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Spycher BD, Silverman M, Pescatore AM, Beardsmore CS, Kuehni CE. Comparison of phenotypes of childhood wheeze and cough in 2 independent cohorts. J Allergy Clin Immunol 2013; 132:1058-67. [PMID: 24075230 DOI: 10.1016/j.jaci.2013.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Among children with wheeze and recurrent cough there is great variation in clinical presentation and time course of the disease. We previously distinguished 5 phenotypes of wheeze and cough in early childhood by applying latent class analysis to longitudinal data from a population-based cohort (original cohort). OBJECTIVE To validate previously identified phenotypes of childhood cough and wheeze in an independent cohort. METHODS We included 903 children reporting wheeze or recurrent cough from an independent population-based cohort (validation cohort). As in the original cohort, we used latent class analysis to identify phenotypes on the basis of symptoms of wheeze and cough at 2 time points (preschool and school age) and objective measurements of atopy, lung function, and airway responsiveness (school age). Prognostic outcomes (wheeze, bronchodilator use, cough apart from colds) 5 years later were compared across phenotypes. RESULTS When using a 5-phenotype model, the analysis distinguished 3 phenotypes of wheeze and 2 of cough as in the original cohort. Two phenotypes were closely similar in both cohorts: Atopic persistent wheeze (persistent multiple trigger wheeze and chronic cough, atopy and reduced lung function, poor prognosis) and transient viral wheeze (early-onset transient wheeze with viral triggers, favorable prognosis). The other phenotypes differed more between cohorts. These differences might be explained by differences in age at measurements. CONCLUSIONS Applying the same method to 2 different cohorts, we consistently identified 2 phenotypes of wheeze (atopic persistent wheeze, transient viral wheeze), suggesting that these represent distinct disease processes. Differences found in other phenotypes suggest that the age when features are assessed is critical and should be considered carefully when defining phenotypes.
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Affiliation(s)
- Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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602
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Vitaliti G, Leonardi S, La Rosa M. Opening interrupter technique in pre-school children with chronic respiratory diseases: a perspective case-control study in the diagnosis of airway hyperesponsiveness. J Asthma 2013; 50:1045-8. [PMID: 24047407 DOI: 10.3109/02770903.2013.834507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Optimal treatment for pediatric respiratory diseases is strictly related to follow-up evaluations of lung function. The aim of our study was to show the efficacy of the Opening Interrupter Technique in diagnosing the presence of airway obstruction in pre-school children. MATERIALS AND METHODS Our study was a prospective case-control study, evaluating 82 patients affected by asthma and/or cystic fibrosis (CF) and 50 healthy pre-school children, as control group. All patients were 3- to 5-years old and they were followed by our Pediatric Department, University of Catania, Italy, from February 2011 to June 2012. Measurements of respiratory resistance (o-Rint) by the opening interrupter technique were made with the MasterScreen PFT device, Jaeger GmbH, Würzburg, Germany, during quiet breathing. The presence of airway obstruction was detected as a value of o-Rint higher than two standard deviations (SD) compared with the theoretical data. RESULTS We found higher values of o-Rint in asthmatic patients than in the control group, with a high statistical difference (p < 0.0001). The same results were found when we compared patients with CF and the control group (p < 0.0001). Nevertheless, we did not find any significant statistical difference between respiratory resistances measured in asthmatic and patients with CF (p > 0.05). There was a significant inverse correlation between o-Rint and height only in asthmatic and patients with CF, but not in healthy controls (p < 0.05). CONCLUSIONS In our study, the opening interrupter technique was efficient in detecting the presence of obstruction in chronic patients affected by asthma and CF.
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Affiliation(s)
- Giovanna Vitaliti
- Operative Unit of Pediatric Pneumology, Allergology and Cystic Fibrosis, University of Catania , Catania , Italy
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603
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García-Río F, Calle M, Burgos F, Casan P, del Campo F, Galdiz JB, Giner J, González-Mangado N, Ortega F, Puente Maestu L. Spirometry. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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604
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Tancredi G, de Castro G, Rugiano A, Zicari A, Indinnimeo L, Nicolai A, Duse M. Measurement of Interrupter Respiratory Resistance and Spirometry in Preschool Children: Influence of Respiratory Symptoms. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary function tests play an important role in the diagnosis and management of respiratory diseases in children. The purpose of the study was to evaluate lung function using the interrupter resistance technique (Rint) and spirometry (flow-volume and volume-time) in preschool children and to correlate the findings with respiratory symptoms. We studied 103 children (65 males, 38 females; mean age 5.2±0.7 years; range 3.6–5.8). For each child we collected family history concerning: respiratory diseases, skin prick tests, smoking during maternal pregnancy, history of gestational and neonatal period. All children performed lung function tests (Rint and spirometry) and skin prick test for inhalant and food allergens. Twenty-eight subjects (27.2%) had respiratory symptoms (RS). Expiratory Rint were performed in all subjects and spirometry was carried out on 76 children (73.8%). Spirometric indices were not statistically different between subjects without respiratory symptoms (controls) and RS children except for FEF25–75 expressed as a percentage of the predicted value (RS: 81.5±13.7% vs controls: 94.5±15.8%; p <0.001). Rint mean values were significantly higher in RS children than in controls (RS: 135.6 ±24.8% vs controls: 102.4 ±21.7%; p< 0.0001). We found a statistically negative correlation between Rint and the following Spirometric indices: FEV0.5 (R= −0.696; p < 0.0001), FEV, (R= − 0.728; p < 0.0001) and FEF25–75 (R= −0.681; p < 0.0001). In preschool children with respiratory disease we found significantly higher mean values of Rint and lower FEF25-75 than in the control group and a significant negative relationship between Rint and Spirometric indices.
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Affiliation(s)
- G. Tancredi
- Department of Pediatrics, “Sapienza” University of Rome, Rome, Italy
| | - G. de Castro
- Department of Pediatrics, “Sapienza” University of Rome, Rome, Italy
| | - A. Rugiano
- Department of Pediatrics, “Sapienza” University of Rome, Rome, Italy
| | - A.M. Zicari
- Department of Pediatrics, “Sapienza” University of Rome, Rome, Italy
| | - L. Indinnimeo
- Department of Pediatrics, “Sapienza” University of Rome, Rome, Italy
| | - A. Nicolai
- Department of Pediatrics, “Sapienza” University of Rome, Rome, Italy
| | - M. Duse
- Department of Pediatrics, “Sapienza” University of Rome, Rome, Italy
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605
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Hanson JR, De Lurgio SA, Williams DD, Dinakar C. Office-based exhaled nitric oxide measurement in children 4 years of age and older. Ann Allergy Asthma Immunol 2013; 111:358-63. [PMID: 24125141 DOI: 10.1016/j.anai.2013.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/27/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FENO) is increasingly being used in the office-based management of asthma, but data in children are limited. OBJECTIVES To report FENO values in 4- to 7-year-old children with suspected asthma and characterize their relation to clinical variables and describe the relation among FENO levels, age, and sex in 4- to 18-year-old children with suspected asthma. METHODS Retrospective data in 4- to 18-year-old children (n = 825) who underwent FENO testing using the NIOX MINO device were collected and analyzed. Chart reviews were performed for the 4- to 7-year-old children (n = 75). RESULTS FENO values ranged from less than or equal to 5 to 89 ppb in 75 4- to 7-year-old children and less than or equal to 5 to 300 ppb in 750 > 7 to 18-year-old children. Approximately one tenth of 4- to 7-year-old children and one third of > 7 to 18-year-old children had FENO values indicative of eosinophilic/allergic inflammation (>35 ppb). In regression analysis of the 4- to 7-year-old children, increasing age (P = .03) and asthma severity (P = .01) were associated with higher FENO levels. Atopic dermatitis was significantly associated (P = .03), whereas allergic rhinitis was marginally associated (P = .06), with higher FENO levels. Inhaled corticosteroid use was associated with lower FENO levels (P = .02). CONCLUSION This study characterizes the largest cohort of 4- to 7-year-old children to undergo FENO testing in ambulatory asthma management. Correlations between FENO levels and clinical variables were consistent with established findings in older children. This preliminary real-world study suggests that FENO assessment may be feasible and useful in the office-based asthma management of children as young as 4 years.
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Affiliation(s)
- Jill R Hanson
- Pediatric Residency Program, Children's Mercy Hospital, Kansas City, Missouri.
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606
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Singer F, Kieninger E, Abbas C, Yammine S, Fuchs O, Proietti E, Regamey N, Casaulta C, Frey U, Latzin P. Practicability of nitrogen multiple-breath washout measurements in a pediatric cystic fibrosis outpatient setting. Pediatr Pulmonol 2013; 48:739-46. [PMID: 22888105 DOI: 10.1002/ppul.22651] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/29/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although lung clearance index (LCI) is a sensitive indicator of mild cystic fibrosis (CF) lung disease, it is rarely measured due to lengthy protocols and the commercial unavailability of multiple-breath washout (MBW) setups and tracer gases. We used a newly validated, commercially available nitrogen (N2 ) MBW setup to assess success rate, duration, and variability of LCI within a 20 min timeframe, during clinical routine. We also evaluated the relationship between LCI and other clinical markers of CF lung disease. METHODS One hundred thirty six children (83 with CF) between 4 and 16 years were studied in a pediatric CF outpatient setting. One hundred eighteen out of 136 children were naïve to MBW. Within 20 min, each child was trained, N2 MBW was performed, and LCI was analyzed. We assessed intra- and between-test reproducibility in a subgroup of children. RESULTS At least one LCI was feasible in 123 (90%) children, with a mean (range) of 3.3 (1.2-6.4) min per test. Two or more measurements were feasible in 56 (41%) children. Comparing LCI in CF versus controls, LCI mean (SD) was 12.0 (3.9) versus 6.1 (0.9), and the intra- and inter-test coefficient of repeatability was 1.00 versus 0.81 and 0.96 versus 0.62, respectively. LCI was correlated with spirometry, blood gases, and Pseudomonas aeruginosa infection. CONCLUSIONS Using available N2 MBW equipment, LCI measurements are practical and fast in children. LCI is correlated with markers of CF lung disease. Longer timeframes would be required for triplicate N2 MBW tests in inexperienced children.
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Affiliation(s)
- Florian Singer
- Division of Respiratory Medicine, Department of Pediatrics, University Hospital of Bern, Bern, Switzerland
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607
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Belgrave DCM, Simpson A, Semic-Jusufagic A, Murray CS, Buchan I, Pickles A, Custovic A. Joint modeling of parentally reported and physician-confirmed wheeze identifies children with persistent troublesome wheezing. J Allergy Clin Immunol 2013; 132:575-583.e12. [PMID: 23906378 DOI: 10.1016/j.jaci.2013.05.041] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have suggested the presence of different childhood wheeze phenotypes through statistical modeling based on parentally reported wheezing. OBJECTIVE We sought to investigate whether joint modeling of observations from both medical records and parental reports helps to more accurately define wheezing disorders during childhood and whether incorporating information from medical records better characterizes severity. METHODS In a population-based birth cohort (n = 1184), we analyzed data from 2 sources (parentally reported current wheeze at 4 follow-ups and physician-confirmed wheeze from medical records in each year from birth to age 8 years) to determine classes of children who differ in wheeze trajectories. We tested the validity of these classes by examining their relationships with objective outcomes (lung function, airway hyperreactivity, and atopy), asthma medication, and severe exacerbations. RESULTS Longitudinal latent class modeling identified a 5-class model that best described the data. We assigned classes as follows: no wheezing (53.3%), transient early wheeze (13.7%), late-onset wheeze (16.7%), persistent controlled wheeze (13.1%), and persistent troublesome wheeze (PTW; 3.2%). Longitudinal trajectories of atopy and lung function differed significantly between classes. Patients in the PTW class had diminished lung function and more hyperreactive airways compared with all other classes. We observed striking differences in exacerbations, hospitalizations, and unscheduled visits, all of which were markedly higher in patients in the PTW class compared with those in the other classes. For example, the risk of exacerbation was much higher in patients in the PTW class compared with patients with persistent controlled wheeze (odds ratio [OR], 3.58; 95% CI, 1.27-10.09), late-onset wheeze (OR, 15.92; 95% CI, 5.61-45.15), and transient early wheeze (OR, 12.24; 95% CI, 4.28-35.03). CONCLUSION We identified a novel group of children with persistent troublesome wheezing, who have markedly different outcomes compared with persistent wheezers with controlled disease.
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Affiliation(s)
- Danielle C M Belgrave
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom; Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
| | - Angela Simpson
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Aida Semic-Jusufagic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Clare S Murray
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Iain Buchan
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Andrew Pickles
- Department of Biostatistics, King's College London, London, United Kingdom
| | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
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608
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França DC, Camargos PAM, Martins JA, Abreu MCS, Avelar e Araújo GH, Parreira VF. Feasibility and reproducibility of spirometry and inductance plethysmography in healthy Brazilian preschoolers. Pediatr Pulmonol 2013; 48:716-24. [PMID: 23281215 DOI: 10.1002/ppul.22743] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 08/22/2012] [Indexed: 11/08/2022]
Abstract
RATIONALE Preschoolers show peculiarities that reinforce the importance of assessing their pulmonary function. However, there are few data on the success rate and between-occasions reproducibility of pulmonary function tests in preschoolers, particularly in the Brazilian population. OBJECTIVE To assess the success rate and between-occasions reproducibility of the variables obtained by spirometry and respiratory inductive plethysmography in healthy children aged 4-6 years. METHODS Breathing pattern was assessed by plethysmography (tidal volume-V(T), respiratory rate-f, inspiratory duty cycle-Ti/Ttot, mean respiratory flow-V(T)/Ti, displacement of the rib cage-RC and phase relation during the total breath-PhRTB) and spirometry (forced vital capacity-FVC, forced expiratory volume in 0.5 sec-FEV0.5 and forced expiratory volume in first second-FEV1) in 47 healthy children, aged 4-6 years. To evaluate between-occasions reproducibility, 10 children (according to the sample size calculation) were reassessed after 3 weeks. Between-occasions reproducibility was evaluated by paired t-test, considering significant P < 0.05, Intraclass Correlation Coefficient (ICC) and coefficient of variation of method error (CV(ME)). RESULTS The results showed an 83% success rate for spirometry and a 98% success rate for plethysmography. Regarding reproducibility, there were no significant differences between the variables of any test. Spirometry ICC was above 0.80 and the CV(ME) was lower than 10%. The plethysmography ICC was between 0.61 and 0.95, and the CV(ME) was between 2% and 31%. CONCLUSIONS These results suggest a high success rate in performing the pulmonary function tests and good between-occasions reproducibility for spirometry and plethysmography in healthy preschoolers.
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Affiliation(s)
- Danielle C França
- Federal University of Minas Gerais, Graduation Program in Science Rehabilitation, Belo Horizonte, Brazil
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609
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Collins SA, Pike KC, Inskip HM, Godfrey KM, Roberts G, Holloway JW, Lucas JSA. Validation of novel wheeze phenotypes using longitudinal airway function and atopic sensitization data in the first 6 years of life: evidence from the Southampton Women's survey. Pediatr Pulmonol 2013; 48:683-92. [PMID: 23401430 PMCID: PMC3689612 DOI: 10.1002/ppul.22766] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND In 1995 the Tucson Children's Respiratory Study (TCRS) identified clinically distinct phenotypes amongst early wheezers; the Avon Longitudinal Study of Parents And Children (ALSPAC) has recently re-examined these. OBJECTIVES To validate statistically derived ALSPAC phenotypes in the Southampton Women's Survey (SWS) using infant and 6-year lung function, and allergic sensitization at 1, 3, and 6 years, comparing these with TCRS phenotypes. METHODS Complete 6-year follow-up data were available for 926 children, selected from 1,973 infants born to 12,579 women characterized pre-conception. Ninety-five children had V'maxFRC and FEV0.4 measured age 5-14 weeks using rapid compression/raised volume techniques. At 6 years we performed spirometry (n = 791), fractional exhaled nitric oxide (FeNO, n = 589) and methacholine challenge (n = 234). Skin prick testing was performed at 12m, 3 and 6 years (n = 1,494, 1,255, 699, respectively). Using wheeze status questionnaire data at 6m, 12m, 2, 3 and 6 years we classified children into TCRS (never, transient early, persistent, late-onset) and ALSPAC based groups (never, early, transient, intermediate-onset, late-onset, persistent). RESULTS Amongst ALSPAC groups, persistent and late-onset wheeze were associated with atopy at 3 and 6 years, whilst intermediate-onset wheeze showed earlier atopic association at 1 year; all three were associated with FeNO at 6 years. Persistent wheezers had lower infant (V'maxFRC P < 0.05) and 6-year lung function (FEV1, FEV1/FVC, and FEF(25-75), P < 0.05), whilst late and intermediate-onset wheezers showed no lung function deficits. Transient wheezers were non-atopic but showed persistent lung function deficits (V'maxFRC in infancy, FEV1 and FEF(25-75) at 6 years, all P < 0.05). Those who wheezed only in the first year (early phenotype) showed no lung function deficits. No associations were seen with 6 years bronchial hyper-responsiveness or infancy FEV0.4. CONCLUSION SWS cohort data validates the statistically derived ALSPAC six-class model. In particular, lung function and atopy successfully differentiate persistent, late-onset and intermediate-onset wheeze, whilst the Tucson "transient early" wheeze phenotype can be sub-classified into groups that reflect early lung function. Since the 4-class model fails to adequately differentiate phenotypes based on lung function and atopy, we propose that strong consideration be given to using the 6-class paradigm for longitudinal outcome work in wheezing with onset in early life.
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Affiliation(s)
- Samuel A Collins
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
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610
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611
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Burity EF, Pereira CAC, Rizzo JA, Brito MCA, Sarinho ESC. Reference values for spirometry in preschool children. J Pediatr (Rio J) 2013; 89:374-80. [PMID: 23791023 DOI: 10.1016/j.jped.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 01/09/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Reference values for lung function tests differ in samples from different countries, including values for preschoolers. The main objective of this study was to derive reference values in this population. METHODS A prospective study was conducted through a questionnaire applied to 425 preschool children aged 3 to 6 years, from schools and day-care centers in a metropolitan city in Brazil. Children were selected by simple random sampling from the aforementioned schools. Peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volumes (FEV1, FEV0.50), forced expiratory flow (FEF25-75) and FEV1/FVC, FEV0.5/FVC and FEF25-75/FVC ratios were evaluated. RESULTS Of the 425 children enrolled, 321 (75.6%) underwent the tests. Of these, 135 (42.0%) showed acceptable results with full expiratory curves and thus were included in the regression analysis to define the reference values. Height and gender significantly influenced FVC values through linear and logarithmic regression analysis. In males, R(2) increased with the logarithmic model for FVC and FEV1, but the linear model was retained for its simplicity. The lower limits were calculated by measuring the fifth percentile residues. CONCLUSION Full expiratory curves are more difficult to obtain in preschoolers. In addition to height, gender also influences the measures of FVC and FEV1. Reference values were defined for spirometry in preschool children in this population, which are applicable to similar populations.
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Affiliation(s)
- Edjane F Burity
- Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco, Recife, PE, Brazil.
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612
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Calogero C, Simpson SJ, Lombardi E, Parri N, Cuomo B, Palumbo M, de Martino M, Shackleton C, Verheggen M, Gavidia T, Franklin PJ, Kusel MMH, Park J, Sly PD, Hall GL. Respiratory impedance and bronchodilator responsiveness in healthy children aged 2-13 years. Pediatr Pulmonol 2013; 48:707-15. [PMID: 23169525 DOI: 10.1002/ppul.22699] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/03/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND The forced oscillation technique (FOT) can be used in children as young as 2 years of age and in those unable to perform routine spirometry. There is limited information on changes in FOT outcomes in healthy children beyond the preschool years and the level of bronchodilator responsiveness (BDR) in healthy children. We aimed to create reference ranges for respiratory impedance outcomes collated from multiple centers. Outcomes included respiratory system resistance (R(rs)) and reactance (X(rs)), resonant frequency (Fres), frequency dependence of R(rs) (Fdep), and the area under the reactance curve (AX). We also aimed to define the physiological effects of bronchodilators in a large population of healthy children using the FOT. METHODS Respiratory impedance was measured in 760 healthy children, aged 2-13 years, from Australia and Italy. Stepwise linear regression identified anthropometric predictors of transformed R(rs) and X(rs) at 6, 8, and 10 Hz, Fres, Fdep, and AX. Bronchodilator response (BDR) was assessed in 508 children after 200 µg of inhaled salbutamol. RESULTS Regression analysis showed that R(rs), X(rs), and AX outcomes were dependent on height and sex. The BDR cut-offs by absolute change in R(rs8), X(rs8), and AX were -2.74 hPa s L(-1), 1.93 hPa s L(-1), and -33 hPa s L(-1), respectively. These corresponded to relative and Z-score changes of -32%; -1.85 for R(rs8), 65%; 1.95 for X(rs8), and -82%; -2.04 for AX. CONCLUSIONS We have established generalizable reference ranges for respiratory impedance and defined cut-offs for a positive bronchodilator response using the FOT in healthy children.
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Affiliation(s)
- Claudia Calogero
- Unit of Respiratory Medicine, Department of Paediatrics, University of Florence, Anna Meyer University Hospital for Children, Florence, Italy
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613
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Komarow HD, Young M, Nelson C, Metcalfe DD. Vocal cord dysfunction as demonstrated by impulse oscillometry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2013; 1:387-93. [PMID: 24565544 PMCID: PMC4830384 DOI: 10.1016/j.jaip.2013.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vocal cord dysfunction (VCD) is a respiratory disorder characterized by inappropriate vocal cord adduction during inspiration. The diagnosis of VCD is challenging, because expected flow volume loop abnormalities are uncommonly noted, and laryngoscopy must be timed to coincide with symptoms. OBJECTIVE We wanted to determine the potential role of impulse oscillometry (IOS) in the diagnosis of VCD. METHODS We conducted an analysis of six patients in which the diagnosis of VCD was being considered as well as seven healthy subjects and five subjects with asthma. All were evaluated with IOS and spirometry, and patients underwent laryngoscopy. Two patients with suspected VCD who did not exhibit symptoms or abnormal pulmonary function at baseline underwent exercise challenge and repeat studies. One patient with suspected VCD underwent an additional irritant challenge. RESULTS VCD was diagnosed by laryngoscopy in three of the six patients in whom the diagnosis of VCD was entertained. These three patients as a group all exhibited higher amplitude (mean, 9.3 cm H20/L/second) and more variable spikes (SD, 4.8 cm H20/L/second) on IOS impedance during inspiration, whereas the three patients in whom the diagnosis was not confirmed by endoscopy did not show these findings (mean, 2.0 cm H20/L/second; P < .0002; SD, 0.8 cm H20/L/second; P < .0001). This pattern was also not observed in the healthy volunteers (mean ± SD, 1.8 ± 0.7 cm H20/L/second) and patients with asthma at baseline (mean, 4.2 ± 1.2 cm H20/L/second) or after exercise challenge (mean, 1.5 ± 0.5 cm H20/L/second). CONCLUSIONS These findings support the conclusion that IOS displays a characteristic pattern in patients with VCD and thus may offer a rapid and noninvasive adjunct to the assessment and diagnosis of patients suspected to have this disorder.
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Affiliation(s)
- Hirsh D Komarow
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| | - Michael Young
- Clinical Research Directorate/Clinical Monitoring Research Program, Science Applications International Corporation (SAIC)-Frederick Inc, Frederick National Laboratory for Clinical Research, Frederick, Md
| | - Celeste Nelson
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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614
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Goldring ST, Griffiths CJ, Martineau AR, Robinson S, Yu C, Poulton S, Kirkby JC, Stocks J, Hooper R, Shaheen SO, Warner JO, Boyle RJ. Prenatal vitamin d supplementation and child respiratory health: a randomised controlled trial. PLoS One 2013; 8:e66627. [PMID: 23826104 PMCID: PMC3691177 DOI: 10.1371/journal.pone.0066627] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Observational studies suggest high prenatal vitamin D intake may be associated with reduced childhood wheezing. We examined the effect of prenatal vitamin D on childhood wheezing in an interventional study. METHODS We randomised 180 pregnant women at 27 weeks gestation to either no vitamin D, 800 IU ergocalciferol daily until delivery or single oral bolus of 200,000 IU cholecalciferol, in an ethnically stratified, randomised controlled trial. Supplementation improved but did not optimise vitamin D status. Researchers blind to allocation assessed offspring at 3 years. Primary outcome was any history of wheeze assessed by validated questionnaire. Secondary outcomes included atopy, respiratory infection, impulse oscillometry and exhaled nitric oxide. Primary analyses used logistic and linear regression. RESULTS We evaluated 158 of 180 (88%) offspring at age 3 years for the primary outcome. Atopy was assessed by skin test for 95 children (53%), serum IgE for 86 (48%), exhaled nitric oxide for 62 (34%) and impulse oscillometry of acceptable quality for 51 (28%). We found no difference between supplemented and control groups in risk of wheeze [no vitamin D: 14/50 (28%); any vitamin D: 26/108 (24%) (risk ratio 0.86; 95% confidence interval 0.49, 1.50; P = 0.69)]. There was no significant difference in atopy, eczema risk, lung function or exhaled nitric oxide between supplemented groups and controls. CONCLUSION Prenatal vitamin D supplementation in late pregnancy that had a modest effect on cord blood vitamin D level, was not associated with decreased wheezing in offspring at age three years. TRIAL REGISTRATION Controlled-Trials.com ISRCTN68645785.
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Affiliation(s)
| | - Chris J. Griffiths
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Adrian R. Martineau
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Stephen Robinson
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Christina Yu
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Sheree Poulton
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Jane C. Kirkby
- Portex Respiratory Unit, University College London, Institute of Child Health, London, United Kingdom
| | - Janet Stocks
- Portex Respiratory Unit, University College London, Institute of Child Health, London, United Kingdom
| | - Richard Hooper
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Seif O. Shaheen
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - John O. Warner
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Robert J. Boyle
- Department of Paediatrics, Imperial College London, London, United Kingdom
- * E-mail:
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Kang SH, Jung YH, Kim HY, Seo JH, Lee JY, Kwon JW, Kim BJ, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Shim JY, Kim JH, Kang MJ, Yu HS, Yu J, Hong SJ. Effect of paracetamol use on the modification of the development of asthma by reactive oxygen species genes. Ann Allergy Asthma Immunol 2013; 110:364-369.e1. [PMID: 23622008 DOI: 10.1016/j.anai.2013.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 03/06/2013] [Accepted: 03/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recent studies have identified an increase in the prevalence of asthma associated with paracetamol use. OBJECTIVE To identify the relationship among asthma, biomarkers, genes, and paracetamol use in preschool children. METHODS We undertook a population-based, cross-sectional survey of 933 preschool children. Asthma status was classified according to medical history and asthmatic symptoms. History of paracetamol use in infancy was recorded. Impulse oscillometry, blood tests for eosinophils and total IgE, and genotyping of NAT2, Nrf2, and GSTP1 polymorphisms by TaqMan assay were conducted. RESULT Paracetamol use in infancy was associated with an increased risk of treatment for asthma within the previous 12 months. Paracetamol use together with a family history of asthma increased the risk of asthma diagnosis ever, current asthma, and treatment for asthma within the previous 12 months. Gene polymorphisms in NAT2 (rs4271002), Nrf2 (rd6726395), and GSTP1 (rd1695) increased the risk of treatment for asthma within the last 12 months. Eosinophils were significantly elevated in the group with paracetamol use and a family history of asthma; however, the serum total IgE level and IOS did not show any significant difference. CONCLUSION Paracetamol use in infancy was significantly associated with increased risk of asthma. The association is more significant in genetically susceptible children, related to antioxidant genes, and the effect may be mediated by eosinophilic inflammation.
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Affiliation(s)
- Sung Han Kang
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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616
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Oh MA, Shim JY, Jung YH, Seo JH, Young Kim H, Kwon JW, Kim BJ, Kim HB, Kim WK, Lee SY, Jang GC, Song DJ, Kim HJ, Shin YJ, Park JW, Cho SH, Lee JS, Hong SJ. Fraction of exhaled nitric oxide and wheezing phenotypes in preschool children. Pediatr Pulmonol 2013; 48:563-70. [PMID: 23129540 DOI: 10.1002/ppul.22705] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/28/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Asthma is a chronic lower airway inflammatory disease. Nitric oxide is an inflammatory mediator produced endogenously in the airway. Previous studies have demonstrated that the fractional concentration of exhaled nitric oxide (FeNO) is increased in asthma. OBJECTIVES To investigate if FeNO concentrations were correlated with wheezing phenotypes in preschool children and to compare the FeNO results with airway hyperresponsiveness (AHR) and pulmonary function test (PFT) results. METHODS We performed skin prick tests, methacholine provocation tests, PFT, impulse oscillometry bronchodilator response (IOS BDR) tests, and FeNO measurements in 372 preschool children between the ages of 4 and 6 years. Wheezing phenotypes were defined according to the age of onset and persistency. RESULTS Persistent wheezers had higher FeNO levels than transient wheezers and non-wheezers. Among persistent wheezers, those with atopy and AHR had significantly higher FeNO levels than those without atopy or AHR. FeNO levels were significantly higher in late-onset wheezers than early-onset wheezers and non-wheezers. Among late-onset wheezers, those with atopy and AHR had a significantly higher FeNO concentration than those without atopy or AHR as well as those with either atopy or AHR. However, there were no significant differences in AHR, PFT, or IOS BDR between persistent and transient wheezers or between late-onset wheezers and early-onset wheezers. CONCLUSION FeNO may be a better marker for asthma phenotypes in preschool children than AHR and PFT results.
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Affiliation(s)
- Mi-Ae Oh
- Department of Pediatrics, Kangbuk Samsung Hospital, Seoul, Korea
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617
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García-Río F, Calle M, Burgos F, Casan P, Del Campo F, Galdiz JB, Giner J, González-Mangado N, Ortega F, Puente Maestu L. Spirometry. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2013; 49:388-401. [PMID: 23726118 DOI: 10.1016/j.arbres.2013.04.001] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/23/2013] [Accepted: 04/01/2013] [Indexed: 11/19/2022]
Abstract
Spirometry is the main pulmonary function test and is essential for the evaluation and monitoring of respiratory diseases. Its utility transcends the field of Respiratory Medicine, is becoming increasingly important in primary care and applications have even been described outside the field of respiratory diseases. This document is therefore intended to serve as support for all health professionals who use spirometry, providing recommendations based on the best scientific evidence available. An update of the indications and contraindications of the test is proposed. The document sets out recommendations on the requirements necessary for conventional spirometers and portable office equipment, as well as on spirometer hygiene and quality control measures. Spirometric parameters that must be considered, performance of manoeuvres, criteria for acceptability and repeatability of measurements and their quality control are defined. A proposal is also established for presentation of the results and an evaluation and interpretation is proposed according to information generated in recent years. Finally, lines of adaptation and integration of spirometry in the field of new technologies are considered.
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Affiliation(s)
- Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz-IdiPaz, Universidad Autónoma de Madrid, CIBERES, Madrid, España.
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618
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Vilozni D, Hakim F, Livnat G, Bentur L. Forced expiratory decay in asthmatic preschool children--is it adult type? Respir Med 2013; 107:975-80. [PMID: 23664671 DOI: 10.1016/j.rmed.2013.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 02/28/2013] [Accepted: 03/18/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The forced expiratory decay in healthy preschool children portrays a convex shape that differs from the linear decay in the older healthy population. The "adult-type" expiratory decay during airway obstruction is concave. The study objective was to determine if the expiratory decay in young asthmatic children is "adult-type". METHODS Among 245 children (age 3-7 yrs), 178 had asthma (asthmatics) and 67 were non-asthmatic (controls). The expiratory flow decay was inspected by FEF25-75/FVC ratio (=1.0 when linear). Values were compared to those of our formerly studied (n = 108) healthy children. A meaningful obstruction in FEF25-75/FVC ratio was defined as 2-zScores from healthy. A meaningful response to bronchodilators was related to non-asthmatics. RESULTS In healthy subjects FEF25-75/FVC ratio declined with age from 1.73 ± 0.17 to 1.28 ± 0.11. Non-asthmatics portrayed ratio values similar to those of healthy subjects. In asthmatics, 118/178 displayed a convex to linear expiratory decay (FEF25-75/FVC = 1.33 ± 0.22). Sixty/178 asthmatics portrayed concavity (FEF25-75/FVC-0.79 ± 0.16) that appeared when FEF50 was 43.4 ± 12%healthy. Concavity appearance was also age-dependent (30.4% of 3-4 y old and 59.1% of 6-7 y). Vital-Capacity decreased in either decays, forming a visually petit curve. Most asthmatic children respond to bronchodilators by a meaningful elevation in FEF25-75/FVC values and by a visual change in the shape of the curve. Other common spirometry indices also increased meaningfully. CONCLUSION Most asthmatic preschool children portray convex to linear expiratory decay with diminished vital-capacity, resulting in a visually smaller than healthy curve, with seemingly normal expiratory decay. These curves may be misinterpreted as "normal" or as "no-cooperation" and may lead to misinterpretation. In response to bronchodilators, FEF25-75/FVC value increases in asthmatics and the curve changes from concave to linear or from linear to convex contour.
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Affiliation(s)
- Daphna Vilozni
- The Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Affiliated with Sackler Medical School, Tel-Aviv, Israel.
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619
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Rama JA, Fan LL, Faro A, Elidemir O, Morales DL, Heinle JS, Smith EO, Hazen ML, Moonnumakal SP, Mallory GB, Schecter MG. Lung transplantation for childhood diffuse lung disease. Pediatr Pulmonol 2013; 48:490-6. [PMID: 22949409 DOI: 10.1002/ppul.22634] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 04/19/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pediatric diffuse lung diseases comprise a heterogeneous group of rare lung disorders which may lead to end stage lung disease and referral for lung transplantation. Previous studies are limited by small numbers of patients with specific forms of diffuse lung disease. Children with all forms of diffuse lung disease who underwent lung transplantation at two pediatric centers were evaluated in terms of several pre- and post-transplant factors and compared to children with other end stage lung disorders. METHODS A retrospective chart review was performed on all patients transplanted between October 1, 2002 and June 15, 2007 at Texas Children's Hospital and St. Louis Children's Hospital. Multiple pre-transplant characteristics and post-transplant morbidities and mortality were compared between diffuse lung disease, cystic fibrosis, and pulmonary vascular disease groups. RESULTS There were 31 diffuse lung disease (DLD), 57 cystic fibrosis (CF), and 16 pulmonary vascular disease (PVD) patients included in our analysis. Patients with DLD had significantly higher pre-transplant morbidity including lower percent predicted of forced expiratory volume in first second (P = 0.013) and more patients with pulmonary hypertension (P = 0.001) and hypercapnia (P = 0.031). Compared to CF patients, more DLD and PVD patients required invasive ventilation (P = 0.001) and care in the pediatric intensive care unit (P = 0.001). After transplant, there was a difference among the three groups with regards to number of acute allograft rejections but statistical limitations preclude knowing between which group the difference lies. A difference in time to bronchiolitis obliterans was found between the PVD and CF groups but not when compared to the DLD patients. The three groups had similar time to post-transplant lymphoproliferative disease, rate of infections, and survival. CONCLUSION Lung transplantation is as successful for patients with end stage diffuse lung disease as compared to other lung transplant candidates.
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Affiliation(s)
- Jennifer A Rama
- Pediatric Pulmonary Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
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620
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Amaral CT, Pontes NN, Maciel BLL, Bezerra HSM, Triesta ANAB, Jeronimo SMB, McGowan SE, Dantas VM. Vitamin A deficiency alters airway resistance in children with acute upper respiratory infection. Pediatr Pulmonol 2013; 48:481-9. [PMID: 22833544 PMCID: PMC7167945 DOI: 10.1002/ppul.22621] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 04/30/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess whether vitamin A deficiency alters the recovery of total respiratory resistance (TRR) following acute upper respiratory tract infection (URI). METHODS This is a case control study of children, age 4-6 years and grouped as: URI, (n = 74), URI and wheezing, (URI-wheezing, n = 52), and healthy controls (n = 51). Vitamin A and total respiratory resistance (TRR) were assessed using the modified relative dose response (MRDR) and forced oscillometry, respectively. RESULTS Children with URI and URI-wheezing had lower retinol, 32.4 ± 13.12 and 18.3 ± 6.83 µg/dl respectively, compared to controls, 56.9 ± 29.82 µg/dl (ANOVA, P < 0.001). The MRDR was elevated in children in the URI or URI-wheezing groups 0.066 ± 0.045 and 0.021 ± 0.021, respectively, compared to controls 0.007 ± 0.006 (ANOVA, P < 0.0001). The TRR in the URI and URI-wheezing groups differed from controls. During convalescence, the TRR failed to decline in the URI-group only when the MRDR was >0.06. In the URI-wheezing group, TRR declined independently of retinol and MRDR. CONCLUSION Vitamin A contributes to preservation of airway function during and in recovery after upper respiratory infection in children.
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Affiliation(s)
- Cleia T Amaral
- Heriberto Bezerra Pediatric Hospital, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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621
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Abstract
The principal aims of asthma management in childhood are to obtain symptom control that allows individuals to engage in unrestricted physical activities and to normalize lung function. These aims should be achieved using the fewest possible medications. Ensuring a correct diagnosis is the first priority. The mainstay of asthma management remains pharmacotherapy. Various treatment options are discussed. Asthma monitoring includes the regular assessment of asthma severity and asthma control, which then informs decisions regarding the stepping up or stepping down of therapy. Delivery systems and devices for inhaled therapy are discussed, as are the factors influencing adherence to prescribed treatment. The role of the pediatric health care provider is to establish a functional partnership with the child and their family in order to minimize the impact of asthma symptoms and exacerbations during childhood.
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Affiliation(s)
- André Schultz
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
| | - Andrew C. Martin
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
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622
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Shackleton C, Barraza-Villarreal A, Chen L, Gangell CL, Romieu I, Sly PD. Reference ranges for Mexican preschool-aged children using the forced oscillation technique. Arch Bronconeumol 2013; 49:326-9. [PMID: 23587799 DOI: 10.1016/j.arbres.2013.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Recently, multi-ethnic reference ranges for spirometry have been created for use worldwide. In comparison, forced oscillation technique (FOT) reference values are limited to specific equipment and study populations, with current FOT reference ranges created in a Caucasian population. We aimed to develop FOT reference ranges for preschool-aged Mexican children and to compare these with current FOT reference ranges. PATIENTS AND METHODS Respiratory resistance (Rrs) and reactance (Xrs) was measured in healthy Mexican children three to five years of age using commercial FOT equipment. The relationship between height and Rrs and Xrs was determined using regression analyses, taking into account age, weight, sex, and exposure to tobacco smoke. Reference equations were calculated for the Mexican children and Z-scores determined for Rrs and Xrs at 6 and 8Hz. A paired t-test assessed the difference in Z-scores between the Australian reference values and those created for the Mexican cohort. RESULTS FOT was successfully measured in 584 children. Height was a significant predictor of Rrs and Xrs at 6 and 8Hz (P<.05). Z-scores calculated using the Australian reference equations overestimated lung function in Mexican children for both Rrs and Xrs at 6 and 8Hz (P<.001). CONCLUSION The development of FOT reference ranges specific to Mexican preschool-aged children will allow for the correct interpretation of FOT measurements. This study also showed that current FOT reference ranges overestimate lung function in Mexican children. Highlighting, the importance of using ethnic appropriate reference ranges for interpreting lung function.
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Affiliation(s)
- Claire Shackleton
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
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623
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Oscillometric and spirometric bronchodilator response in preschool children with and without asthma. Can Respir J 2013; 19:273-7. [PMID: 22891189 DOI: 10.1155/2012/560323] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bronchodilator responses (BDR) are routinely used in the diagnosis and management of asthma; however, their acceptability and repeatability have not been evaluated using quality control criteria for preschool children. OBJECTIVES To compare conventional spirometry with an impulse oscillometry system (IOS) in healthy and asthmatic preschool children. METHODS Data from 30 asthmatic children and 29 controls (two to six years of age) who underwent IOS and spirometry before and after salbutamol administration were analyzed. RESULTS Stable asthmatic subjects significantly differed versus controls in their spirometry-assessed BDR (forced expiratory volume in 1 s [FEV1], forced vital capacity and forced expiratory flow at 25% to 75% of forced vital capacity) as well as their IOS-assessed BDR (respiratory resistance at 5 Hz [Rrs5], respiratory reactance at 5 Hz and area under the reactance curve). However, comparisons based on the area under the ROC curve for ΔFEV1 %initial versus ΔRrs5 % initial were 0.82 (95% CI 0.71 to 0.93) and 0.75 (95% CI 0.62 to 0.87), respectively. Moreover, the sensitivity and specificity for ΔFEV1 >=9% were 0.53 and 0.93, respectively. Importantly, sensitivity increased to 0.63 when either ΔFEV1 >=9% or ΔRrs5 >=29% was considered as an additional criterion for the diagnosis of asthma. CONCLUSION The accuracy of asthma diagnosis in preschool children may be increased by combining spirometry with IOS when measuring BDR.
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624
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Robinson PD, Stocks J, Aurora P, Lum S. Abbreviated multi-breath washout for calculation of lung clearance index. Pediatr Pulmonol 2013; 48:336-43. [PMID: 22833543 DOI: 10.1002/ppul.22618] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/05/2012] [Accepted: 05/07/2012] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Various functional residual capacity (FRC) repeatability criteria have been proposed for lung clearance index (LCI) measurement by multiple breath washout (MBW). Adult guidelines recommend three technically acceptable tests with FRC values within 10%, whilst preschool guidelines recommend two such tests. Feasibility of and need for recommendations in children is unclear. METHODS Retrospective analysis of MBW data was undertaken in healthy control (n = 90) and cystic fibrosis (CF) subjects (n = 108) encompassing infancy, pre-school and school age ranges. Feasibility of FRC repeatability recommendations was investigated in those with three technically acceptable tests. Validity of mean LCI from the first two tests alone (vs. all three) was investigated by comparing mean data and sensitivity to detect abnormal peripheral airway function in CF. RESULTS LCI coefficient of variation (CoV) was related to FRC CoV (P < 0.001) and disease category (P = 0.002). Application of adult repeatability criteria decreased LCI CoV (4.7 vs. 8.5%, P < 0.001), but had poor feasibility beyond infancy (62/150, 41%). Preschool recommendations increased feasibility but only to 70% overall. There was no difference in mean LCI (All three minus 1st two tests) in healthy controls [mean (95% CI) difference: 0.02 (-0.01, 0.06; P = 0.15)], this difference being statistically but not clinically significant in CF subjects [0.07 (0.00,0.13; P = 0.04)]. Sensitivity in CF subjects was unaffected. CONCLUSION Adult FRC repeatability recommendations improved LCI repeatability in pediatric subjects, but poor feasibility limited utility. In an experienced pediatric MBW center, recent preschool recommendations can be extended to two technically acceptable tests, irrespective of FRC repeatability, without significantly affecting mean LCI or compromising sensitivity.
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Affiliation(s)
- Paul D Robinson
- Portex Respiratory Unit, UCL Institute of Child Health, London.
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625
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Ritz T, Meuret AE, Trueba AF, Fritzsche A, von Leupoldt A. Psychosocial factors and behavioral medicine interventions in asthma. J Consult Clin Psychol 2013; 81:231-50. [PMID: 23025250 PMCID: PMC6019133 DOI: 10.1037/a0030187] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This review examines the evidence for psychosocial influences in asthma and behavioral medicine approaches to its treatment. METHOD We conducted a systematic review of the literature on psychosocial influences and the evidence for behavioral interventions in asthma with a focus on research in the past 10 years and clinical trials. Additional attention was directed at promising new developments in the field. RESULTS Psychosocial factors can influence the pathogenesis and pathophysiology of asthma, either directly through autonomic, endocrine, immunological, and central nervous system mechanisms or indirectly through lifestyle factors, health behaviors, illness cognitions, and disease management, including medication adherence and trigger avoidance. The recent decade has witnessed surging interest in behavioral interventions that target the various pathways of influence. Among these, self-management training, breathing training, and exercise or physical activation programs have proved particularly useful, whereas other essential or promising interventions, such as smoking cessation, dietary programs, perception and biofeedback training, and suggestive or expressive psychotherapy, require further, more rigorous evaluation. Given the high comorbidity with anxiety and mood disorders, further evaluation of illness-specific cognitive behavior therapy is of particular importance. Progress has also been made in devising community-based and culturally tailored intervention programs. CONCLUSION In concert with an essential medication treatment, behavioral medicine treatment of asthma is moving closer toward an integrated biopsychosocial approach to disease management.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX 75275, USA.
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626
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Singer F, Luchsinger I, Inci D, Knauer N, Latzin P, Wildhaber JH, Moeller A. Exhaled nitric oxide in symptomatic children at preschool age predicts later asthma. Allergy 2013; 68:531-8. [PMID: 23414302 DOI: 10.1111/all.12127] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prediction of asthma in young children with respiratory symptoms is hampered by the lack of objective measures applicable in clinical routine. In this prospective study in a preschool children cohort, we assessed whether the fraction of exhaled nitric oxide (FeNO), a biomarker of airway inflammation, is associated with asthma at school age. METHODS At baseline, IgE and eosinophils were measured in the blood, and FeNO was measured offline in 391 children aged 3-47 months with lower airway symptoms. We developed an asthma predictive index (API) including high FeNO as major criterion. At follow-up, primary outcome was physician-diagnosed asthma based on standardized interviews in those children reaching school age (n = 166). RESULTS FeNO was significantly elevated in those children with later asthma (68/166) as compared to children not developing asthma. Median (IQR) FeNO was 10.5 (6.6-17.2) vs. 7.4 (5.3-10.3) ppb. Per 5 ppb FeNO increase, the odds ratio (95% CI) for asthma increased by 2.44 (1.61-3.70) without changing when adjusting for confounders. Using the new API, children scored at risk had 58.0% probability for later asthma, whereas the negative predictive value was 78.2%, which was comparable to the classical API. CONCLUSIONS In this cohort of high-risk preschool children, elevated FeNO is associated with increased risk for school-age asthma. The new API including FeNO identifies children at risk of later asthma comparably to the classical API, but does not require blood sampling.
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Affiliation(s)
- F. Singer
- Division of Respiratory Medicine; University Children's Hospital Bern; University of Bern; Bern; Switzerland
| | - I. Luchsinger
- Division of Respiratory Medicine; University Children′s Hospital Zurich; Zurich; Switzerland
| | - D. Inci
- Division of Respiratory Medicine; University Children's Hospital Bern; University of Bern; Bern; Switzerland
| | - N. Knauer
- Division of Respiratory Medicine; University Children′s Hospital Zurich; Zurich; Switzerland
| | - P. Latzin
- Division of Respiratory Medicine; University Children's Hospital Bern; University of Bern; Bern; Switzerland
| | | | - A. Moeller
- Division of Respiratory Medicine; University Children′s Hospital Zurich; Zurich; Switzerland
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627
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Pike KC, Inskip HM, Robinson SM, Cooper C, Godfrey KM, Roberts G, Lucas JSA. The relationship between maternal adiposity and infant weight gain, and childhood wheeze and atopy. Thorax 2013; 68:372-9. [PMID: 23291350 PMCID: PMC3661999 DOI: 10.1136/thoraxjnl-2012-202556] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Obesity and asthma have increased in westernised countries. Maternal obesity may increase childhood asthma risk. If this relation is causal, it may be mediated through factors associated with maternal adiposity, such as fetal development, pregnancy complications or infant adiposity. We investigated the relationships of maternal body mass index (BMI) and fat mass with childhood wheeze, and examined the influences of infant weight gain and childhood obesity. METHODS Maternal prepregnancy BMI and estimated fat mass (from skinfold thicknesses) were related to asthma, wheeze and atopy in 940 children. Transient or persistent/late wheeze was classified using questionnaire data collected at ages 6, 12, 24 and 36 months and 6 years. At 6 years, skin-prick testing was conducted and exhaled nitric oxide and spirometry measured. Infant adiposity gain was calculated from skinfold thickness at birth and 6 months. RESULTS Greater maternal BMI and fat mass were associated with increased childhood wheeze (relative risk (RR) 1.08 per 5 kg/m(2), p=0.006; RR 1.09 per 10 kg, p=0.003); these reflected associations with transient wheeze (RR 1.11, p=0.003; RR 1.13, p=0.002, respectively), but not with persistent wheeze or asthma. Infant adiposity gain was associated with persistent wheeze, but not significantly. Adjusting for infant adiposity gain or BMI at 3 or 6 years did not reduce the association between maternal adiposity and transient wheeze. Maternal adiposity was not associated with offspring atopy, exhaled nitric oxide, or spirometry. DISCUSSION Greater maternal adiposity is associated with transient wheeze but not asthma or atopy, suggesting effects upon airway structure/function but not allergic predisposition.
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Affiliation(s)
- Katharine C Pike
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
| | - Hazel M Inskip
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Southampton Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sian M Robinson
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Southampton Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Southampton Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Keith M Godfrey
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Southampton Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Graham Roberts
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
| | - Jane SA Lucas
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
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628
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van Leeuwen JC, Driessen JMM, Kersten ETG, Thio BJ. Assessment of exercise-induced bronchoconstriction in adolescents and young children. Immunol Allergy Clin North Am 2013; 33:381-94, viii-ix. [PMID: 23830131 DOI: 10.1016/j.iac.2013.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent research shows important differences in exercise-induced bronchoconstriction (EIB) between children and adults, suggesting a different pathophysiology of EIB in children. Although exercise can trigger classic symptoms of asthma, in children symptoms can be subtle and nonspecific; parents, children, and clinicians often do not recognize EIB. With an age-adjusted protocol, an exercise challenge test can be performed in children as young as 3 years of age. However, an alternative challenge test is sometimes necessary to assess potential for EIB in children. This review summarizes age-related features of EIB and recommendations for assessing EIB in young children and adolescents.
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Affiliation(s)
- Janneke C van Leeuwen
- Department of Pediatrics, Medisch Spectrum Twente, VKC poli 17, Haaksbergerstraat 55, Enschede 7513 ER, The Netherlands.
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629
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Grasemann H, Ratjen F. Early lung disease in cystic fibrosis. THE LANCET RESPIRATORY MEDICINE 2013; 1:148-57. [PMID: 24429095 DOI: 10.1016/s2213-2600(13)70026-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lung disease in patients with cystic fibrosis is characterised by inflammation and recurrent and chronic infections leading to progressive loss in pulmonary function and respiratory failure. Early management of disease results in substantially improved pulmonary function at first testing (at roughly 6 years of age), but the annual decline in pulmonary function tests in older patients has remained unchanged showing how important the early years are in the disease process. Treatment regimens for patients with cystic fibrosis have changed from predominantly symptomatic treatment to preventive or causal (ie, treatments that address the underlying mechanisms of disease) therapeutic interventions. The infant and preschool age (2-5 years) could represent a unique period of opportunity to postpone or even prevent the onset of cystic fibrosis lung disease. We summarise the current knowledge and the methods used to characterise and quantify early lung disease. We discuss treatment strategies including new drugs that are being developed and their potential role in the treatment of early lung disease in patients with cystic fibrosis.
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Affiliation(s)
- Hartmut Grasemann
- Division of Respiratory Medicine, Department of Paediatrics, and Programme in Physiology and Experimental Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Paediatrics, and Programme in Physiology and Experimental Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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630
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Calabrese C, Corcione N, Di Spirito V, Guarino C, Rossi G, Domenico Gargiulo G, Vatrella A. Recurrent respiratory infections caused by a double aortic arch: The diagnostic role of spirometry. Respir Med Case Rep 2013; 8:47-50. [PMID: 26029616 PMCID: PMC3920393 DOI: 10.1016/j.rmcr.2012.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/29/2012] [Accepted: 12/11/2012] [Indexed: 11/21/2022] Open
Abstract
A young woman with a clinical history characterized by recurrent respiratory infections, occurring since early infancy, was referred to our hospital. When the patient was a young girl, she underwent sweat chloride test, serum analysis of immunoglobulins, and evaluation of blood lymphocyte subsets; all these diagnostic tests were normal, as well as chest X ray aside from pneumonia episodes. Skin prick tests were positive for several different allergens, and a diagnosis of allergic rhinitis was made. At the age of 11 years, she started to complain of gastroesophageal reflux disease (GERD) symptoms, and a gastroscopy detected a hiatal hernia with esophagitis. Despite pharmacologic treatments for allergic rhinitis and GERD, the patient continued to complain of chronic cough, associated with choking and recurrent respiratory infections treated with antibiotic therapy. For the first time in her life, we performed a spirometry that showed a flow-volume curve characterized by a plateau in the expiratory phase, suggestive of an central airway obstruction. Bronchoscopy demonstrated a compression of the distal portion of trachea. Computed tomography (CT) angiogram revealed a double aortic arch. Barium enhancement evidenced an esophageal compression. A surgical division of the smaller of the two arches was then performed. Therefore, we strongly suggest to perform lung function tests in all cases of unexplained respiratory complaints.
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Affiliation(s)
- Cecilia Calabrese
- Dipartimento di Scienze Cardiotoraciche e Respiratorie, Seconda Università degli Studi di Napoli, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy
| | - Nadia Corcione
- Dipartimento di Scienze Cardiotoraciche e Respiratorie, Seconda Università degli Studi di Napoli, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy
| | - Valentina Di Spirito
- Dipartimento di Scienze Cardiotoraciche e Respiratorie, Seconda Università degli Studi di Napoli, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy
| | - Carmine Guarino
- UOC di Broncologia, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy
| | - Giovanni Rossi
- UOC di Broncologia, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy
| | - Gaetano Domenico Gargiulo
- Dipartimento Cardiovascolare, Università degli Studi di Bologna, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Alessandro Vatrella
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Via S. Allende, 84081 Baronissi, Salerno, Italy
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631
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França DC, Vieira DSR, Vieira BDSPP, Oliveira TGE, Britto RR, Parreira VF. Lower-limb endurance training program influences thoracoabdominal motion of patients with COPD? FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Thoracoabdominal-TA asynchrony is an important sign of Chronic Obstructive Pulmonary Disease (COPD). Studies investigating the influence of endurance training on TA asynchrony have not been found. OBJECTIVE: To analyze lower-limb endurance training effects on TA asynchrony in patients with COPD. MATERIALS AND METHODS: Two patients with severe COPD were evaluated in a single-subject design AB (A-baseline for six weeks, B-training on cycle ergometer with intensity of 70% of baseline peak load, for 12 weeks) with repeated measures of variables: phase inspiratory relation (PhRIB), phase expiratory relation (PhREB) and phase angle (PhAng). These variables were assessed by respiratory inductive plethysmography during incremental exercise tests on a cycle ergometer (same load and peak load of each test). Statistical methods included visual analysis, two-standard deviation band test and split middle line test, considering significant p < 0.05. It was considered the results for variables with agreement of at least two analyses. Data are presented as mean ± SD for phases A and B. RESULTS: During phase B, Patient 1 presented significant decrease of PhRIB (22.7 ± 3.4 x 17.0 ± 4.9) and PhAng (16.5 ± 5.1 x 13.2 ± 2.1) for same load and PhREB (16.8 ± 3.1 x 13.3 ± 3.1) and PhAng (23.4 ± 1.7 x 20.1 ± 2.3) at peak load. Patient 2 showed significant decrease of PhRIB for same load and (14.4 ± 3.8 x 13.9 ± 3.9) at peak load (19.1 ± 2.5 x 15.7 ± 2.7). CONCLUSIONS: These results suggest that lower-limb endurance training reduced TA asynchrony in patients with severe COPD. The findings may be related, according to the literature, to the lower ventilatory demand and greater exercise capacity of patients with COPD undergoing endurance training.
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632
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Shin YH, Baek JH, Yoon JW, Jee HM, Yum HY, Choi SH, Kim HY, Han MY. Comparison of Reference Values and Short-Term Variability for Oscillatory and Spirometric Lung Function in Healthy Korean Preschool Children. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:25-31. [PMID: 35927844 DOI: 10.1089/ped.2012.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Respiratory function measurements are important in the diagnosis and follow-up assessment of respiratory diseases. The aims of this study were to establish reference values for spirometry, to compare them with respiratory resistance and impedance by an impulse oscillometry system (IOS), and to analyze 3-month follow-up studies in healthy Korean preschool children. Six hundred seven questionnaires were distributed and 497 (82%) were returned. Lung function tests were performed in 183 healthy children of the age of 3-6 years. The 3-month follow-up studies were conducted from 19 children who visited our clinic twice. Of the 183 children who underwent both IOS and spirometry, 164 (90%) and 150 (82%) met the quality-control criteria for IOS and spirometry, respectively. The regression equations of each spirometric parameter were obtained. Height was the most consistently correlated measurement in both boys and girls. All spirometry parameters, except for FEF25-75/FVC, were significantly correlated with IOS parameters. There were no significant differences in respiratory resistance at 5 Hz measured by IOS (RrsIOS5), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1) between the first and second sets. The intraclass correlation coefficients and relative coefficients of repeatability for FEV1, RrsIOS5, and respiratory system reactance (Xrs)IOS5 were 0.90 (95% CI 0.73-0.96), 0.82 (95% CI 0.53-0.93), and 0.55 (95% CI -0.17-0.83) and 22.6%, 35.5%, and 91.8%, respectively. The obtained values and regression equations provide a reference for Korean preschool children and may be of importance in evaluating lung function of preschool children with pulmonary problems. Respiratory resistance and FEV1 for healthy young Korean children are lower than literature reported reference values for Caucasian children. RrsIOS5 appears to be more stable on repeat testing than XrsIOS5.
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Affiliation(s)
- Youn Ho Shin
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Hyeon Baek
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jung Won Yoon
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hye Yung Yum
- Atopy Clinic, Seoul Medical Center, Seoul, Republic of Korea
| | - Sun Hee Choi
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | | | - Man Yong Han
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Republic of Korea
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633
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Abstract
Since preschool wheezing is the common expression of several heterogeneous disorders, identification of children at risk for persistent asthma is particularly challenging. To date, efforts to predict the outcome of preschool wheeze have mainly relied on predictive rules consisting of simple clinical and laboratory parameters. Among these tools, the asthma predictive index (API) has been introduced in international guidelines and position papers and is recommended for use in clinical practice. This article reviews the currently available asthma predictive models focusing on their validity and performance characteristics. Although these tools are generally simple and easy to apply, they suffer important intrinsic and practical limitations and they have been insufficiently validated to allow for widespread use in clinical settings. We also present evidence that their ability to predict the long-term outcome of preschool wheeze is limited in general populations, and even poorer in high-risk children in which prediction of asthma persistence might have important clinical and prognostic implications. Due to the complex and multifactorial nature of asthma, prediction of asthma persistence based on simple clinical models is practically impossible.
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Affiliation(s)
- Sotirios Fouzas
- Paediatric Respiratory Unit, Department of Paediatrics, University Hospital of Patras, Patras, Greece
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634
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Jensen R, Stanojevic S, Gibney K, Salazar JG, Gustafsson P, Subbarao P, Ratjen F. Multiple breath nitrogen washout: a feasible alternative to mass spectrometry. PLoS One 2013; 8:e56868. [PMID: 23457632 PMCID: PMC3574055 DOI: 10.1371/journal.pone.0056868] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 01/15/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The lung clearance index (LCI), measured by multiple breath washout (MBW), reflects global ventilation inhomogeneity and is a sensitive marker of early cystic fibrosis (CF) lung disease. Current evidence is based on a customized mass spectrometry system that uses sulfur hexafluoride (SF6) as a tracer gas, which is not widely available. Nitrogen (N2) washout may be better suited for clinical use and multi-center trials. OBJECTIVE To compare the results obtained from a N2 washout system to those generated by the SF6 based system in healthy children and children with CF. METHODS Children with CF were recruited from outpatient clinics; healthy children were recruited from the Research4Kids online portal. Participants performed MBWSF6 (Amis 2000, Innovision, Denmark) and MBWN2 (ExhalyzerD, EcoMedics, Switzerland) in triplicate, in random order on the same day. Agreement between systems was assessed by Bland-Altman plot. RESULTS Sixty-two healthy and 61 children with CF completed measurements on both systems. In health there was good agreement between systems (limits of agreement -0.7 to 1.9); on average N2 produced higher values of LCI (mean difference 0.58 (95% CI 0.42 to 0.74)). In CF the difference between systems was double that in health with a clear bias towards disproportionately higher LCIN2 compared to LCISF6 at higher mean values of LCI. CONCLUSION LCIN2 and LCISF6 have similar discriminative power and intra-session repeatability but are not interchangeable. MBWN2 offers a valid new tool to investigate early obstructive lung disease in CF, but requires independent normative values.
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Affiliation(s)
- Renee Jensen
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sanja Stanojevic
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Research Institute, the Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Karyn Gibney
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Juliana Giraldo Salazar
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Per Gustafsson
- Department of Pediatrics, Central Hospital, Skövde, Sweden
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada
- * E-mail:
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635
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Shin YH, Yoon JW, Choi SH, Baek JH, Kim HY, Jee HM, Yum HY, Han MY. Use of impulse oscillometry system in assessment of asthma severity for preschool children. J Asthma 2013; 50:198-203. [PMID: 23294170 DOI: 10.3109/02770903.2012.751996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The National Asthma Education and Prevention Program/Expert Panel Report (NAEPP/EPR)-3 Guidelines for asthma treatment categorize asthma severity based on impairment and risks and on medications administered. The objective of this study was to determine whether impulse oscillometry system (IOS) measures in preschool children are consistent with asthma severity as defined by NAEPP/EPR-3 Guidelines. METHODS Asthma severity of the 162 subjects (aged 2-5 years) was classified by impairment and risks for exacerbations requiring oral systemic corticosteroids, by medication usage, and by combination classification (higher severity of impairment and risks or medication usage). An experienced pediatrician determined the appropriate medications for each child and parents completed structured questionnaires regarding day and night symptoms and interference with normal activity over the preceding 4 weeks. All children were tested by IOS. RESULTS The mean age was 3.7 ± 0.9 years and 91 (56%) of the total patients were males. When asthma severity was based on (1) impairment and risks and (2) medication usage, asthma was "intermittent" in 17.9% and 11.1% of the total patients, "mild persistent" in 42.0% and 50.6% of total patients, and "moderate-severe persistent" in 40.1% and 38.3% of total patients, respectively. The agreement between severity based on impairment and risks and medication usage was not significant. Xrs(5) z-scores differed between intermittent asthma and mild/moderate-severe persistent asthma, as determined by medication usage and combination classification, but not by impairment and risks. As asthma severity (assessed by medication usage) increased, the duration of asthma increased. CONCLUSIONS Xrs(5) can be used to discriminate intermittent and persistent asthma in preschool children. Further studies with larger sample sizes are warranted to confirm this finding and to determine the underlying mechanism.
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Affiliation(s)
- Youn Ho Shin
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Republic of Korea
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636
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Abstract
Asthma is considered a chronic disease, but not all preschool wheezing is asthma since most will eventually grow out of their symptoms. Although still a matter of debate, preschool wheezing can be classified in 2 major groups: virus-induced wheezing and multitrigger wheezing, having a different prognosis and a different treatment approach. Virus-induced wheezing is the most common phenotype of preschool wheezing and is usually associated with a good prognosis. Treatment should be conservative, but if preventive treatment is required, leukotriene-receptor antagonists might be the first choice treatment. Multitrigger wheezing is associated with an allergic disposition and has a higher risk of persistent symptoms. Inhaled corticosteroids may give short-term reduction in exacerbations, but the beneficial effect of long-term use of inhaled corticosteroids and other anti-inflammatory agents have not yet been established. This review aims to give an opinion on preschool wheezing, and its association with asthma.
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637
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Kirkby J, Bonner R, Lum S, Bates P, Morgan V, Strunk RC, Kirkham F, Sonnappa S, Stocks J. Interpretation of pediatric lung function: impact of ethnicity. Pediatr Pulmonol 2013; 48:20-6. [PMID: 22431502 PMCID: PMC3736844 DOI: 10.1002/ppul.22538] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 01/13/2012] [Indexed: 02/02/2023]
Abstract
RATIONALE To evaluate the appropriateness of spirometric and plethysmographic reference equations in healthy young children according to ethnic origin. METHODS Spirometry data were collated in 400 healthy children (214 Black and 186 White) aged 6-12 years. Of these children, 68 Black and 115 White children also undertook plethysmography. Results were expressed as percent predicted according to commonly used equations for spirometry and plethysmography. RESULTS Black children had lower lung function for a given height compared to White children. The magnitude and direction of these differences varied according to specific outcome. In the studied age range (6-12 years) the ethnic-specific Wang equations were adequate for spirometry (mean results approximating 100% predicted in both ethnic groups). By contrast, significant differences were found between observed and % predicted plethysmographic lung volumes according to published equations derived from White children: Among the Black children, function residual capacity (FRC) and total lung capacity (TLC) were on average, 14 and 6% lower than predicted, whereas mean residual volume (RV) and RV/TLC were 4 and 10% higher. Among White children, the Rosenthal equations gave the best fit, with the exception of FRC which was, on average, 9% lower than predicted. CONCLUSION Spirometry equations may suffice in Black children; however, interpretation of static lung volumes in Black children is limited due to inappropriate reference equations. More appropriate plethysmographic reference equations that are applicable to all ethnic groups across the entire age range are urgently needed.
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Affiliation(s)
- J Kirkby
- Portex Unit, Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK.
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638
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Yoon JW, Hur HY, Jee HM, Baek JH, Kim HY, Shin YH, Han MY. Comparison of bronchial responsiveness assessing dose-response slope between cough-variant asthma and classic asthma in young children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.4.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Hye Young Hur
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Ji Hyeon Baek
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyeong Yoon Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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639
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Exequibilidade do estudo funcional respiratório em idade pré-escolar na prática clínica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2013; 19:38-41. [DOI: 10.1016/j.rppneu.2012.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022] Open
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640
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Lungenfunktionsdiagnostik. PÄDIATRISCHE PNEUMOLOGIE 2013. [PMCID: PMC7123361 DOI: 10.1007/978-3-642-34827-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lungenfunktionsdiagnostik beinhaltet eine Vielzahl von Messmethoden, mit denen jeweils bestimmte Qualitten der Lungen in verschiedenen Altersgruppen überwiegend nichtinvasiv untersucht werden können.
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641
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Pulmonary function tests in emergency department pediatric patients with acute wheezing/asthma exacerbation. Pulm Med 2012; 2012:724139. [PMID: 23304496 PMCID: PMC3523566 DOI: 10.1155/2012/724139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/23/2012] [Accepted: 10/23/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Pulmonary function tests (PFT) have been developed to analyze tidal breathing in patients who are minimally cooperative due to age and respiratory status. This study used tidal breathing tests in the ED to measure asthma severity. Design/Method. A prospective pilot study in pediatric patients (3 to 18 yrs) with asthma/wheezing was conducted in an ED setting using respiratory inductance plethysmography and pneumotachography. The main outcome measures were testing feasibility, compliance, and predictive value for admission versus discharge. Results. Forty patients were studied, of which, 14 (35%) were admitted. Fifty-five percent of the patients were classified as a mild-intermittent asthmatic, 30% were mild-persistent asthmatics, 12.5% were moderate-persistent asthmatics, and 2.5% were severe-persistent. Heart rate was higher in admitted patients as was labored breathing index, phase angle, and asthma score. Conclusions. Tidal breathing tests provide feasible, objective assessment of patient status in the enrolled age group and may assist in the evaluation of acute asthma exacerbation in the ED. Our results demonstrate that PFT measurements, in addition to asthma scores, may be useful in indicating the severity of wheezing/asthma and the need for admission.
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642
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Oliveira LCD, Campos TF, Borja RDO, Chaves GSDS, Delgado RN, Mendes REDF, Mendonça KMPPD. Pressões respiratórias máximas de pico e sustentada na avaliação da força muscular respiratória de crianças. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2012. [DOI: 10.1590/s1519-38292012000400002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: comparar os valores de PImax e PEmax de pico e sustentado em uma população de crianças em idade escolar. MÉTODOS: estudo observacional descritivo de caráter transversal. Foram avaliadas 144 crianças saudáveis de 7 a 11 anos de ambos os gêneros. Foirealizada avaliação antropométrica e mensuraçãodas pressões respiratórias máximas, de pico e sustentada, através do manovacuômetro digital. A criança sorteou qual pressão respiratória iria realizar inicialmente. A medida da PImax foi realizada a partir da capacidade pulmonar total e a medida da PEmax a partir do volume residual. Os dados foram analisados através do programa SPSS 17.0 atribuindose o nível de significância de 5%. RESULTADOS: os achados obtidos foram: 78,53 ± 22,53 cmH2O para PIpico ; 91,11 ± 23,0 cmH2O para a PEpico e 72,95 ± 21,22 cmH2O e 86,25 ± 21,8 cmH2O para PIsust e PEsust, respectivamente. Osvalores obtidos através das pressões respiratórias de pico (PIpico e PEpico) foram significativamente superiores as medidas obtidas para as pressões respiratórias sustentadas (PIsust e PEsust) independentemente do gênero ou idade avaliada (p=0,001). CONCLUSÕES: a utilização de medidas de pico na avaliação das pressões respiratórias máximas, mais facilmente obtidas na prática clínica, pode comprometer a real mensuração da força muscular respiratória em crianças de 7 a 11 anos.
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643
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Pittman JE, Johnson RC, Jones PW, Davis SD. Variability of a closed, rebreathing setup for multiple breath wash-out testing in children. Pediatr Pulmonol 2012; 47:1242-50. [PMID: 22467329 DOI: 10.1002/ppul.22531] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/20/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The multiple breath wash-out technique (MBW) that measures lung clearance index (LCI) and functional residual capacity (FRC) may be more sensitive than spirometry for identification of early obstructive airways disease. The open MBW setup using mass spectrometry referenced in previous publications is not readily available in the U.S. Our objective was to assess validity and sensitivity of a commercially available device that uses a closed (rebreathing) setup with photoacoustic spectroscopy for MBW testing. STUDY DESIGN AND METHODS Subjects aged 5-21 who were either healthy or had a history of cystic fibrosis were enrolled. Subjects completed MBW (Innocor device; Innovision, Denmark) and spirometry; measures obtained included LCI, FRC, and forced expiratory volume in 1 sec, as well as changes in end-tidal carbon dioxide levels (CO(2) ) and tidal volume during MBW testing. RESULTS Seventeen subjects attempted a total of 76 MBW maneuvers; 80% were completed and 60% met criteria for acceptability; most were unacceptable due to errors in the tracer gas curve. Substantial intra-subject variability for LCI and FRC were noted (mean 26% ± 55 and 36% ± 63, respectively). Subjects were also noted to have significant increases in exhaled CO(2) and tidal volume during MBW testing. CONCLUSIONS In our initial experience using a commercially available closed setup for MBW testing, we found a significant degree of intra-subject variability leading us to suspend testing. Variability could be due to hypercapnea and instability of tidal breathing secondary to the rebreathing setup. Further studies are needed to better understand the closed system MBW setup.
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Affiliation(s)
- Jessica E Pittman
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Konstantinou GN, Xepapadaki P, Manousakis E, Makrinioti H, Kouloufakou-Gratsia K, Saxoni-Papageorgiou P, Papadopoulos NG. Assessment of airflow limitation, airway inflammation, and symptoms during virus-induced wheezing episodes in 4- to 6-year-old children. J Allergy Clin Immunol 2012. [PMID: 23199600 PMCID: PMC7112251 DOI: 10.1016/j.jaci.2012.10.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background It is disputed whether recurrent episodes of wheeze in preschool-aged children comprise a distinct asthma phenotype. Objective We sought to prospectively assess airflow limitation and airway inflammation in children 4 to 6 years old with episodic virus-induced wheeze. Methods Ninety-three children 4 to 6 years old with a history of mild, virus-induced episodes of wheeze who were able to perform acceptable fraction of exhaled nitric oxide (Feno) maneuvers and spirometry (with forced expiratory time ≥0.5 seconds) were followed prospectively. Lung function and Feno values were measured every 6 weeks (baseline) within the first 48 hours of an acute wheezing episode (day 0) and 10 and 30 days later. Symptom scores and peak flow measurement were recorded daily. Results Forty-three children experienced a wheezing episode. At day 0, Feno values were significantly increased, whereas forced expiratory volume at 0.5 seconds (FEV0.5) significantly decreased compared with baseline (16 ppb [interquartile range {IQR}, 13-20 ppb] vs 9 ppb IQR, 7-11 ppb] and 0.84 L [IQR, 0.75-0.99 L] vs 0.99 L [IQR, 0.9-1.07 L], respectively; both P < .001). Airflow limitation at day 0 was reversible after bronchodilation. FEV0.5 and Feno values were significantly associated with each other and with lower and upper respiratory tract symptoms when assessed longitudinally but not cross-sectionally at all time points independently of atopy. Feno and FEV0.5 values returned to baseline levels within 10 days. Conclusions Mild episodes of wheeze in preschoolers are characterized by enhanced airway inflammation, reversible airflow limitation, and asthma-related symptoms. Feno values increase significantly during the first 48 hours and return to personal baseline within 10 days from the initiation of the episode. Longitudinal follow-up suggests that symptoms, inflammation, and lung function correlate well in this phenotype of asthma.
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Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece.
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645
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The importance of imaging and physiology measurements in assessing the delivery of peripherally targeted aerosolized drugs. Ther Deliv 2012; 3:1329-45. [DOI: 10.4155/tde.12.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Considerable recent effort has been directed towards developing new aerosol formulations and delivery devices that can target drugs to the lung periphery. In order to determine the efficacy of targeted drug therapy, it is essential that the peripheral lung region be adequately assessed. Imaging of the airways structure and pathology has greatly advanced in the last decade and this rate of growth is accelerating as new technologies become available. Lung imaging continues to play an important role in the study of the peripheral airways and, when combined with state-of-the-art lung function measurements and computational modeling, can be a powerful tool for investigating the effects of inhaled medication. This article focuses on recent strategies in imaging and physiological measurements of the lungs that allow the assessment of inhaled medication delivered to the periphery and discusses how these methods may help to further optimize and refine future aerosol delivery technology.
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O'Reilly R, Ullmann N, Irving S, Bossley CJ, Sonnappa S, Zhu J, Oates T, Banya W, Jeffery PK, Bush A, Saglani S. Increased airway smooth muscle in preschool wheezers who have asthma at school age. J Allergy Clin Immunol 2012; 131:1024-32, 1032.e1-16. [PMID: 23069488 DOI: 10.1016/j.jaci.2012.08.044] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increased airway smooth muscle (ASM) is a feature of established asthma in schoolchildren, but nothing is known about ASM in preschool wheezers. OBJECTIVE We sought to determine endobronchial biopsy specimen ASM area fraction in preschool wheezers and its association with asthma at school age. METHODS ASM area, reticular basement membrane thickness, and mucosal eosinophil and ASM mast cell values were quantified in endobronchial biopsy specimens previously obtained from preschool children undergoing clinically indicated bronchoscopy: severe recurrent wheezers (n=47; median age, 26 months) and nonwheezing control subjects (n=21; median age, 15 months). Children were followed up, and asthma status was established at age 6 to 11 years. Preschool airway pathology was examined in relation to asthma at school age. RESULTS Forty-two (62%) of 68 children had 1 or more evaluable biopsy specimens for ASM. At school age, 51 of 68 children were followed up, and 15 (40%) of 37 preschool wheezers had asthma. Children who had asthma and an evaluable biopsy specimen had increased preschool ASM area fraction (n=8; median age, 8.2 years [range, 6-10.4 years]; median ASM, 0.12 [range, 0.08-0.16]) compared with that seen in children without asthma (n=24; median age, 7.3 years [range, 5.9-11 years]; median ASM, 0.07 [range, 0.02-0.23]; P=.007). However, preschool reticular basement membrane thickness and mucosal eosinophil or ASM mast cell values were not different between those who did or did not have asthma at school age. CONCLUSION Increased preschool ASM is associated with those children who have asthma at school age. Thus a focus on early changes in ASM might be important in understanding the subsequent development of childhood asthma.
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Affiliation(s)
- Ruth O'Reilly
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Peták F, Czövek D, Novák Z. Spirometry and forced oscillations in the detection of airway hyperreactivity in asthmatic children. Pediatr Pulmonol 2012; 47:956-65. [PMID: 22451241 DOI: 10.1002/ppul.22551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/29/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Provocation tests are routinely used to detect airway hyperreactivity (AH) in the diagnosis of asthma. We compared the sensitivities of the forced oscillation technique (FOT) and spirometry in the detection of AH in asthmatic children. METHODS FOT and spirometry were performed in 20 asthmatic children (aged 5-18 years) following aerosolized histamine and methacholine at an interval of 2 weeks. The respiratory system input impedance was measured by FOT; the resistance at 6 Hz (R(6) ), the average resistance between 4 and 24 Hz, the area under the reactance curve (AX) and the resonant frequency were extracted from these recordings. Spirometry was used to obtain forced expiratory volumes and flow parameters. RESULTS Following provocation with the two agonists, the FOT detected the airway response as early as spirometry. When the greater variability of the impedance parameters was taken into account, the two methods were observed to have similar sensitivities. Among the lung function parameters studied, AX and R(6) were the most sensitive for the demonstration of AH. CONCLUSIONS Our findings demonstrate that FOT is as suitable as spirometry for the measurement of bronchoconstriction and thus it may be considered for the detection of AH in asthmatic children. Since its application requires minimal cooperation, this approach imposes less stress and may be particularly favorable in the diagnosis of asthma at a young age.
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Affiliation(s)
- Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, Hungary.
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Beydon N, Mahut B, Maingot L, Guillo H, La Rocca MC, Medjahdi N, Koskas M, Boulé M, Delclaux C. Baseline and post-bronchodilator interrupter resistance and spirometry in asthmatic children. Pediatr Pulmonol 2012; 47:987-93. [PMID: 22328540 DOI: 10.1002/ppul.22526] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 12/31/2011] [Indexed: 11/11/2022]
Abstract
In children unable to perform reliable spirometry, the interrupter resistance (R(int) ) technique for assessing respiratory resistance is easy to perform. However, few data are available on the possibility to use R(int) as a surrogate for spirometry. We aimed at comparing R(int) and spirometry at baseline and after bronchodilator administration in a large population of asthmatic children. We collected retrospectively R(int) and spirometry results measured in 695 children [median age 7.8 (range 4.8-13.9) years] referred to our lab for routine assessment of asthma disease. Correlations between R(int) and spirometry were studied using data expressed as z-scores. Receiver operator characteristic curves for the baseline R(int) value (z-score) and the bronchodilator effect (percentage predicted value and z-score) were generated to assess diagnostic performance. At baseline, the relationship between raw values of R(int) and FEV(1) was not linear. Despite a highly significant inverse correlation between R(int) and all of the spirometry indices (FEV(1) , FVC, FEV(1) /FVC, FEF(25-75%) ; P < 0.0001), R(int) could detect baseline obstruction (FEV(1) z-score ≤ -2) with only 42% sensitivity and 95% specificity. Post-bronchodilator changes in R(int) and FEV(1) were inversely correlated (rhô = -0.50, P < 0.0001), and R(int) (≥35% predicted value decrease) detected FEV(1) reversibility (>12% baseline increase) with 70% sensitivity and 69% specificity (AUC = 0.79). R(int) measurements fitted a one-compartment model that explained the relationship between flows and airway resistance. We found that R(int) had poor sensitivity to detect baseline obstruction, but fairly good sensitivity and specificity to detect reversibility. However, in order to implement asthma guidelines for children unable to produce reliable spirometry, bronchodilator response measured by R(int) should be systematically studied and further assessed in conjunction with clinical outcomes.
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Affiliation(s)
- Nicole Beydon
- AP-HP, Unité Fonctionnelle d'Explorations Fonctionnelles Respiratoires, Hôpital Armand-Trousseau, Paris, France.
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Maternal plasma phosphatidylcholine fatty acids and atopy and wheeze in the offspring at age of 6 years. Clin Dev Immunol 2012; 2012:474613. [PMID: 23049600 PMCID: PMC3463812 DOI: 10.1155/2012/474613] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/13/2012] [Accepted: 07/25/2012] [Indexed: 12/21/2022]
Abstract
Variation in exposure to polyunsaturated fatty acids (PUFAs) might influence the development of atopy, asthma, and wheeze. This study aimed to determine whether differences in PUFA concentrations in maternal plasma phosphatidylcholine are associated with the risk of childhood wheeze or atopy. For 865 term-born children, we measured phosphatidylcholine fatty acid composition in maternal plasma collected at 34 weeks' gestation. Wheezing was classified using questionnaires at 6, 12, 24, and 36 months and 6 years. At age of 6 years, the children underwent skin prick testing, fractional exhaled nitric oxide (FENO) measurement, and spirometry. Maternal n-6 fatty acids and the ratio of n-3 to n-6 fatty acids were not associated with childhood wheeze. However, higher maternal eicosapentaenoic acid, docosahexaenoic acid, and total n-3 fatty acids were associated with reduced risk of non-atopic persistent/late wheeze (RR 0.57, 0.67 and 0.69, resp. P = 0.01, 0.015, and 0.021, resp.). Maternal arachidonic acid was positively associated with FENO (P = 0.024). A higher ratio of linoleic acid to its unsaturated metabolic products was associated with reduced risk of skin sensitisation (RR 0.82, P = 0.013). These associations provide some support for the hypothesis that variation in exposure to n-6 and n-3 fatty acids during pregnancy influences the risk of childhood wheeze and atopy.
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