{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T20:19:44Z","timestamp":1776111584671,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2014,5,21]],"date-time":"2014-05-21T00:00:00Z","timestamp":1400630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Danish Children's Cancer Association"},{"DOI":"10.13039\/100008363","name":"Danish Cancer Society","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100008218","name":"Gangsted Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008218","id-type":"DOI","asserted-by":"crossref"}]},{"name":"The John and Birthe Meyer Foundation"},{"name":"Anders Hasselbalchs Foundation"},{"name":"The Danish Lung Association"},{"name":"Beckett Foundation"},{"DOI":"10.13039\/501100005275","name":"Capital Region of Denmark","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005275","id-type":"DOI","asserted-by":"crossref"}]},{"name":"V\u00e4stra G\u00f6taland Research Council, Sweden"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic graft\u2010versus\u2010host disease (cGvHD) in the lungs is a life\u2010threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT). Pulmonary cGvHD is initiated in the peripheral airways, and diagnosis may be delayed by low sensitivity of standard pulmonary function tests. Multiple breath nitrogen washout (MBW<jats:sub>N2<\/jats:sub>) is a promising, sensitive method to assess small airways function. This is the first report on MBW<jats:sub>N2<\/jats:sub> in survivors of pediatric HSCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross\u2010sectional study undertaken 3\u201310 years post\u2010HSCT, included 64 patients and 64 matched controls who all performed spirometry, whole\u2010body plethysmography and MBW<jats:sub>N2<\/jats:sub>. From MBW<jats:sub>N2<\/jats:sub> the lung clearance index (LCI) and indices reflecting ventilation inhomogeneity arising close to the acinar lung zone (S<jats:sub>acin<\/jats:sub>) and in the conductive airway zone (S<jats:sub>cond<\/jats:sub>) were derived. Subjective respiratory morbidity was assessed using the St. George Respiratory Questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>LCI, S<jats:sub>acin<\/jats:sub>, and S<jats:sub>cond<\/jats:sub> were significantly higher in HSCT\u2010patients compared with controls. Despite few reported symptoms and normal forced expiratory volume in 1\u2009sec (FEV<jats:sub>1<\/jats:sub>) in 91%, LCI, S<jats:sub>cond<\/jats:sub>, and S<jats:sub>acin<\/jats:sub> were abnormal in 34%, 52%, and 25% of HSCT\u2010patients, respectively. LCI and S<jats:sub>cond<\/jats:sub> correlated weakly with spirometric findings in HSCT\u2010patients, but not in controls. S<jats:sub>cond<\/jats:sub> was abnormal in 82% (9\/11) of patients with evidence of cGvHD, and was associated with cGvHD in the multivariate analysis (r<jats:sup>2<\/jats:sup>\u2009=\u20090.26, <jats:italic>P<\/jats:italic>\u2009=\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Small airways dysfunction as measured by MBW<jats:sub>N2<\/jats:sub> was a common finding at long term follow\u2010up of children after allogeneic HSCT and was associated with cGvHD. The majority of these subjects had normal spirometric values and did not report any respiratory symptoms. Prospective studies are required to evaluate the long term clinical consequences of these signs of small airway disease and the value of MBW<jats:sub>N2<\/jats:sub> as an early marker of pulmonary cGvHD. <jats:bold>Pediatr Pulmonol. 2015; 50:704\u2013712.<\/jats:bold> \u00a9 2014 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.23058","type":"journal-article","created":{"date-parts":[[2014,5,21]],"date-time":"2014-05-21T08:17:20Z","timestamp":1400660240000},"page":"704-712","source":"Crossref","is-referenced-by-count":30,"title":["Small airways dysfunction in long\u2010term survivors of pediatric stem cell transplantation"],"prefix":"10.1002","volume":"50","author":[{"given":"Hilde Hylland","family":"Uhlving","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine Rigshospitalet University of Copenhagen Copenhagen Denmark"},{"name":"Research Unit Women's and Children's Health Rigshospitalet University of Copenhagen Copenhagen Denmark"},{"name":"Institute for Inflammation Research Rigshospitalet University of Copenhagen Copenhagen Denmark"},{"name":"Pediatric Pulmonary Service Rigshospitalet University of Copenhagen Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sidsel","family":"Mathiesen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine Rigshospitalet University of Copenhagen Copenhagen Denmark"},{"name":"Pediatric Pulmonary Service Rigshospitalet University of Copenhagen Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederik","family":"Buchvald","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine Rigshospitalet University of Copenhagen Copenhagen Denmark"},{"name":"Pediatric Pulmonary Service Rigshospitalet University of Copenhagen Copenhagen 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