Childhood Interstitial Lung Diseases (chILD)
Childhood interstitial lung diseases (chILDs) are a group of rare but serious conditions that affect the lungs, causing inflammation and scarring (fibrosis) in the tissues surrounding the lung air sacs. These conditions can lead to reduced lung function and difficulty breathing, potentially affecting a child’s growth, and development.
Causes and Risk Factors of Childhood Interstitial Lung Diseases
- Genetic conditions: Some children inherit genetic mutations that make them susceptible to developing ILDs.
- Autoimmune diseases like juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE)
- Certain viral or bacterial infections can trigger inflammation in the lungs that may lead to scarring, particularly in infants or young children.
- Environmental exposures: e.g. pigeon droppings, mould (read hypersensitivity pneumonitis below)
Some ILDs are idiopathic, meaning their exact cause is unknown.
Symptoms of Childhood Interstitial Lung Diseases
- Chronic cough
- Shortness of breath, particularly on exertion
- Rapid breathing
As the disease progresses, children may also experience fatigue and poor growth. In more severe cases, cyanosis (a bluish tint to the skin) and clubbing (widening of the fingertips) may develop.
Diagnosis
- Detailed medical history and physical examination
- Chest X-ray ± CT scan of the chest
- Pulmonary function tests (PFTs) such as spirometry can help determine how well the lungs are functioning.
- Blood tests: to check for autoimmune markers or signs of inflammation.
- Lung biopsy: In some cases, a tissue sample may be taken from the lungs to confirm the diagnosis and determine the specific type of ILD
Treatment of ChILD
The treatment of ChILD depends on the underlying cause and severity of the condition.
- Corticosteroids and other immunosuppressive drugs may be prescribed to reduce inflammation and manage autoimmune-related ILDs.
- For children with significant breathing difficulties or low oxygen levels, supplemental oxygen may be required to help them breathe more easily.
- Pulmonary rehabilitation program includes exercises and techniques to improve lung function and endurance, helping children maintain physical activity and strength.
Hypersensitivity pneumonitis (HP) is a rather common type of ILD that occurs when a child’s lungs become inflamed due to an allergic reaction to inhaled environmental allergens. These allergens are typically organic particles such as mould, bird droppings, or contaminated water from humidifiers. When a child is repeatedly exposed to these irritants, their immune system reacts, causing inflammation in the air sacs of the lungs, leading to symptoms like cough, shortness of breath and chest tightness. Acute episodes may occur suddenly, often following exposure to a specific allergen, while chronic HP can develop over time with prolonged exposure. Diagnosis entails a thorough medical history, imaging tests such as chest X-rays and/or CT scans, and pulmonary function tests to assess lung damage. Treatment involves avoiding the exposure and medications like corticosteroids. Early recognition and management of HP are crucial to prevent long-term lung damage.
If your child is experiencing persistent respiratory symptoms or has a family history of lung disease, it’s important to seek medical advice from a pediatric pulmonologist.