Respiratory function in childhood following repair of oesophageal atresia and tracheoesophageal fistula

Aim-To determine the relation between respiratory function in infancy and a t: school age in children who have undergone oesophageal atresia and trache oesophageal fistula repair, and assess the value of infant respiratory func tion testing; and to examine the effect of bronchodilators. Method-Fourteen children (6 girls, and 8 boys) who had undergone respirator y function testing in infancy were retested at school age (7-12 years). Mea surements included lung volume, airways resistance, peak flow, and spiromet ry. Clinical problems were investigated bg questionnaire. Twelve children h ad repeat measurements after taking salbutamol. Results-Predominant complaints were non-productive cough and dysphagia, but even those children with major problems in infancy reported few restrictio ns at school or in sport or social activities. Respiratory function and cli nical findings at school age appeared unrelated to status in infancy, such that even the patients with severe tracheomalacia requiring aortopexy did n ot have lung function testing suggestive of malacia at school age. Most pat ients showed a restrictive pattern of lung volume which would appear to res ult from reduced lung growth after surgery rather than being a concomitant feature of the primary congenital abnormality. Although six children report ed wheeze and four had a diagnosis of asthma, only one responded to salbuta mol, This suggests that a tendency to attribute all lower respiratory sympt oms to asthma may have led to an overdiagnosis of this condition in this pa tient group. Conclusion-Respiratory function testing in infancy is of limited value in m edium term prognosis, but may aid management of contemporary clinical signs . In children respiratory function testing is valuable in assessing suspect ed asthma and effects of bronchodilators.