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Comparison of pulmonary diseases in common variable immunodeficiency and X-linked agammaglobulinaemia
Article first published online: 27 DEC 2009
DOI: 10.1111/j.1440-1843.2009.01679.x
© 2009 The Authors. Journal compilation © 2009 Asian Pacific Society of Respirology
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How to Cite
AGHAMOHAMMADI, A., ALLAHVERDI, A., ABOLHASSANI, H., MOAZZAMI, K., ALIZADEH, H., GHARAGOZLOU, M., KALANTARI, N., SAJEDI, V., SHAFIEI, A., PARVANEH, N., MOHAMMADPOUR, M., KARIMI, N., SADAGHIANI, M. S. and REZAEI, N. (2010), Comparison of pulmonary diseases in common variable immunodeficiency and X-linked agammaglobulinaemia. Respirology, 15: 289–295. doi: 10.1111/j.1440-1843.2009.01679.x
Publication History
- Issue published online: 26 JAN 2010
- Article first published online: 27 DEC 2009
- Received 18 June 2009; invited to revise 17 July 2009, 8 September 2009; revised 11 August 2009; accepted 16 September 2009 (Associate Editor: Jerry Brown).
- Abstract
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Keywords:
- common variable immunodeficiency;
- lung complication;
- pneumonia;
- pulmonary function test;
- X-linked agammaglobulinaemia
Patients with CVID are at greater risk of developing lung complications than patients with XLA because of delayed diagnosis and possible immune dysregulation. Early diagnosis and appropriate treatment reduces the incidence of pulmonary infections in both groups of patients. However, CVID patients are prone to progressive lung disease despite optimal immunoglobulin therapy.
ABSTRACT
Background and objective: Pulmonary disease is the most common complication in patients with common variable immunodeficiency (CVID) or X-linked agammaglobulinaemia (XLA). Pulmonary disease may progress despite immunoglobulin replacement therapy. In this study pulmonary complications were compared in patients with CVID or XLA.
Methods: Pulmonary complications were evaluated in 115 patients (76 with CVID and 39 with XLA) by reviewing hospital records of chest infections, pulmonary function tests and high-resolution CT scans.
Results: Thirty-two patients with XLA (82%) presented with 59 episodes of pneumonia before diagnosis, whereas 15 patients (38.4%) experienced pneumonia after immunoglobulin replacement therapy (1.67 vs 0.45 episodes per patient per year). Among the CVID patients, 196 episodes of pneumonia were documented in 59 patients (77.6%) before diagnosis, while 36 patients (47.3%) experienced pneumonia after therapy (1.11 vs 0.58 episodes of pneumonia per patient per year). Forty-seven (41%) patients (38 with CVID and 9 with XLA) developed chronic lung disease. The CVID patients developed more complications, including bronchiectasis and lymphoid interstitial pneumonitis, than the XLA patients.
Conclusions: Patients with CVID had a greater likelihood of developing lung disease, possibly due to delayed diagnosis and immune dysregulation, as compared with XLA patients. Early diagnosis of patients with primary antibody deficiencies and adequate i.v. immunoglobulin replacement therapy substantially reduces the number of pulmonary infections. However, CVID patients are prone to progression of lung disease despite optimal immunoglobulin therapy because of the nature of the disease. This important issue should be addressed in further studies.