EXERCISE CAPACITY IN CHILDREN AND ADOLESCENTS WITH POST-INFECTIOUS BRONCHIOLITIS OBLITERANS: A SYSTEMATIC REVIEW

Rodrigues, Camila Menna Barros; Schiwe, Daniele; Campos, Natália Evangelista de; Niederauer, Fabiana; Heinzmann-Filho, João Paulo

doi:10.1590/1984-0462/;2019;37;2;00017

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Revista Paulista de Pediatria

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Review Article • Rev. paul. pediatr. 37 (2) • Apr-Jun 2019 • https://doi.org/10.1590/1984-0462/;2019;37;2;00017 copy

EXERCISE CAPACITY IN CHILDREN AND ADOLESCENTS WITH POST-INFECTIOUS BRONCHIOLITIS OBLITERANS: A SYSTEMATIC REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans.

Data source:

This is a systematic review based on data from PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), and Physiotherapy Evidence Database (PEDro). We used the following search strategy: “Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six-minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans.” We selected studies that evaluated exercise capacity through maximal/submaximal testing in children and adolescents with post-infectious bronchiolitis obliterans, and no other associated disease. We searched articles in English, Portuguese, and Spanish, without restrictions regarding the period of publication. The methodological quality was assessed by the Agency for Healthcare Research and Quality (AHRQ) protocol.

Data synthesis:

Out of the 81 articles found, only 4 were included in this review. The studies totaled 135 participants (121 with post-infectious bronchiolitis obliterans and 14 healthy), with sample sizes between 14 and 58 subjects. All patients underwent spirometry to evaluate pulmonary function, indicating an obstructive ventilatory pattern. Among them, 3/4 had their physical performance assessed by the six-minute walk test and 2/4 by the cardiopulmonary exercise testing. These test results were compared to those of a control group (1/4) and presented as percentage of predicted and/or in meters (3/4). Lastly, 3/4 of the studies showed reduced exercise capacity in this population. The studies included were classified as having high methodological quality.

Conclusions:

Findings of the study demonstrate that children and adolescents with post-infectious bronchiolitis obliterans have reduced exercise capacity.

Keywords:
Exercise capacity; Physical fitness; Physical activity; Bronchiolitis obliterans; Pediatrics

First author & year	Country (origin)	Groups assessed	Age group (years)	Sample size
Frohlich et al. (2014)²²22. Frohlich LF, Vieira PJ, Teixeira PJ, Silva FA, Ribeiro JP, Berton DC. Exercise capacity in adolescent and adult patients with post infectious bronchiolitis obliterans. Pediatr Pulmonol. 2014;49:911-8.	Brazil	Healthy PIBO	10-23 10-23	14 16
Zenteno et al. (2009)²³23. Zenteno D, Puppo H, González R, Pavón D, Vera R, Torres R, et al. Six minute walk test in children with post-infectious obliterans bronchiolitis. Its relation with spirometry. Rev Chil Enferm Respir. 2008;24:15-9.	Chile	PIBO	8-14	27
Mattiello et al. (2008)¹¹11. Mattiello R, Sarria EE, Stein R, Fischer GB, Mocelin HT, Barreto SS, et al. Functional capacity assessment during exercise in children and adolescents with post-infectious bronchiolitis obliterans. J Pediatr (Rio J). 2008;84:337-43. 12. [No authors listed]. Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur Respir J. 1997;10:2662-89.	Brazil	PIBO	8-16	20
Gerbase et al. (2008)²⁴24. Gerbase MW, Soccal PM, Spiliopoulos A, Nicod LP, Rochat T. Long-term health-related quality of life and walking capacity of lung recipients with and without bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2008;27:898-904.	Switzerland	PIBO	5.6±2.9*	58

First author & year	Groups assessed	Pulmonary function (% of predicted)	Exercise testing used	Results of the exercise testing (% of predicted)	Conclusion of the exercise capacity
Frohlich et al. (2014)²²22. Frohlich LF, Vieira PJ, Teixeira PJ, Silva FA, Ribeiro JP, Berton DC. Exercise capacity in adolescent and adult patients with post infectious bronchiolitis obliterans. Pediatr Pulmonol. 2014;49:911-8.	Healthy	FEV₁: 112±15 FVC: 112±16 FEV₁/FVC: 99±03	CPET	VO_2max.: 101±17	Reduced exercise capacity compared to healthy individuals (p-value<0.05)
	PIBO	FEV₁: 60±30 FVC: 74±22 FEV₁/FVC: 78±21	CPET	VO_2max.: 84±15
Zenteno et al. (2009)²³23. Zenteno D, Puppo H, González R, Pavón D, Vera R, Torres R, et al. Six minute walk test in children with post-infectious obliterans bronchiolitis. Its relation with spirometry. Rev Chil Enferm Respir. 2008;24:15-9.	PIBO	FVC: 85.4±15 FEV₁: 58.3±23 FEV₁/FVC: 59.3±32 FEF_25-75: 31.7±25	6MWT	Distance covered: 598±71^#	Preserved exercise capacity (>476 m)
Mattiello et al. (2008)¹¹11. Mattiello R, Sarria EE, Stein R, Fischer GB, Mocelin HT, Barreto SS, et al. Functional capacity assessment during exercise in children and adolescents with post-infectious bronchiolitis obliterans. J Pediatr (Rio J). 2008;84:337-43. 12. [No authors listed]. Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur Respir J. 1997;10:2662-89.	PIBO	FEV₁: 57.7±17.9 FVC: 66.8±17.3 FEV₁/FVC: 57.9±12.5 FEF_25-75: 20.4±12.6	6MWT CPET	Distance covered: 77±15.7 VO_2max.: 77.5±37.5	Reduced exercise capacity (<80% of predicted)
Gerbase et al. (2008)²⁴24. Gerbase MW, Soccal PM, Spiliopoulos A, Nicod LP, Rochat T. Long-term health-related quality of life and walking capacity of lung recipients with and without bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2008;27:898-904.	PIBO	FEV₁: 73.9±25.1	6MWT	Distance covered: 30.4 (4.5-8.1)*	Reduced exercise capacity (<80% of predicted)

Criteria evaluated*	Reference score	Frohlich et al. (2014)²²22. Frohlich LF, Vieira PJ, Teixeira PJ, Silva FA, Ribeiro JP, Berton DC. Exercise capacity in adolescent and adult patients with post infectious bronchiolitis obliterans. Pediatr Pulmonol. 2014;49:911-8.	Zenteno et al. (2009)²³23. Zenteno D, Puppo H, González R, Pavón D, Vera R, Torres R, et al. Six minute walk test in children with post-infectious obliterans bronchiolitis. Its relation with spirometry. Rev Chil Enferm Respir. 2008;24:15-9.	Mattiello et al. (2008)¹¹11. Mattiello R, Sarria EE, Stein R, Fischer GB, Mocelin HT, Barreto SS, et al. Functional capacity assessment during exercise in children and adolescents with post-infectious bronchiolitis obliterans. J Pediatr (Rio J). 2008;84:337-43. 12. [No authors listed]. Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur Respir J. 1997;10:2662-89.	Gerbase et al. (2008)²⁴24. Gerbase MW, Soccal PM, Spiliopoulos A, Nicod LP, Rochat T. Long-term health-related quality of life and walking capacity of lung recipients with and without bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2008;27:898-904.
Study question	2	2	2	2	2
Study population	8	5	5	8	5
Comparability of individuals for observational studies	22	19	19	19	17
Exposure or intervention	11	11	11	11	11
Result measurements	20	15	15	15	15
Statistical analysis	19	12	12	14	12
Results	8	8	8	8	8
Discussion	5	5	5	5	3
Funding and sponsorship	5	0	0	0	0
Total score	100	77	77	82	73

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[1] Corresponding author. E-mail: joao.heinzmann@pucrs.br (J.P. Heinzmann Filho).