闭塞性细支气管炎的临床特点.方法对北京儿童医院2001年4月-2007年8月诊断闭塞性细支气管炎的42例患儿进行分析,内容包括患儿年龄、性别、临床表现、病因、肺功能改变、影像学改变、治疗及随访预后等方面.结果 42例患儿(男31例,女11例)诊断时年龄最小的7个月,最大的12岁2个月,均以持续咳嗽、喘息为主要表现.肺部体征有喘鸣音及湿性啰音.病因为感染后32例(76.2%),其中考虑为腺病毒肺炎者8例(占感染后闭塞性细支气管炎的25%),考虑为麻疹肺炎者7例(占感染后闭塞性细支气管炎的21.9%),考虑为呼吸道合胞病毒感染者2例(占感染后闭塞性细支气管炎的6.2%).病因为Steven-Johnson综合征的4例(9.5%).骨髓移植后1例(2.4%).肺功能表现为小气道阻塞性通气功能障碍35例(89.7%),混合性通气功能障碍4例(10.3%).肺CT有典型的马赛克灌注征者34例(81.0%),支气管扩张14例(33.3%),支气管壁增厚14例(33.3%),肺不张4例(9.5%),合并Swyer-James综合征2例(4.8%).所有患儿均予皮质醇激素、小剂量红霉素或阿奇霉素口服治疗,辅以糖皮质激素和支气管扩张剂吸入,或白三烯受体拮抗剂口服治疗.随访1个月至5年,除2例临床表现及影像检查、肺功能有一定程度好转外,其余患儿均有不同程度的加重,死亡1例.结论儿童闭塞性细支气管炎多为感染后起病,其特征性的临床、影像学和肺功能表现基本可以确定诊断.该病预后不佳.     

儿童反复咯血的病因及临床诊治分析

目的 分析儿童反复咯血的病因、临床特点、治疗方法及预后,以提高儿科医师对小儿反复咯血的病因诊断及治疗水平。方法 收集1996 年1 月至2013 年2 月39 例反复咯血患儿的临床、实验室及影像学资料,对其起病年龄、病因、咯血量、影像学改变、治疗方法及随访转归等进行回顾性分析。结果 39 例反复咯血患儿中,特发性肺含铁血黄素沉着症16 例（41%）,肺血管畸形8 例（21%）,肺动静脉瘘7 例（18%）,支气管扩张症3 例（8%）,肺结核和肺囊性纤维化各2 例（5%）,肺肿瘤1 例（3%）。肺部增强CT 扫描和肺动脉-支气管动脉造影发现35 例患儿肺部有不同程度的影像学改变。反复咯血患儿以Ⅰ度（51%）和Ⅱ度（28%）咯血为主,Ⅲ度（21%）咯血少见。39 例患儿根据不同病因经相应的治疗后咯血均得到有效控制,随访0.5~5 年,除3 例特发性肺含铁血黄素沉着症患儿失访外,其余患儿均未再次发生咯血。结论 反复咯血患儿的病因以特发性肺含铁血黄素沉着症为主,肺部增强CT 扫描和肺动脉-支气管动脉造影检查是诊断反复咯血患儿病因的重要方法,应根据患儿不同的病因选择不同的治疗方法。     

182 例重庆地区支气管扩张患儿临床特征及病因构成分析

目的探讨儿童支气管扩张的常见病因及临床特征。方法回顾分析1991年至2015年5月在重庆医科大学附属儿童医院确诊为支气管扩张的住院患儿,以及中文数据库中,1990年至今病例数≥20例的支气管扩张患儿的病例资料。结果重庆地区支气管扩张182患儿例中男114例,女68例,中位年龄118个月。引起支气管扩张的前三位病因为感染后(29.7%)、原发性免疫缺陷病(7.7%)和支气管异物(7.7%)。慢性湿性咳嗽是儿童支气管扩张的主要表现,最常受累肺叶为左肺下叶、右肺中叶和右肺下叶。确诊需结合胸部CT。支气管扩张抗生素选择依据呼吸道分泌物培养,重庆地区最常见的分离菌为肺炎链球菌。另对重庆在内的中国7个城市共572例(男347例,女225例)支气管扩张儿童进行分析发现,前三位病因与重庆相同,所占比例分别为感染后45.5%、原发性免疫缺陷病7.3%和支气管异物5.6%。结论早期诊断、识别病因和综合管理利于儿童支气管扩张的预后。     

外科治疗儿童支气管扩张症的单中心回顾CSCD

目的总结儿童支气管扩张症的外科诊治经验。方法回顾性分析2017年1月至2020年12月于四川大学华西医院小儿外科接受手术治疗的13例支气管扩张症患儿临床资料,其中男7例,女6例;年龄1岁3个月至15岁;均经术前高分辨率CT(high-resolution computed tomography,HRCT)及术后肺组织病理结果明确诊断,收集患儿治疗方法及预后情况。结果13例术前HRCT均提示局限性肺部支气管明显扩张伴管壁增厚,9例因异物或反复感染进展为支气管扩张不可逆期。11例行肺叶切除术,2例行肺段切除术,均获得满意疗效。术后病理检查结果提示支气管扩张的病因分别为:4例为先天性肺畸形,5例为异物吸入,1例为肺部感染,3例原因不明。术后并发症:皮下气肿4例,同侧或对侧肺部感染2例,肺不张1例,伤口感染1例;均经伤口换药、抗感染、雾化祛痰、翻身拍背及体位引流等治愈。门诊随访1~5年,患儿临床症状及生活质量均明显改善,复查胸部CT均恢复良好,随访过程中无一例复发。结论不同潜在病因所致支气管扩张症应采取不同的诊治策略,先天性肺畸形、异物吸入及终末期肺部感染是儿童支气管扩张症的主要手术指征。     

外科治疗儿童支气管扩张症的单中心回顾

目的总结儿童支气管扩张症的外科诊治经验。方法回顾性分析2017年1月至2020年12月于四川大学华西医院小儿外科接受手术治疗的13例支气管扩张症患儿临床资料, 其中男7例, 女6例;年龄1岁3个月至15岁;均经术前高分辨率CT(high-resolution computed tomography, HRCT)及术后肺组织病理结果明确诊断, 收集患儿治疗方法及预后情况。结果 13例术前HRCT均提示局限性肺部支气管明显扩张伴管壁增厚, 9例因异物或反复感染进展为支气管扩张不可逆期。11例行肺叶切除术, 2例行肺段切除术, 均获得满意疗效。术后病理检查结果提示支气管扩张的病因分别为:4例为先天性肺畸形, 5例为异物吸入, 1例为肺部感染, 3例原因不明。术后并发症:皮下气肿4例, 同侧或对侧肺部感染2例, 肺不张1例, 伤口感染1例;均经伤口换药、抗感染、雾化祛痰、翻身拍背及体位引流等治愈。门诊随访1～5年, 患儿临床症状及生活质量均明显改善, 复查胸部CT均恢复良好, 随访过程中无一例复发。结论不同潜在病因所致支气管扩张症应采取不同的诊治策略, 先天性肺畸形、异物吸入及终末期肺部感染是...     

肺炎支原体及衣原体肺炎致支气管扩张27例临床分析

目的探讨肺炎支原体(MP)及衣原体肺炎(CP)致儿童支气管扩张的临床特征、治疗及预后。方法回顾性分析27例高分辨CT提示有支气管扩张的MP、CP感染肺炎患儿的临床资料。结果 MP及CP感染肺炎患儿的支气管扩张发生率为0.56%。27例患儿的平均年龄(75.4±52.7)月。27例(100%)患儿均有咳嗽,发热19例(70.4%),气促和三凹征10例(37%),肺部湿罗音20例(74%);MP-IgM阳性16例(69.6%),CP-IgM阳性5例(18.5%),两者同时阳性6例(22.2%);合并其他病原体感染8例(29.6%),其中细菌感染6例。影像学表现弥漫性支扩13例(48.1%),局限性支扩14例(51.9%);支气管镜检查提示内膜炎症,黏膜肿胀,部分糜烂;合并黏膜滤泡增生16例(66.7%),短柱状痰栓形成5例(20.8%),包括1例塑形性支气管炎形成。患儿均使用大环内酯类抗生素治疗,10例(37%)合用甲泼尼龙,3例(11.1%)合用丙种球蛋白,20例(74%)联用其他类抗生素;平均住院时间(12±4.3)d。23例在4个月内支气管扩张征象消失,2例在9~15个月仍有支气管扩张,并有反复肺炎史。结论 MP、CP感染肺炎可导致急性支气管扩张,大部分患儿经有效治疗后可恢复。     

儿童咯血的病因及程序性诊断方法探讨

目的：分析儿童咯血的病因分布,并对儿童咯血的程序性诊断方法进行探讨。方法回顾性分析湖南省儿童医院呼吸内科病房2012年6月至2015年6月收治的42例咯血患儿的临床资料,根据病因进行分类,并对程序性诊断方法进行总结和评估,最终的诊断结果分为明确诊断和病因未明。结果明确诊断41例(97．6%),病因未明1例(2．4%)。感染为主要病因,包括肺炎8例(19．0%)、支气管炎5例(11．9%),其他依次为支气管动脉-肺动脉瘘10例(23．8%)、肺含铁血黄素沉着症8例(19．0%)、支气管扩张5例(11．9%)、肺大血管畸形并肺动脉高压3例(7．2%)、肺结核1例(2．4%)、支气管异物1例(2．4%)。13例呼吸道感染及5例支气管扩张患儿通过胸部CT确诊,10例支气管动脉-肺动脉瘘患儿通过血管造影确诊,8例肺含铁血黄素沉着症、1例肺结核及1例支气管异物患儿通过纤维支气管镜确诊,3例肺大血管畸形并肺动脉高压患儿通过多排螺旋CT血管造影技术、心脏彩超确诊。结论儿童咯血是一组异质性疾病,病因复杂。采用程序性诊断方法能明确大多数咯血患儿的诊断,病史、纤维支气管镜、多排螺旋CT血管造影技术、心脏彩超、数字减影血管造影在儿童咯血的病因诊断中发挥重要作用。     

Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial

ABSTRACT: BACKGROUND: The prevalence of chronic suppurative lung disease (CSLD) and bronchiectasis unrelated to cystic fibrosis (CF) among Indigenous children in Australia, New Zealand and Alaska is very high. Antibiotics are a major component of treatment and are used both on a short or long-term basis. One aim of long-term or maintenance antibiotics is to reduce the frequency of acute pulmonary exacerbations and symptoms. However, there are few studies investigating the efficacy of long-term antibiotic use for CSLD and non-CF bronchiectasis among children. This study tests the hypothesis that azithromycin administered once a week as maintenance antibiotic treatment will reduce the rate of pulmonary exacerbations in Indigenous children with bronchiectasis.Methods/designWe are conducting a multicentre, randomised, double-blind, placebo controlled clinical trial in Australia and New Zealand. Inclusion criteria are: Aboriginal, Torres Strait Islander, Maori or Pacific Island children aged 1 to 8 years, diagnosed with bronchiectasis (or probable bronchiectasis) with no underlying disease identified (such as CF or primary immunodeficiency), and having had at least one episode of pulmonary exacerbation in the last 12 months. After informed consent, children are randomised to receive either azithromycin (30 mg/kg once a week) or placebo (once a week) for 12--24 months from study entry. Primary outcomes are the rate of pulmonary exacerbations and time to pulmonary exacerbation determined by review of patient medical records. Secondary outcomes include length and severity of pulmonary exacerbation episodes, changes in growth, school loss, respiratory symptoms, forced expiratory volume in 1-second (FEV1; for children [GREATER-THAN OR EQUAL TO]6 years), and sputum characteristics. Safety endpoints include serious adverse events. Antibiotic resistance in respiratory bacterial pathogens colonising the nasopharynx is monitored. Data derived from medical records and clinical assessments every 3 to 4 months for up to 24 months from study entry are recorded on standardised forms. DISCUSSION: Should this trial demonstrate that azithromycin is efficacious in reducing the number of pulmonary exacerbations, it will provide a much-needed rationale for the use of long-term antibiotics in the medical management of bronchiectasis in Indigenous children.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12610000383066.     

High torquetenovirus loads are correlated with bronchiectasis and peripheral airflow limitation in children

BACKGROUND: The aim of the study was to evaluate the prevalence of torquetenovirus (TTV) infection in a group of children with recurrent lower respiratory tract infections and radiologic evidence of bronchiectasis. Correlations between TTV loads and severity of bronchiectasis and between TTV loads and lung function were evaluated. METHODS: In 38 subjects, high-resolution computed tomography (HRCT) and plasma tests for TTV detection and quantification were done. In 21/38 subjects, spirometry was also performed. RESULTS: TTV was found in 31/38 (81.6%) patients. The correlation between TTV loads and severity of bronchiectasis was statistically significant (r = 0.548; P = 0.01). TTV loads showed inverse correlation with FEF25-75% (r = -0.541; P = 0.011), and FEF25-75%/FVC (r = -0.512; P = 0.018). Inverse correlation was found also between severity of bronchiectasis and functional lung parameters: FEF25-75% (r = -0.635; P = 0.002), FEV1/FVC (r = -0.541; P = 0.011), and FEF25-75%/FVC (r = -0.645; P = 0.002). CONCLUSIONS: This study demonstrated the high prevalence of TTV infection in children with bronchiectasis. Moreover, we have shown a significant correlation between TTV loads and airflow limitation within the peripheral airways, as well as between severity of bronchiectasis and decrease of lung function.     

Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children

Purpose

To determine the clinical characteristics of patients submitted to surgical treatment for non-cystic fibrosis (CF) bronchiectasis, the indications for surgery, and the results obtained at a referral facility for pediatric thoracic surgery.

Methods

Between January 1998 and December 2009, we retrospectively reviewed the medical charts of 109 pediatric patients with non-CF bronchiectasis who underwent surgical treatment. These findings were subsequently analyzed by focusing on postoperative complications and long-term results.

Results

Of the 109 patients undergoing pulmonary resection, the mean age was 7.6 years (ranging from 1 to 15.5 y–o) with male predominance (59 %). The most common procedure was segmentectomy (43 %) followed by left lower lobectomy (38 %). Minor postoperative complications occurred in 36 % of the patients; the most common was transient atelectasis (26 %), followed by air leak (6 %), and postoperative pain (4 %). There was one death within the 30-day postoperative period, but it was unrelated to the procedure. Eighty-three children were followed after discharge, with a mean follow-up period of 667 days. Sixty-five (76 %) patients showed improvement of clinical symptoms after surgery.

Conclusions

Lung resection for the treatment of non-CF bronchiectasis in children is a safe procedure, with no life-treating morbidity and low mortality. This procedure also leads to significant improvements in symptoms and quality of life.     

Paediatric bronchiectasis in the twenty-first century: experience of a tertiary children's hospital in New Zealand

OBJECTIVE: Despite its decline in developed countries, bronchiectasis appeared to be a common diagnosis in Auckland, New Zealand children. The aims of this study were: to document the number of children in Auckland with bronchiectasis, their severity, clinical characteristics and possible aetiologies; to assess whether there was a relationship between ethnicity and poverty; and to estimate a crude bronchiectasis prevalence rate for New Zealand. METHODS: A retrospective review of the case histories of all children attending a tertiary children's hospital in Auckland with bronchiectasis diagnosed by high-resolution chest computed tomography (CT) scan, during the period 1998-2000 was undertaken. Data collected included patient demographics, number of hospitalizations pre- and post-diagnosis, lung function tests, radiology and investigations. The New Zealand deprivation 1996 index was applied to the data to obtain a measure of socio-economic status. RESULTS: Bronchiectasis was found to be common, with an estimated prevalence of approximately one in 6000 in the Auckland paediatric population. It was disproportionately more common in the Pacific Island and Maori children. In Pacific Island children, bronchiectasis not caused by cystic fibrosis was nearly twice as common in the general population than cystic fibrosis. Socio-economic deprivation and low immunization rates may be significant contributing factors. The bronchiectasis seen was extensive. Ninety-three percent had bilateral disease and 64% had involvement of four or more lobes on chest CT scan. A wide range of comorbidities and underlying aetiologies were evident. CONCLUSIONS: Paediatric bronchiectasis in Auckland, New Zealand, is common but underresourced. Only the most severe cases are being recognized, providing a significant challenge for paediatric health professionals.     

Chest imaging findings of chronic respiratory disease in HIV-infected adolescents on combined anti retro viral therapy

Early treatment with combination antiretroviral therapy (cART) has improved survival of children perinatally infected with HIV into adolescence. This population is at risk of long term complications related to HIV infection, particularly chronic respiratory disease. Limited data on chest imaging findings in HIV-infected adolescents, suggest that the predominant disease is of small and large airways: predominantly bronchiolitis obliterans or bronchiectasis. Single cases of emphysema have been reported. Lung fibrosis, lymphocytic interstitial pneumonitis, post tuberculous apical fibrocystic changes and malignancies do not feature in this population. Chest radiograph (CXR) is easily accessible and widely used, especially in resource limited settings, such as sub Saharan Africa, where the greatest burden of HIV disease occurs. Lung ultrasound has been described for the diagnosis of pneumonia in children, pulmonary oedema and interstitial lung disease [1], [2], [3]. The use of this modality in chronic respiratory disease in adolescents where the predominant finding is small airway disease and bronchiectasis has however not been described. CXR is useful to evaluate structural/post infective changes, parenchymal opacification and nodules, hyperinflation or extensive bronchiectasis. CXR however, is inadequate for diagnosing small airway disease, for which high resolution computed tomography (HRCT) is the modality of choice. Where available, low dose HRCT should be used early in the course of symptomatic disease in adolescents and for follow up in children who are non responsive to treatment or clinically deteriorating.This article provides a pictorial review of the spectrum of CXR and HRCT imaging findings of chronic pulmonary disease in perinatally HIV-infected adolescents on cART and guidelines for imaging.     

Impact of underlying cause of bronchiectasis on clinical outcome: A comparative study on CF and Non-CF bronchiectasis in Egyptian children

Background

Bronchiectasis represents an important cause of chronic lung disease in children in developing countries and continues to be one of the leading causes of morbidity and mortality with worsening quality of life in these children.

Effects of childhood bronchiectasis on cardiac functions

BACKGROUND: Bronchiectasis is still a widespread disease in developing countries. It is an important cause of mortality and morbidity. The information on cardiac involvement in bronchiectasis is limited. However, cor pulmonale is common in patients with chronic lung disease, such as cystic fibrosis. METHODS: We utilized echocardiography and exercise tests, along with clinical scoring, chest radiograph scoring, and pulmonary function tests in 21 patients to determine whether detectable changes in cardiac functions were present, and the nature of their relationship to the underlying disease severity. RESULTS: The ventricular systolic functions were preserved in all patients. Some of the patients had changes in left ventricular diastolic function indices, characterized by abnormal Ewave/Awave (E/A) ratios or isovolumetric relaxation time values. Isovolumetric relaxation time but not E/A ratios was found to have a significant negative correlation with the clinical score. In addition, exercise capacity was decreased in bronchiectatic children. Most of the patients stopped the exercise test due to exhaustion before reaching maximum heart rate. CONCLUSION: Left ventricular diastolic functions are affected in bronchiectasis, and the performance of patients is dependent on their pulmonary status. This is the first study demonstrating the cardiac effects of bronchiectasis according to our survey of the published literature.     

EVI1与BCR/ABL基因共表达的儿童白血病临床分析

目的 研究EVI1与BCR/ABL基因共表达的儿童白血病的临床特征。方法 收集并比较分析4例EVI1与BCR/ABL基因共表达的儿童白血病以及8例BCR/ABL基因表达阳性而EVI1表达阴性的慢性粒细胞性白血病（CML）的临床资料。结果 4例EVI1与BCR/ABL基因共表达的白血病患儿初诊时2例为CML慢性期,1例为CML加速期,1例为高危急性淋巴细胞性白血病（ALL）。3例EVI1与BCR/ABL基因共表达的CML与8例BCR/ABL基因表达阳性而EVI1表达阴性CML临床特征比较无明显差异。EVI1与BCR/ABL共表达的患儿均高表达CD33、CD38。染色体分析发现4例患儿都存在t（9;22）。截止到随访日期2013年8月,3例EVI1基因表达阳性的CML患儿2例在治疗1个月或3个月后达到血液学缓解;2例BCR/ABL基因和EVI1基因均未转阴,1例EVI1基因转阴而BCR/ABL基因仍未转阴。除ALL第一疗程治疗后未达缓解,放弃治疗失访外,其余3例患儿均存活,无复发,总生存期分别为20、13、14个月。结论 EVI1与BCR/ABL融合基因共表达可存在于儿童CML和ALL中,其临床特征无特异性,其预后还需扩大样本量进一步明确。     

The radiology of chronic lung disease in children.

Chronic lung disease (CLD) in children represents a heterogeneous group of many distinct clinicopathological entities. The prevalence of CLD has increased in the past decade because of the more advanced and intensive respiratory support provided for compromised children and additionally the overall improved survival of preterm babies. The disorders which constitute CLD generally have a slow tempo of progression over many months or even years. The most common causes of CLD in children are cystic fibrosis (CF), and other causes of bronchiectasis (such as immunodeficiency, and in the third world, post-infective bronchiectasis, for example, measles), bronchopulmonary dysplasia (BPD) (or lung disease of prematurity), asthma, chronic gastro-oesophageal reflux/aspiration pneumonitis, and constrictive obliterative bronchiolitis.