LUCIND: profiling respiratory comorbidity in paediatric neurological diseases.

Abstract

Background: Children and adolescents with neurodisability are at high risk of respiratory comorbidity and secondary pulmonary disease due to impaired airway clearance, thoracic restriction, dysphagia and microbial airway colonisation. Despite the clinical relevance of these complications, systematic imaging data on structural lung changes and their clinical correlates in this population remain scarce.

Methods: LUCIND (Lung Comorbidity in Neurological Diseases) is a prospective, cross-sectional imaging study enrolling 150 children and adolescents with neurodisability without primary pulmonary disease. Participants are stratified into three risk-based subgroups (n=50 each): 1) neurodisability with tracheostomy, 2) neurodisability with dysphagia, and 3) neurodisability without dysphagia. The primary objective is to detect chronic structural lung abnormalities such as bronchiectasis, bronchial wall thickening and consolidations using ultralow-dose photon-counting computed tomography. This technique yields robust morphological data at radiation levels approaching those of conventional radiography. Due to ultra-short acquisition times, imaging is performed without sedation, ensuring high patient safety and feasibility in this vulnerable population. Secondary aims include the correlation of radiological findings with clinical features, such as swallowing function, respiratory infection burden, microbial airway colonisation, and therapeutic measures including airway clearance and antibiotic use. Imaging will be complemented by standardised clinical data, logopaedic assessment, and detailed caregiver questionnaires.

Conclusion: LUCIND will provide a unique dataset to refine our understanding of chronic lung disease in children with neurodisability. Results may inform future risk stratification, early intervention strategies, and optimised clinical pathways, potentially improving both quality of life and long-term respiratory outcomes.