Methods
All biopsy proven HL survivors of age 6-18 years, within 5 years of treatment completion and in complete remission attending Pediatric cancer survivor clinic (PCSC) at tertiary care center in New Delhi were enrolled for the study. The demographic details of the patients, clinical pulmonary symptoms (chronic cough, breathlessness), grade of dyspnea according to Modified Medical research council (mMRC scale) past history of respiratory illness (asthma/recurrent nebulisations in the past/ tuberculosis/pneumonia), treatment history including chemotherapy related- regimen used (ABVD/BEACOPP), number of cycles, cumulative dose of bleomycin, cyclophosphamide, Adriamycin and dacarbazine, radiotherapy related-site, dose and fraction of radiation received, disease related history (primary presentation, site of involvement, bulky disease, stage and B symptoms) were recorded in a structured proforma. A detailed physical examination was done for all patients, Vitals (including SpO2) and anthropometry were recorded in detail. Nutritional status was assessed. Respiratory system examination was done in detail. Relevant investigations including hemogram at the time of evaluation, and previous echocardiography findings of ejection fraction was collected. Pulmonary function was evaluated by spirometry and 3 minute step test. Pulmonary dysfunction was determined as presence of obstructive, restrictive or mixed pattern on spirometry or abnormality in three minute step test. Subclinical pulmonary dysfunction was determined as patients who were clinically asymptomatic but had pulmonary dysfunction on spirometry or three minute step test