Pediatric interstitial lung disease

Interstitial lung disease in children (chILD) is rare and encompasses more than 200 entities, with new especially genetic causes being discovered. Several classifications have been proposed, and there is considerable overlap with entities which present in adult life. Presentation may be shortly after birth with acute respiratory distress and in infancy and childhood either with a primary respiratory presentation or with systemic symptoms such as poor feeding and failure to thrive. Newborn acute presentations are usually due either to a mutation in one of the surfactant protein (Sp) genes or the alveolar capillary dysplasia (ACD)-congenital alveolar dysplasia (CAD) spectrum. The latter usually progress rapidly to extracorporeal membrane oxygenation, and early lung biopsy is advisable to prevent prolonged futile treatment being offered. Outside the newborn period, a staged protocol for investigation is proposed. This starts with a computed tomography scan, which confirms or otherwise the presence of chILD, and occasionally can lead to a specific diagnosis. In particular in settings where there is a high burden of infection, infective mimics of chILD need to be excluded. The next investigations aim to try to move from pattern recognition to specific diagnoses, both genetic and environmental. The speed of progression to lung biopsy will depend on the clinical state of the child, and the biopsy itself may suggest a hunt for a new underlying cause, such as immunodeficiency. Specific genetic causing chILD includes mutations in SpB and SpC and processing genes (thyroid transcription factor-1 [TTF-1] and adenosine triphosphate-binding cassette subfamily A) (the last three can present at any time in the life course); genes involved in Sp catabolism (granulocyte-macrophage colony factor receptor A and B genes), an increasing number implicated in the ACD-CAD spectrum, and other non-Sp related genes such as Filamin-A and integrin genes. Environmental causes are also important and vary across the world. Vaping has been implicated as causing a large number of chILDs, and a vaping history is essential in any young person with an unusual respiratory illness. Medications, both prescribed and over-the-counter such as oily laxatives, are also causes of chILD. There are important conditions of unknown cause presenting in early childhood. Neuroendocrine cell hyperplasia of infancy (NEHI) and pulmonary interstitial glycogenosis generally have a good prognosis, and are probably best considered as part of a spectrum of pulmonary dysmaturity syndromes, in some of which underlying gene mutations have been detected, for example, TTF-1 for NEHI. Pulmonary alveolar proteinosis is an example of an umbrella description, which may present at any age, and has a number of underlying causes with different specific treatments, underscoring the need to move from pattern recognition to specific diagnoses. chILDs have important implications for adult physicians; there may be late as yet poorly described sequelae of the disease or its treatment in adult life; there may be genetic implications for the wider family; and there may be late chILD relapses. Smooth transition to adult services is essential for all chILD survivors, with pediatric and adult chest physicians working closely together

Diagnostic workup of childhood interstitial lung disease

Interstitial and orphan lung diseaseEnfermedad pulmonar intersticial y huérfanaMalaltia pulmonar intersticial i orfeChildhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review summarises the roles of the general paediatrician, paediatric pulmonologists and expert centres in the complex diagnostic workup. Each patient's aetiological chILD diagnosis must be reached without prolonged delays in a stepwise approach from medical history, signs, symptoms, clinical tests and imaging, to advanced genetic analysis and specialised procedures including bronchoalveolar lavage and biopsy, if necessary. Finally, as medical progress is fast, the need to revisit a diagnosis of “undefined chILD” is stressed

Research in progress: put the orphanage out of business

Paediatric interstitial lung disease (ILD) is rare and diverse, meaning no single centre will see sufficient children to perform the studies needed to make progress. This EU FP-7 grant will standardise the evaluation of these rare conditions by establishing pan-European multidisciplinary expert panels and establish consensus on treatment protocols and standard operating procedures across Europe. We will work with patient groups to determine optimal treatment end-points and biomarkers. A biobank will be established as a Europe-wide resource for mechanistic studies. Ultimately we aim to do the first randomised controlled trial of a pharmacological treatment in paediatric ILD

Journeying Beyond Clinical Boundaries: Pragmatic patient-centric research into Childhood Interstitial Lung Disease (ChILD)

Abstract Childhood Interstitial Lung Disease (chILD) is a set of rare diseases (RDs) that encompasses an array of rare respiratory disorders that impact the lung interstitium in children and young adults (CYAs). While Interstitial Lung Disease (ILD) is more commonly recognised as affecting adults, there are rare instances where CYAs may develop ILD. Due to its rarity and chILD being a relatively newly explored area of ILD, more research is needed on the psychosocial impact of living with a child. This thesis had two main aims. The first was to explore the chILD research landscape to help provide a baseline of understanding of how chILD research is being conducted and to understand the needs and preferences of CYAs and their parent caregivers when participating in clinical research. The second aim was to explore the lived experiences of chILD in three different scenarios: a health event (COVID-19), an unexplored symptom of chILD (fatigue), and service provision (paediatric to adult transition services). Five studies using a mixed-methods approach were conducted: one systematic review, one quantitative study, and three qualitative studies. Due to chILD being rare in hospital clinic settings, this thesis used a non-clinical population recruitment strategy by recruiting CYAs and their parent caregivers from UK-based chILD patient organisations and chILD online communities. Two Patient and Public Involvement (PPI) focused studies fulfilled the first aim. The first was a systematic review employing a unique approach using Clinical Trial identifiers as key search terms and applying the GRIPP2-SF framework to identify how PPI is acknowledged in clinical literature. Of 42 published articles, 9.5% (n = 4) included PPI mention, distributed across the Methods and Acknowledgment sections. While one mention provided a comprehensive PPI statement, others used a generic format. This study highlighted the continued challenges in reporting PPI representation, with potential limitations linked to authors' and publishers' non-mandatory nature of PPI reporting. The outcomes contribute to the academic discourse on paediatric respiratory health and provide practical implications for refining PPI strategies in similar clinical studies investigating PPI usage. The second study aimed to understand the perspectives of clinical research in 33 young people (aged 6 to 17) with a rare paediatric respiratory condition and their parents through a child-parent dyad survey. Results revealed that parents were more open to their children participating in clinical research compared to their children (p = .007). Preferences varied, with parents expressing less inclination for research involving untested medicines and surgery, whereas young people showed less preference for research involving untested medication, surgery, venepuncture and sharing of experiences. These novel findings suggest a potential disconnect between young people's needs and opinions and parents' preferences for clinical research. The study recommended enhanced communication of clinical research opportunities, and the role of an independent advocate for CYAs is to ensure representation of the CYA ‘voice’. The second aim of lived experience included three qualitative studies examining differing chILD perspectives: a global health event, a chILD symptom and a healthcare service. The first was a longitudinal study exploring COVID-19 and chILD (n = 8). Interviews in two timeframes captured experiences, coping mechanisms, and evolving perceptions, revealing themes of uncertainty and adaptation. The study contributes unique insights into the challenges individuals with rare diseases face during a global pandemic, emphasising the importance of caregiver traits and resilience in positive adaptation. The second qualitative study examined the complex phenomenon of fatigue in those with chILD. The research delved into the communication, symptoms, and impact of fatigue of 15 participants, uncovering three main themes: the experience of fatigue, its consequences on education and quality of life, and motivational strategies for managing fatigue. The findings highlight the multi-dimensional nature of fatigue in chILD, emphasising the need to discuss fatigue in clinical settings to assess its impact on quality of life. The final qualitative study investigated the experience of seven young people and parents in the UK transitioning from paediatric to adult healthcare services for chILD. Participants shared insights into the lack of transition preparation, challenges in adapting to adult services, and the role of parents as advocates. The study underscored the need for improved transition processes and offered recommendations for enhancing support and education for young people and parents entering this crucial phase. To interconnect these studies, a Grounded Theory of chILD is presented. The theory accounts for the experience of the parent and the child and a process of adaptation to varying life events identified within the thesis. The theory aligns with Uncertainty of Illness theory (Mishel, 1988) whereby a process of appraisal (of life challenges/events), uncertainty, and the availability of supportive care needs (information, psychological and emotional, and social needs), and coping traits identified within the thesis support adaptation. Areas for further exploration and recommendations are provided to build on this chILD theory. This thesis highlights how CYAs and parent caregivers can contribute valuable insights into their healthcare experiences, ultimately enhancing the care provided for chILD and RD’s. Collecting their ‘voice’ of novel data and insights results in 1) the amplification of their unique voice in healthcare and policy discussions, 2) presenting patient-centred recommendations to help support the chILD research agenda, and 3) promoting a structured patient engagement framework, enabling meaningful involvement of chILD CYAs and parent caregivers in their healthcare decision-making processes

Future Direction of Interstitial Lung Disease in childhood: A UK consultation

This is a Welcome Trust (UK) funded PPI consultation

The European research collaboration for Children's Interstitial Lung Disease (ChILDEU) ERS Clinical Research Collaboration

International audienceNo abstract availabl

Experiences of UK-based adult transition services for interstitial lung disease in childhood: "There's a lot less cushioning".

Interstitial lung disease in childhood (chILD) is rare and no longer purely a childhood issue as many survive into adulthood, and so have to transition from pediatric to adult healthcare services. Transition is a significant life event that has the potential to impact on physical and mental health outcomes. The European Respiratory Society (ERS) statement on chILD transition highlighted the lack of standardised transition services for chILD transition resulting in a haphazard process. This qualitative study explores how young people and parents in the United Kingdom experienced transition from paediatric to adult healthcare services for chILD. Participants (n = 7) were recruited from chILD patient organisations and online communities. We focused on the experience of transition exploring if there were any information packs or support provided for the transition. Such support may be generic, such as "Ready Steady Go" which provides a systematic approach to transition and disease-specific literature. These latter have not been developed for ILD. Data were analysed by constructivist grounded theory. We present a lived experience of transition with themes of lack of transition preparation and planning, challenges of adapting to adult services, and a changing healthcare scene. Due to the complexity of chILD, parents discussed their need to remain, in part, as an advocate for the young person. Respondents provided recommendations for how transition could be improved along with tips for young people who are new to the transition process, which include educating oneself about the condition, learning medical terminology, and reaching out for support

Research in progress: put the orphanage out of business

Paediatric interstitial lung disease (ILD) is rare and diverse, meaning no single centre will see sufficient children to perform the studies needed to make progress. This EU FP-7 grant will standardise the evaluation of these rare conditions by establishing pan-European multidisciplinary expert panels and establish consensus on treatment protocols and standard operating procedures across Europe. We will work with patient groups to determine optimal treatment end-points and biomarkers. A biobank will be established as a Europe-wide resource for mechanistic studies. Ultimately we aim to do the first randomised controlled trial of a pharmacological treatment in paediatric ILD

Diagnostic workup of childhood interstitial lung disease

Childhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review summarises the roles of the general paediatrician, paediatric pulmonologists and expert centres in the complex diagnostic workup. Each patient's aetiological chILD diagnosis must be reached without prolonged delays in a stepwise approach from medical history, signs, symptoms, clinical tests and imaging, to advanced genetic analysis and specialised procedures including bronchoalveolar lavage and biopsy, if necessary. Finally, as medical progress is fast, the need to revisit a diagnosis of "undefined chILD" is stressed. Childhood interstitial lung diseases are rare and severe diseases. A stepwise approach to an aetiological diagnosis includes specific investigations performed in expert centres. The term "undefined chILD" must be regularly reassesse

Diagnostic workup of childhood interstitial lung disease

Childhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review summarises the roles of the general paediatrician, paediatric pulmonologists and expert centres in the complex diagnostic workup. Each patient's aetiological chILD diagnosis must be reached without prolonged delays in a stepwise approach from medical history, signs, symptoms, clinical tests and imaging, to advanced genetic analysis and specialised procedures including bronchoalveolar lavage and biopsy, if necessary. Finally, as medical progress is fast, the need to revisit a diagnosis of “undefined chILD” is stressed