751
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Garcia G, Perez T, Mahut B. [Lung function testing and assessment of distal airways in asthma]. Rev Mal Respir 2009; 26:395-406; quiz 479, 482. [PMID: 19421092 DOI: 10.1016/s0761-8425(09)74044-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Small airways are defined (in humans) as those<2mm in diameter. BACKGROUND They were originally described as the "quiet zone" of the lungs contributing less than 10% of the total resistance to airflow. Pulmonary function tests remain the most used method to assess distal airway flow limitation. VIEWPOINTS However, these tests are limited in adults and also in children because MEF25-75% and FEF50% are highly variable spirometric indices and they depend on vital capacity, which increases with expiratory time in obstructed subjects. There is a need for promising non invasive new tools like the forced oscillation technique to measure resistance. The increased availability of the exhaled fraction of nitric oxide (FeNO) measurement means that this method is accessible and attractive. CONCLUSION The production of nitric oxide (NO) can be assessed by measuring the fraction of NO during a prolonged expiration (FENO) or by estimating other parameters of NO exchange including the alveolar NO concentration (CalvNO) and may provide information about small airway inflammation and assist the optimal control of the disease.
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Affiliation(s)
- G Garcia
- Service d'Explorations fonctionnelles multidisciplinaires, Hôpital Antoine-Béclère, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France.
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752
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Abstract
STUDY DESIGN Review. OBJECTIVE To review and outline the preoperative evaluation and approach in assessing children with congenital vertebral malformation. SUMMARY OF BACKGROUND DATA Congenital vertebral malformations encompass a broad spectrum of conditions. A high association of renal, cardiac, and intraspinal anomalies with congenital vertebral malformation has been well documented in the literature. Vertebral malformation with involvement of the thoracic cage may lead to the development of thoracic insufficiency. The natural history, the character, and location of the deformity ultimately influence the propensity for progression and the necessity for treatment. Multiple factors should be considered before treatment with the goal of treatment aimed at providing the best possible care to be able to optimize the child's overall function and potential for growth. METHODS Narrative and review of literature. CONCLUSION Congenital scoliosis is a multifaceted condition. The presentation of the condition can be quite varied from those presenting with an isolated hemivertebrae to those with severe malformations, complicated by multiple medical conditions. A thorough preoperative evaluation is necessary before the institution of any treatment protocol. The presence of any medical condition must be addressed; the treatment should be tailor-made for each patient putting into consideration the patients' age and the effects of treatment on pulmonary function at maturity.
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753
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Li AM, Lam HS, So HK, Leung M, Tsen T, Au CT, Chang AB. Interrupter Respiratory Resistance in Healthy Chinese Preschool Children. Chest 2009; 136:554-560. [DOI: 10.1378/chest.08-2798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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754
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Robinson PD, Cooper P, Van Asperen P, Fitzgerald D, Selvadurai H. Using index of ventilation to assess response to treatment for acute pulmonary exacerbation in children with cystic fibrosis. Pediatr Pulmonol 2009; 44:733-42. [PMID: 19598271 DOI: 10.1002/ppul.20956] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The use of alternative more sensitive measures has become a focus of research in CF. The utility of indexes of ventilation, Lung Clearance Index (LCI) and peak aerobic capacity (peak VO(2)), were studied as assessment tools in gauging response to intravenous (IV) therapy in acute pulmonary exacerbation, in comparison to the more commonly used index of forced expiratory volume in 1 sec (FEV(1)). The utility of a previously published clinical score was further explored. METHODS Patients aged 8-18 years admitted for IV antibiotic treatment of a pulmonary exacerbation were recruited. Spirometry, plethysmography, multiple breath nitrogen washout, exercise testing, and Cystic Fibrosis Clinical Score (CFCS) were performed on admission and prior to discharge. RESULTS Twenty-eight patients were recruited, with a mean (range) age of 13.7 (8; 17) years, 16 female and 12 male. Mean (range) admission FEV(1) was 61.4 (28; 92)% predicted, or z-score -3.09 (-6.15; -0.52), FVC 83.0 (38; 120)% predicted, or z-score -1.71 (-5.66; -1.17), and Shwachman-Kulczycki 68.9 (50; 90). FEV(1) increased by 7.0% (P < 0.01) from admission to discharge. Mean (range) admission LCI, 10.10 (6.87; 14.83), decreased by 3.8% (P = 0.03). Mean (range) admission peak VO(2) (ml/kg/min), 31.2 (23.4; 45.4), increased on discharge by 6.6% (P < 0.01). Proposed clinical thresholds, based on the available variability data, highlighted the heterogeneity of response in lung function tests. Mean (range) admission CFCS, 26.5 (19; 39), decreased to 19.9 (13; 31) on discharge, a 25.2% improvement (P < 0.01). CFCS demonstrated improvement in 27 of 28 patients. Changes in peak VO(2) (r = -0.50, P = 0.02) and LCI (r = 0.48, P = 0.01) correlated with CFCS change. CONCLUSIONS In children with mild-to-moderate CF, whilst statistically significant improvement in both LCI and peak VO(2) were seen, heterogeneity of response was evident. The most consistent improvement was seen in CFCS. Correlation of LCI and peak VO(2) with change in clinical score (CFCS) was seen. The full clinical significance of these changes in LCI and peak VO(2) needs to be evaluated further with additional variability data. The CFCS may be useful in the assessment of response to treatment in CF but requires formal validation.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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755
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Davies JC, Alton EW. Monitoring respiratory disease severity in cystic fibrosis. Respir Care 2009; 54:606-17. [PMID: 19393105 DOI: 10.4187/aarc0493] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Measurements of disease severity provide a guide for the physician to tailor therapies, for the patient and family to gauge progress, and are required for clinical trials. For many respiratory diseases, including cystic fibrosis, sensitive, noninvasive measurements are few, and some of those that are available are applicable only to certain subgroups of patients or lack sufficient sensitivity. We discuss currently available measurements in 4 groups: physiology, infection, inflammation, and radiology. For each group we highlight strengths and weaknesses, ask how we could improve upon these, and provide details of alternative methods.
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Affiliation(s)
- Jane C Davies
- Department of Gene Therapy, Imperial College, Emmanuel Kaye Building, Manresa Road, London SW3 6NP, United Kingdom.
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756
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Rech VV, Vidal PCV, Melo Júnior HTD, Stein RT, Pitrez PMC, Jones MH. Airway resistance in children measured using the interrupter technique: reference values. J Bras Pneumol 2009; 34:796-803. [PMID: 19009212 DOI: 10.1590/s1806-37132008001000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 01/30/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The interrupter technique is used for determining interrupter resistance (Rint) during quiet breathing. This noninvasive method requires minimal cooperation and can therefore be useful in evaluating airway obstruction in uncooperative children. To date, no reference values have been determined for Rint in a Brazilian population. The objective of this study was to define a prediction equation for airway resistance using the interrupter technique for healthy children aged 3-13 years. METHODS This was a prospective, cross-sectional study involving preschool and school children in Porto Alegre, Brazil, in whom Rint was measured during peak expiratory flow. RESULTS One-hundred and ninety-three children were evaluated. Univariate analysis using linear regression showed that height, weight and age correlated significantly and independently with Rint. Multiple regression with height, weight, age and gender as variables resulted in a model in which only height and weight were significant, independent predictors of Rint. Collinearity was identified among height, weight and age. CONCLUSIONS Reference values and an equation for calculating Rint in healthy children were obtained and are adjusted for height.
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757
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Vilozni D, Livnat G, Dabbah H, Elias N, Hakim F, Bentur L. The potential use of spirometry during methacholine challenge test in young children with respiratory symptoms. Pediatr Pulmonol 2009; 44:720-7. [PMID: 19499592 DOI: 10.1002/ppul.20978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The concentration of methacholine that causes a fall of 20% from baseline forced expiratory volume in the first second (PC20-FEV1) in the methacholine challenge test (MCT) is not usually considered a diagnostic tool in preschool children since PC20-FEV1 may not be achievable <6 years of age. AIM To assess the usefulness of various spirometry indices obtained during MCT in a large group of 3- to 6-year-old children with respect to their clinical diagnosis. METHODS Standardized MCT (inhaled triple-concentration increments [0.057-13.925 mg] of methacholine solution) was performed by 84 children previously diagnosed with asthma (asthmatics) and 48 with prolonged cough (coughers). Spirometry was determined at baseline and between inhalations; PC20-FEV1 and PC25-FEV0.5 were calculated. RESULTS PC20-FEV1 values were significantly less in the asthmatics than in the coughers (mean +/- SD was 3.21 +/- 4.32 vs. 22.35 +/- 3.66 ml/mg). Similarly, PC25-FEV0.5 was 1.48 +/- 3.08 in the asthmatics and 9.45 +/- 12.59 mg/ml/Mch in the coughers, P < 0.0001. A cut-off at 4.0 mg/ml for PC20-FEV1 had 77.4% sensitivity and 75.0% specificity, a cut-off at 2.2 mg/ml for PC25-FEV0.5 had 73.8% sensitivity and 72.9% specificity, for clinical diagnosis of asthma. PC25-FEV0.5 also showed a correlation with age. CONCLUSIONS Our findings suggest that MCT can be performed in preschool children with various respiratory symptoms. PC25-FEV0.5 may be a better end-point parameter. Children with a clinical diagnosis of asthma respond to a lower MCT concentration than children with cough. Further studies are needed to determine airway responsiveness in healthy young children and to further assess the contribution of MCT to the clinical diagnosis in this age group.
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Affiliation(s)
- Daphna Vilozni
- Pediatric Pulmonary Unit, Meyer Children's Hospital, Rambam Medical Center, Technion-Israel Institute of Technology, Haifa 31096, Israel.
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758
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Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, Casale TB, Chanez P, Enright PL, Gibson PG, de Jongste JC, Kerstjens HAM, Lazarus SC, Levy ML, O'Byrne PM, Partridge MR, Pavord ID, Sears MR, Sterk PJ, Stoloff SW, Sullivan SD, Szefler SJ, Thomas MD, Wenzel SE. An Official American Thoracic Society/European Respiratory Society Statement: Asthma Control and Exacerbations. Am J Respir Crit Care Med 2009; 180:59-99. [DOI: 10.1164/rccm.200801-060st] [Citation(s) in RCA: 1321] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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759
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Jeng MJ, Chang HL, Tsai MC, Tsao PC, Yang CF, Lee YS, Soong WJ, Tang RB. Spirometric pulmonary function parameters of healthy Chinese children aged 3-6 years in Taiwan. Pediatr Pulmonol 2009; 44:676-82. [PMID: 19517562 DOI: 10.1002/ppul.21038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spirometry is a well-known technique for evaluating pulmonary function, but few studies have focused on preschool children. The aim of this study was to determine reference values of forced spirometric parameters in young Chinese children, aged 3-6 years, in Taiwan. Spirometric measurements were performed at day care centers by experienced pediatricians. Of 248 children without a history of chronic respiratory illness, at least two valid spirometric attempts were obtained from 214 children (109 boys and 105 girls; age: 36-83 [mean = 61] months; height: 90-131 [mean = 111] cm). Values of forced expiratory volume in 1 sec (FEV1) and 0.5 sec (FEV(0.5)), forced vital capacity (FVC), peak expiratory flow rate (PEF), forced expiratory between 25% and 75% FVC (FEF(25-75)), and forced expiratory flow rate at 25%, 50%, and 75% of FVC (FEF(25), FEF(50), and FEF(75)) were derived and analyzed. There were significant positive correlations between study parameters and body height, body weight, and age. Height was the most consistently correlated measurement in both boys and girls. Although boys tended to have higher spirometric values than girls, we found significant differences only in FVC and FEV1 between boys and girls aged 6 years. The regression equations of each parameter were obtained. In conclusion, spirometric pulmonary function tests are feasible in 3- to 6-year-old children. The obtained values and regression equations provide a reference for Chinese preschool children and may be of value in evaluating pulmonary function of children with respiratory problems in this age group.
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Affiliation(s)
- Mei-Jy Jeng
- Department of Pediatrics, School of Medicine, Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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760
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Vilozni D, Szeinberg A, Barak A, Yahav Y, Augarten A, Efrati O. The relation between age and time to maximal bronchoconstriction following exercise in children. Respir Med 2009; 103:1456-60. [PMID: 19497724 DOI: 10.1016/j.rmed.2009.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 04/15/2009] [Accepted: 04/23/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND The exercise challenge test (ECT) is a common tool for assessment of asthma in children. Many studies suggest that the "time to maximal bronchoconstriction" (Nadir-t) after exercise challenge in asthmatic children may be age-dependent, although this has never been systematically studied. Such findings may influence epidemiological surveys where the schedule of post-exercise measurements is trimmed. This study systematically assesses the relation between age and time to maximal bronchoconstriction post-ECT. METHODS Data were collected retrospectively from 131 subjects (87 male; 3-18 years) who were referred for ECT. The routine ECT was performed according to ATS recommendation of a 6-min run. Spirometry was measured at 1, 3, 5, 10, 15, and 20 min post-exercise. The post-exercise nadir of FEV1 (%baseline) (FEV1-nadir) and the time to maximal fall in Nadir-t (minutes) were sought and values were related to age. RESULTS Baseline FEV1 values (mean+/-SD) were 90.5+/-13.8% predicted. FEV1-nadir was -23.6+/-11.7% from baseline values. The Nadir-t was reached at 5.1+/-2.6 min (range 2-12 min). A positive correlation between children's age and Nadir-t was observed (r2=0.542; SD of residuals=1.79; p<0.001), regardless of FEV1-nadir, whether the cutoff of point was -10% or -15% of baseline FEV1. Children <10 years of age showed Nadir-t at 3.4+/-1.7 min post-exercise and older children at 6.6+/-2.5 min post-exercise (p<0.0001). CONCLUSION Our results indicate that the time to maximal bronchoconstriction is age-dependent in children and adolescents, and imply that the schedule of post-exercise FEV(1) measurements should be cautiously trimmed.
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Affiliation(s)
- Daphna Vilozni
- Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Ramat Gan 52625, Affiliated to the Sackler Medical School, Tel-Aviv University, Israel.
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761
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von Ungern-Sternberg BS, Erb TO, Habre W, Sly PD, Hantos Z. The Impact of Oral Premedication with Midazolam on Respiratory Function in Children. Anesth Analg 2009; 108:1771-6. [DOI: 10.1213/ane.0b013e3181a324c3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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762
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Carlsen KCL, Håland G, Carlsen KH. Natural history of lung function in health and diseases. Curr Opin Allergy Clin Immunol 2009; 9:146-50. [PMID: 19307885 DOI: 10.1097/aci.0b013e3283292243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To outline major advances in the understanding of factors that influence lung function development through childhood. RECENT FINDINGS New study approaches such as adjusting for 'tracking' or analysing without predefined phenotypes suggest that reduced lung function reported with several pre or coexisting features such as lower respiratory tract infections and early allergic sensitization may be spurious rather than causative. Also, two large, recent studies have clearly demonstrated that living close to major roads causes significant lung function deficits in school children, with the possible long-term impact this can have on health in adult life. Furthermore, it is becoming clear that we need to focus upon early life events that can cause harm as well as have a potential for catch-up growth or development in postnatal life. SUMMARY The implications of these findings are clearly that there is a potential for intervening in a potential pathological development. Furthermore, there is a clear need to focus research upon early life events that can improve lung growth in the damaged lung and prevent damage to the potentially healthy lung at the very start of life.
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763
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Abstract
PURPOSE OF REVIEW To describe a prospective classification for preschool wheezers according to temporal symptom pattern, and summarize findings relating to the management of viral wheeze and the use of short-term therapy for intermittent severe wheeze. RECENT FINDINGS Phenotypes defined from cohort studies should only be applied retrospectively at school age. A new classification that can be applied prospectively is discussed. The importance of early rhinovirus-induced wheezing as a risk factor for asthma has become apparent. However, there is no benefit from short-course oral steroids for acute viral wheeze in the majority of cases. There is conflicting evidence for the role of intermittent montelukast or inhaled steroids in the treatment of acute, intermittent wheeze. A link between reduced vitamin D intake during pregnancy and increased preschool wheeze in offspring has emerged, suggesting a potential role for vitamin D supplementation in primary prevention. SUMMARY On the basis of current evidence, a trial of bronchodilators is first-line therapy for viral wheeze, and maintenance montelukast or inhaled steroids may be considered in preschool wheezers with persistent symptoms and risk factors for future asthma. No disease-modifying therapies are available. New therapeutic options for preschool wheezing disorders are desperately needed.
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764
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Treggiari MM, Rosenfeld M, Mayer-Hamblett N, Retsch-Bogart G, Gibson RL, Williams J, Emerson J, Kronmal RA, Ramsey BW. Early anti-pseudomonal acquisition in young patients with cystic fibrosis: rationale and design of the EPIC clinical trial and observational study'. Contemp Clin Trials 2009; 30:256-68. [PMID: 19470318 PMCID: PMC2783320 DOI: 10.1016/j.cct.2009.01.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/27/2008] [Accepted: 01/06/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND The primary cause of morbidity and mortality in patients with cystic fibrosis (CF) is progressive obstructive pulmonary disease due to chronic endobronchial infection, particularly with Pseudomonas aeruginosa (Pa). Risk factors for and clinical impact of early Pa infection in young CF patients are less well understood. PURPOSE The present studies are designed to evaluate risk factors and outcomes associated with early Pa acquisition, and the benefits and harms of four anti-pseudomonal treatment regimens in young CF patients initiated after the first Pa positive respiratory culture. METHODS The Early Pseudomonas Infection Control (EPIC) program consists of two studies, a randomized multicenter trial in CF patients ages 1-12 years at first isolation of Pa from a respiratory culture, and a longitudinal cohort study enrolling Pa-negative patients. Using a factorial design, trial participants are assigned for 18 months to either anti-pseudomonal treatment on a scheduled quarterly basis (cycled therapy) or based on recovery of Pa from quarterly respiratory cultures (culture-based therapy). The study drugs include inhaled tobramycin (300 mg BID) for 28 days, combined with either oral ciprofloxacin (15-20 mg/kg BID) or oral placebo for 14 days. The primary endpoints of the trial are the time to pulmonary exacerbation requiring IV antibiotics or hospitalization for respiratory symptoms, and the proportion of patients with new Pa-positive respiratory cultures during the study. The broad goals of the observational study are to describe the risk factors and outcomes associated with early acquisition of Pa. 306 patients were randomized in the clinical trial and 1787 were enrolled in the cohort study. CONCLUSIONS These companion studies will provide valuable epidemiological and microbiological information on early CF lung disease and Pa acquisition, and safety and clinical efficacy data on anti-pseudomonal treatment strategies for early Pa infections in the airways of young children with CF.
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Affiliation(s)
- Miriam M Treggiari
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA.
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765
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Mahut B, Trinquart L, Bokov P, Le Bourgeois M, Waernessyckle S, Peiffer C, Delclaux C. Relationships between specific airway resistance and forced expiratory flows in asthmatic children. PLoS One 2009; 4:e5270. [PMID: 19381269 PMCID: PMC2667212 DOI: 10.1371/journal.pone.0005270] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/24/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The earliest changes associated with airflow obstruction in asthmatic children are a proportionally greater reduction in FEF(50%) than in FEV(1) using spirometry, and an increase in specific airway resistance (sRaw) using body plethysmography. Consequently, we hypothesized that sRaw could be better linked to FEF(50%) than to FEV(1). The first aim was to assess the relationships between forced expiratory flows and sRaw in a large group of asthmatic children in a transversal study. We then performed a longitudinal study in order to determine whether sRaw of preschool children could predict subsequent impairment of forced expiratory flows at school age. METHODOLOGY Pulmonary function tests (sRaw and forced expiratory flows) of 2193 asthmatic children were selected for a transversal analysis, while 365 children were retrospectively selected for longitudinal assessment from preschool to school age. PRINCIPAL FINDINGS The transversal data showed that sRaw is differently related to FEF(50%) (-1/sRaw) and to FEV(1) (near linearly). These results were further explained by a simple one-compartment lung model, which justified the shape of the observed relationships. As hypothesized, sRaw correlated more strongly to FEF(50%) than to FEV(1) (r = -0.64 versus -0.39, respectively; p<0.001). In the longitudinal part of the study, sRaw at preschool age correlated with subsequent FEF(50%) (% predicted) (-0.31, 95% CI, -0.40 to -0.22), but weakly with subsequent FEV(1) (% predicted) (-0.09, 95% CI, -0.20 to 0). CONCLUSION Specific Raw is more strongly related to FEF(50%) than to FEV(1) and could be used in preschool children to predict subsequent mild airflow limitation.
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Affiliation(s)
- Bruno Mahut
- Cabinet La Berma, Antony, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Physiologie, Radio-Isotopes, Clinique de la Dyspnée, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Service de Pneumo-Allergologie Pédiatrique, Paris, France
- Mosquito Respiratory Research Group, Paris, France
| | - Ludovic Trinquart
- Université Paris Descartes, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompido, Unité de Recherche Clinique et d'Epidémiologie, Paris, France
- Mosquito Respiratory Research Group, Paris, France
- INSERM CIE 4, Paris, France
| | - Plamen Bokov
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Physiologie, Radio-Isotopes, Clinique de la Dyspnée, Paris, France
- Université Paris Descartes, Paris, France
- Laboratoire Matière et Systèmes Complexes (MSC); UMR 7057 CNRS & Université Paris Diderot, Paris, France
- Mosquito Respiratory Research Group, Paris, France
| | - Muriel Le Bourgeois
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Service de Pneumo-Allergologie Pédiatrique, Paris, France
| | - Serge Waernessyckle
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Service de Pneumo-Allergologie Pédiatrique, Paris, France
| | - Claudine Peiffer
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Physiologie, Radio-Isotopes, Clinique de la Dyspnée, Paris, France
- Mosquito Respiratory Research Group, Paris, France
| | - Christophe Delclaux
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Physiologie, Radio-Isotopes, Clinique de la Dyspnée, Paris, France
- Université Paris Descartes, Paris, France
- Mosquito Respiratory Research Group, Paris, France
- * E-mail:
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766
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767
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Hall GL, Gangell C, Fukushima T, Horak F, Patterson H, Stick SM, Sly PD, Franklin PJ. Application of a shortened inhaled adenosine-5'-monophosphate challenge in young children using the forced oscillation technique. Chest 2009; 136:184-189. [PMID: 19318674 DOI: 10.1378/chest.08-2848] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adenosine-5'-monophosphate (AMP) is an indirect challenge agent thought to reflect allergic airway inflammation. The forced oscillation technique (FOT) is ideal for use in young children and is suitable for inhaled challenge studies in patients who are in this age group. We assessed the agreement between a shortened and a standard AMP challenge and the repeatability of the shortened AMP challenge using FOT as a primary outcome variable. METHODS Eighteen children completed a shortened and a standard AMP challenge, and 20 children completed repeated shortened AMP challenges. The children inhaled nebulized AMP tidally for 2 min, following which the presence of wheeze and pulse oximetric saturation (Spo(2)) was recorded prior to FOT measurement. Testing continued until the maximum dose was reached or until wheeze, a decrease in Spo(2) to < 90%, or an increase in respiratory resistance at 8 Hz of 2.0 hPa/s/L or 30% was noted. Concordance was assessed as a binary response, and agreement in provocation concentrations (PCs) causing a response was assessed with intraclass correlations. RESULTS There was a high degree of concordance between the shortened and standard AMP protocols (94%) and repeated shortened AMP protocols (100%). The mean log(10) PCs displayed a high degree of agreement for both AMP protocols, with intraclass correlation coefficients of 0.94 (95% confidence interval, 0.85 to 0.98) and 0.94 (95% confidence interval, 0.82 to 0.98), respectively. CONCLUSIONS We demonstrated that a shortened AMP challenge that can be applied to young children is comparable to the standard AMP challenge and is highly repeatable. Further studies in young children to assess the clinical role of a shortened AMP challenge using FOT are required.
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Affiliation(s)
- Graham L Hall
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia; School of Paediatric and Child Health, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia.
| | - Catherine Gangell
- School of Paediatric and Child Health, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Takayoshi Fukushima
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Friedrich Horak
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia; Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Hilary Patterson
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Stephen M Stick
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia; School of Paediatric and Child Health, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Peter D Sly
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Peter J Franklin
- School of Paediatric and Child Health, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
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768
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Pérez-Yarza EG, Sardón Prado O, Korta Murua J. [Recurrent wheezing in three year-olds: facts and opportunities]. An Pediatr (Barc) 2009; 69:369-82. [PMID: 18928707 DOI: 10.1157/13126564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The 3 year-old group of children has an increased incidence and prevalence of recurrent wheezing episodes. There are different subgroups, who give different inflammatory responses to different triggering agents, and subgroups that differ in aetiopathology and immunopathology. Current diagnostic methods (exhaled nitric oxide in multiple breaths, nitric oxide in exhaled air condensate, induced sputum, broncho-alveolar lavage and endo-bronchial biopsy), enable the inflammatory pattern to be identified and to give the most effective and safe treatment. The various therapeutic options for treatment are reviewed, such as inhaled glucocorticoids when the inflammatory phenotype is eosinophilic, and leukotriene receptor antagonists, when the inflammatory phenotype is predominantly neutrophilic. In accordance with the current recommendations, for the diagnosis as well as for the therapy initiated in children of this age, they must be regularly reviewed, so that if the benefit is not clear, the treatment must be stopped and an alternative diagnosis and treatment considered. The start of treatment should be determined depending on the intensity and frequency of the symptoms, with the aim of decreasing morbidity and increasing the quality of life of the patient.
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Affiliation(s)
- E G Pérez-Yarza
- Unidad de Neumología, Servicio de Pediatría, Hospital Donostia, San Sebastián, España.
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769
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Vilozni D, Efrati O, Barak A, Yahav Y, Augarten A, Bentur L. Forced inspiratory flow volume curve in healthy young children. Pediatr Pulmonol 2009; 44:105-11. [PMID: 19142889 DOI: 10.1002/ppul.20835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Spirometry testing should include both expiratory and inspiratory measurements. Inspiratory forced maneuvers can demonstrate extrathoracic airway abnormalities, of which various symptoms may suggest asthma. However, the inspiratory portion of the forced flow/volume maneuver in young healthy children has not yet been described. OBJECTIVES To document and analyze the forced inspiratory flow volume curve indices in healthy young children. SETTINGS AND PARTICIPANTS Healthy preschool children (age 2.5-6.5 years) from community kindergartens around Israel. METHODS The teaching method included multi-target, interactive spirometry games and accessory games for inspiration (e.g., inspiratory whistle). RESULTS One hundred and fourteen out of a total of 157 children performed duplicate full adequate inspiratory maneuvers. Repeatability between two maneuvers was 5.6%, 4.0%, 5.1%, 7.3% for inspiratory capacity (IC), forced inspiratory vital capacity (FIVC), peak inspiratory flow (PIF), and mid inspiratory flow (FIF50). Inspiratory flow indices were significantly lower than the expiratory flow indices. The time to reach PIF was significantly longer (mean +/- SD; 229 +/- 21 msec) than the time to reach peak expiratory flow (92 +/- 8 msec; P < 0.0001). The shape of the inspiratory curve was parabolic and did not vary with age. The formed predicted equations were in agreement with the extrapolated values for older healthy children. CONCLUSIONS The majority of healthy young children can perform reliable maximum inspiratory flow volume curves. Our results provide a framework of reference equations for maximum inspiratory flow volume curve in the young children. The clinical applications of these equations have to be explored.
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Affiliation(s)
- Daphna Vilozni
- The Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center Tel-HaShomer, Affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
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770
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Seo HK, Chang SJ, Jung DW, Wee YS, Jee HM, Seo JY, Han MY. The quality control and acceptability of spirometry in preschool children. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.11.1267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hyun Kyong Seo
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Sun Jung Chang
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Da Woon Jung
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Young Sun Wee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Ji Young Seo
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
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771
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Zuidgeest MGP, van Dijk L, Spreeuwenberg P, Smit HA, Brunekreef B, Arets HGM, Bracke M, Leufkens HGM. What drives prescribing of asthma medication to children? A multilevel population-based study. Ann Fam Med 2009; 7:32-40. [PMID: 19139447 PMCID: PMC2625831 DOI: 10.1370/afm.910] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Diagnosing asthma in children with asthmatic symptoms remains a challenge, particularly in preschool children. This challenge creates an opportunity for variability in prescribing. The aim of our study was to investigate how and to what degree patient, family, and physician characteristics influence prescribing of asthma medication in children. METHODS We undertook a multilevel population-based study using the second Dutch national survey of general practice (DNSGP-2), 2001. Participants were 46,371 children aged 1 to 17 years belonging to 25,537 families registered with 109 general practitioners. Using a multilevel multivariate logistic regression analysis with 3 levels, our main outcome measure was the prescribing of asthma medication, defined as at least 1 prescription for beta(2)-adrenergic agonists, inhaled corticosteroids, cromones, or montelukast during the 1-year study period. RESULTS We identified characteristics significantly associated with prescribing asthma medication on all 3 levels (child, family, and physician). The variance in prescribing among physicians was significantly higher with children who were younger than 6 years than with children aged 6 years and older (95% CI, 3.5%-25.2% vs 2.4%-13.4%). Several diagnoses other than asthma and asthmatic complaints were strongly associated with prescribing asthma medication, including bronchitis/bronchiolitis (OR = 9.04; 95% CI, 7.57-10.8) and cough (OR = 6.51; 95% CI, 5.68-7.47). CONCLUSIONS Our study shows a much higher variance in prescribing patterns among general practitioners for children younger than 6 years compared with older children, which could be a direct result of the diagnostic complexities found in young children with asthmatic symptoms. Thus diagnostic gaps may lead to more physician-driven prescribing irrespective of the clinical context.
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Affiliation(s)
- Mira G P Zuidgeest
- Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
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772
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e Tramont CVV, Faria ACD, Lopes AJ, Jansen JM, de Melo PL. Influence of the ageing process on the resistive and reactive properties of the respiratory system. Clinics (Sao Paulo) 2009; 64:1065-73. [PMID: 19936180 PMCID: PMC2780523 DOI: 10.1590/s1807-59322009001100006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 08/03/2009] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In an increasingly old society, the study of the respiratory system changes and new techniques dedicated to older patients are of interest in physiologic studies as well as in the diagnosis of respiratory diseases. OBJECTIVES (1) To investigate the impact of ageing on the resistive and reactive properties of the respiratory system, and (2) to compare the easiness of accomplishment of spirometry and forced oscillation for assessing lung function. METHODS We conducted a cross-sectional study in which forced oscillation was used to investigate respiratory system resistive and reactive properties, while spirometry was used as a reference test to evaluate 80 normal subjects aged between 20 and 86 years. A questionnaire was used to evaluate the easiness of accomplishment of spirometry and forced oscillation. RESULTS There was a significant increase in the respiratory system resonance frequency (p<0.003) and a reduction in the mean reactance (p<0.004) with increasing age. Respiratory system resistance and dynamic compliance were not related to the ageing process. The easiness of accomplishment of forced oscillation measurements was greater than that of spirometry. This result was particularly relevant in subjects over 70 years old (p<0.05). CONCLUSIONS Respiratory system resistance and dynamic compliance are not modified with ageing. On the other hand, respiratory system homogeneity decreases during the ageing process. Forced oscillation is easy to perform and provides information complementary to spirometry. This technique may be a promising alternative and/or complement to other conventional exams used to evaluate older people who are unable to adequately perform spirometric tests.
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Affiliation(s)
| | | | - Agnaldo José Lopes
- Pulmonary Function Laboratory - Faculty of Medical Sciences - Rio de Janeiro/RJ, Brazil.
, Tel: 55 21 2587.7773
| | - José Manoel Jansen
- Pulmonary Function Laboratory - Faculty of Medical Sciences - Rio de Janeiro/RJ, Brazil.
, Tel: 55 21 2587.7773
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773
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Kivastik J, Talts J, Primhak RA. Interrupter technique and pressure oscillation analysis during bronchoconstriction in children. Clin Physiol Funct Imaging 2009; 29:45-52. [DOI: 10.1111/j.1475-097x.2008.00832.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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774
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Espirometría forzada en preescolares sanos bajo las recomendaciones de la ATS/ERS: estudio CANDELA. An Pediatr (Barc) 2009; 70:3-11. [DOI: 10.1016/j.anpedi.2008.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/03/2008] [Indexed: 11/22/2022] Open
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775
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776
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Schweitzer C, Marchal F. Dyspnoea in children. Does development alter the perception of breathlessness? Respir Physiol Neurobiol 2008; 167:144-53. [PMID: 19114130 DOI: 10.1016/j.resp.2008.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 12/03/2008] [Accepted: 12/03/2008] [Indexed: 01/08/2023]
Abstract
Dyspnoea, the perception of an unpleasant and/or uncomfortable sensation of breathlessness, offers several physiological, anatomical and teleological analogies with pain. Pain perception has been shown to exist in the newborn, suggesting that dyspnoea may also occur from birth onwards. The perception of breathlessness will be subservient to developmental changes in the behaviour of sensors and lung and muscular receptors implicated in dyspnoea, some of which are known to be active at time of birth. For example, perinatal resetting of the arterial chemoreceptor could lead to transient depression of the dyspnoeic response to hypoxia. However, though early evoked ventilatory responses and peripheral receptor maturation do exist, dyspnoea will only occur if the corresponding central neural circuitry undergoes parallel maturation. Our knowledge of dyspnoea in later childhood is based on a small number of clinical or psychophysical studies, predominantly dealing with asthma and exercise. There is a thus a clear need for systematic assessment of the existence and severity of dyspnoea sensing in younger children that takes into account its role as an alarm mechanism for triggering adaptive and/or protective responses.
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777
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Nowowiejska B, Tomalak W, Radliński J, Siergiejko G, Latawiec W, Kaczmarski M. Transient reference values for impulse oscillometry for children aged 3-18 years. Pediatr Pulmonol 2008; 43:1193-7. [PMID: 18988256 DOI: 10.1002/ppul.20926] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Impulse oscillometry (IOS) is a technique of assessing mechanical properties of respiratory system by means of measuring resistances and reactances in a number of frequencies during tidal breathing. It is especially useful in preschool children, however has also been validated in older children and adults. The aim of the present study was to construct equations describing normal values of oscillatory parameters in pediatric population of healthy polish children. Six hundred twenty-six healthy children aged 3.1-18.9 years (278 boys and 348 girls) completed the study. Analysis revealed that body height was the best predictor and resistances are best described with exponential model while reactances with linear one, with correlation coefficient r reaching the value of 0.9. Oscillometric resistances decrease with height, while reactances increase. Reference values for children and adolescents will allow not only the interpretation of the measurement, but also will make possible to study changes of oscillometric indices during growth.
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778
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Mayer OH, Jawad AF, McDonough J, Allen J. Lung function in 3-5-year-old children with cystic fibrosis. Pediatr Pulmonol 2008; 43:1214-23. [PMID: 18991339 DOI: 10.1002/ppul.20930] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It is well established that the lung disease of CF can occur early in life and may progress through the preschool years when accurate lung function assessment has been challenging to perform. We hypothesized that respiratory inductive plethysmography (RIP) and spirometry could be effectively performed in 3-6-year-old children and could be used to assess both longitudinal changes in lung function and the acute changes that occur during exacerbation of pulmonary disease. Both RIP and spirometry were equally feasible; however, the success rate for spirometry gradually increased with age to become higher than that for RIP in the 6-year-old subjects. Forty-four subjects were studied longitudinally and demonstrated significant increases in FVC, FEV(1), and FEV(0.5), but not in FEF(25-75) or RIP variables. There were significant differences in FVC, FEV(1), and phase angle (a measure of thoracoabdominal asynchrony) during exacerbations of lung disease. Although both RIP and spirometry were able to show differences in lung function in subjects with acute clinical worsening, spirometry was more robust in demonstrating change in lung function longitudinally and in children who had an exacerbation of lung disease.
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Affiliation(s)
- Oscar H Mayer
- Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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779
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Dellon EP, Donaldson SH, Johnson R, Davis SD. Safety and tolerability of inhaled hypertonic saline in young children with cystic fibrosis. Pediatr Pulmonol 2008; 43:1100-1106. [PMID: 18828160 DOI: 10.1002/ppul.20909] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inhaled hypertonic saline (HS) improves lung function and decreases pulmonary exacerbations in older patients with cystic fibrosis (CF). Initiating therapies in young patients has potential to preserve lung function. Before conducting a therapeutic trial of HS in this population, its safety must be evaluated and protocols for monitoring response must be tested. METHODS We administered single dose 3% and 7% HS post-albuterol to 4-7 year-olds with CF able to perform spirometry ("preschool" group) and 4 month to 3 year-olds ("infant" group) using the raised volume rapid thoracoabdominal compression technique (RVRTC). Vital signs and cough episodes were measured after each inhaled treatment. RESULTS Eight preschool subjects (mean age 5.7 +/- 0.8 years) and 6 infants (1.6 +/- 1.0 years) completed the 3% HS protocol, and no clinically important change in vital signs or decrease in FVC, FEV(1), FEV(0.5), or FEF(25-75) occurred post-HS. Preschoolers had more cough episodes post-HS (P = 0.01). Seven preschoolers (6.1 +/- 0.7 years) and 8 infants (1.6 +/- 0.7 years) completed the 7% HS protocol. In the preschool group, FVC, FEV(0.5), and FEF(25-75) did not change significantly. A statistically significant drop in median FEV(1) occurred post-7% HS attributable to a transient >20% drop in one subject. Infant PFT parameters were unchanged post-7% HS. Preschoolers had more cough episodes post-HS (P = 0.03). CONCLUSION Acute administration of 3% and 7% HS appears to be safe and well-tolerated in most young children with CF. Given the demonstrated benefits in older patients, a therapeutic trial in this age group is warranted.
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Affiliation(s)
- Elisabeth P Dellon
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Scott H Donaldson
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Robin Johnson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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780
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Thamrin C, Albu G, Sly PD, Hantos Z. Negative impact of the noseclip on high-frequency respiratory impedance measurements. Respir Physiol Neurobiol 2008; 165:115-8. [PMID: 19010453 DOI: 10.1016/j.resp.2008.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 10/13/2008] [Accepted: 10/16/2008] [Indexed: 11/15/2022]
Abstract
The noseclip is conventionally used in lung function testing to prevent leakage via the nasal compartments. However, some subjects exhibit a velum-opening reflex which may affect results. We performed forced oscillation measurements at frequencies (8-256 Hz) that include the first antiresonance, comparing the noseclip with a cotton wool nose plug to eliminate upper airway contribution. Three sets of measurements were made in 18 adults: with and without noseclip, and with cotton wool. Velum opening during noseclip measurements was monitored using a nasal pressure transducer. A significantly greater proportion of subjects produced a characteristic distortion to the first antiresonance with the noseclip than with either no noseclip or with cotton wool. Distortion of the spectrum coincided with the transmission of oscillations into the nasal cavity. Thus, the noseclip cannot be used in high-frequency forced oscillation measurements because of the velum reflex. The cotton wool plug offers a simple alternative. This effect has unknown impact in other lung function tests.
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Affiliation(s)
- Cindy Thamrin
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
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781
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Wang JY, Liou YH, Wu YJ, Hsiao YH, Wu LSH. An association study of 13 SNPs from seven candidate genes with pediatric asthma and a preliminary study for genetic testing by multiple variants in Taiwanese population. J Clin Immunol 2008; 29:205-9. [PMID: 18931892 DOI: 10.1007/s10875-008-9256-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 09/24/2008] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Asthma is one of the most common chronic diseases in children. It is caused by complex interactions between various genetic factors and exposures to environmental allergens and irritants. Because of the heterogeneity of the disease and the genetic and cultural differences among different populations, a proper association study and genetic testing for asthma and susceptibility genes is difficult to perform. MATERIALS AND METHODS We assessed 13 single-nucleotide polymorphisms (SNPs) in seven well-known asthma susceptibility genes and looked for association with pediatric asthma using 449 asthmatic subjects and 512 non-asthma subjects in Taiwanese population. RESULTS CD14-159 C/T and MS4A2 Glu237Gly were identified to have difference in genotype/allele frequencies between the control group and asthma patients. Moreover, the genotype synergistic analysis showed that the co-contribution of two functional SNPs was riskier or more protective from asthma attack. Our study provided a genotype synergistic method for studying gene-gene interaction on polymorphism basis and genetic testing using multiple polymorphisms.
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Affiliation(s)
- Jiu-Yao Wang
- Department of Pediatrics and Institute of Molecular Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
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782
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Fuentes-Leonarte V, Tenías JM, Ballester F. Environmental factors affecting children's respiratory health in the first years of life: a review of the scientific literature. Eur J Pediatr 2008; 167:1103-9. [PMID: 18636274 DOI: 10.1007/s00431-008-0761-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 04/28/2008] [Accepted: 05/06/2008] [Indexed: 11/28/2022]
Abstract
The aim of this paper is to quantitatively summarize the original articles on the relationship between environmental hazards and respiratory health in young children. A search was carried out in the main biomedical bibliographical sources in December 2006 and then the results were updated in June 2007. The study period covered 11 years (1996-2006). The information was assessed by reviewing the abstracts. Six hundred and forty documents were recovered. Documents from the United States accounted for 23.5% of articles. The production tended to increase over the study period. The factor most widely studied was air pollution, with outdoor air pollution being studied more (just over 50% of articles) than indoor air pollution (40%). Asthma was the most often studied condition (75% of articles). In a third of the cases, the information was obtained from hospital or health center records, and in 20% from questionnaires. The main diagnostic criterion was clinical. Infection of the inferior respiratory tracts predominated in children less than 3 years of age. An awareness of the role played by pollution and environmental hazards is fundamental in the management and prevention of respiratory problems in childhood, and this is reflected in the literature reviewed. However, very few synthesis studies have been carried out on this matter.
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Affiliation(s)
- Virginia Fuentes-Leonarte
- Research Foundation, Hospital La Fe, Valencia Maternal Hospital, 11th floor, INMA project, Avda. Campanar 21, 46009, Valencia, Spain.
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783
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Loeb JS, Blower WC, Feldstein JF, Koch BA, Munlin AL, Hardie WD. Acceptability and repeatability of spirometry in children using updated ATS/ERS criteria. Pediatr Pulmonol 2008; 43:1020-4. [PMID: 18785259 DOI: 10.1002/ppul.20908] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spirometry in pediatrics can be limited by the child's development which is usually related to age. In 2005 the American Thoracic Society (ATS) and European Respiratory Society (ERS) published updated quality control criteria for spirometry. In 2007 the ATS/ERS published specific criteria for spirometry in preschool children 6 years of age and younger. Our primary objective was to determine the influence of age on the ability of children to meet updated spirometry criteria for acceptable and repeatable tests. Our second objective was to determine which criteria are associated with unacceptable tests. Data was prospectively collected over 12 months for children 4-17 years of age performing spirometry for the first time. Unsuccessful tests were analyzed to determine specific criteria not achieved. Three hundred ninety-three studies were collected and 292 (74%) met recently revised ATS/ERS criteria for acceptable and repeatable tests. Acceptable and repeatable test success was not correlated to the gender or race of the children. The percentage of acceptable and repeatable spirometry increased with age rising above 50% by age 6 and reached a plateau with approximately 85% success at age 10. The most common unmet criteria for an unacceptable study among preschool children was glottic closure and non-maximal efforts, while in school-age children was failure to plateau. These data demonstrate most children are able to perform acceptable/repeatable spirometry with their first effort based on revised ATS/ERS criteria.
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Affiliation(s)
- Jeffrey S Loeb
- Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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784
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Vu LTT, Demoulin B, Nguyen YT, Nguyen MTH, Marchal F. Respiratory impedance and response to salbutamol in healthy Vietnamese children. Pediatr Pulmonol 2008; 43:1013-9. [PMID: 18785258 DOI: 10.1002/ppul.20904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A high incidence of childhood asthma has been reported in Ha Noi, Viet Nam, indicating a need to document lung function in these children. The degree of airway obstruction and reversibility may be evaluated from the forced oscillation assessment of respiratory resistance to reactance (Rrs, Xrs). Appropriate controls are necessary for a proper interpretation of patients. The aim of the study was to provide reference values on Rrs and Xrs and response to salbutamol in healthy Vietnamese children. One hundred seventy-five children aged 6-11 year recruited from one public school in Ha Noi were studied. Measurements were obtained at baseline and after 200 microg inhaled salbutamol. Significant correlations were disclosed between Rrs or Xrs and standing height (P < 0.0001). Salbutamol significantly decreased Rrs (from 7.1 +/- 1.9 hPa.sec/L to 6.2 +/- 1.8 hPa sec/L, P < 0.0001) and increased Xrs (from -1.22 +/- 0.64 to -0.91 +/- 0.61 hPa.sec/L, P < 0.0001). Rrs response to salbutamol lower limit of 95% confidence interval was -38% from baseline Rrs and, Xrs upper limit was +16% from baseline impedance. It is concluded that reference values for respiratory impedance (Zrs) and thresholds for clinically relevant response to bronchodilator are provided in primary school Vietnamese children. A smaller slope for the observed Rrs-body height relationship is suggested with reference to relevant studies in healthy Caucasians.
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Affiliation(s)
- Lan T T Vu
- Khoa ho hap nhi Xanh pon, Department of Pediatric Pulmonology Saint Paul Hospital, Ha Noi, Viet Nam
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785
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Vilozni D, Hakim F, Adler A, Livnat G, Bar-Yishay E, Bentur L. Reduced vital capacity after methacholine challenge in early childhood--is it due to trapped air or loss of motivation. Respir Med 2008; 103:109-16. [PMID: 18804359 DOI: 10.1016/j.rmed.2008.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 06/12/2008] [Accepted: 07/16/2008] [Indexed: 11/28/2022]
Abstract
UNLABELLED In a previous study we assessed the feasibility of measuring bronchial-reactivity (BHR) in young asthmatic children by the determination of PC(20)-FEV(1) along with clinical end-of-test criteria during a methacholine challenge test (MCT). The end-point was associated with a significant reduction in both flow and vital capacity values. The findings could be due to the children's loss of motivation, which may preclude use of this test. Alternatively, if it reflects air trapping during airway obstruction, it might reinforce its applicability in preschool age children. OBJECTIVES To elucidate the mechanism of low vital capacity at PC(20)-FEV(1) in preschool age children. SUBJECTS Twenty-eight children (3.3-6.9 years) with recurrent respiratory symptoms. METHODS An MCT was carried out using tripling doses (0.06-13.9 mg/ml) delivered by a dosimeter. Spirometry was measured at baseline and after each inhalation in duplicate sets. Whole body plethysmography was measured at baseline and at end-of-test (defined by clinical criteria) according to the recommendations for older populations. RESULTS Plethysmography was reliably performed by 20 children before and after MCT. At baseline, lung function was within the healthy range. At end-of-test (PC(20)-FEV(1)=4.02+/-3.47 mg/ml), the spirometry parameters and specific conductance values were markedly reduced in correlation with a significant increase in residual volume and resistance. CONCLUSIONS The study shows that diminished vital capacity is due to the increase in FRC at end-of-test. Our findings support the use of PC(20)-FEV(1) during BHR in young children and suggest that lung volume measurement by a plethysmograph may be feasible in early childhood. Larger studies should be performed to establish the clinical applicability of PC20-FEV1 determination in the preschool age.
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Affiliation(s)
- Daphna Vilozni
- Pediatric Pulmonary Unit, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel.
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786
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Abstract
Measurement of lung function is routine in older children and adults with cystic fibrosis (CF) but not in infants and preschool children. Pulmonary infection, neutrophil-dominated inflammation and clinical exacerbations in young children similar to those seen in older subjects have been identified and highlight the urgent need to evaluate lung function in early life. Mounting evidence suggests lung function techniques sensitive to changes in peripheral lung function may be required to detect the early functional abnormalities in infants and preschool children with CF. In addition, the majority of studies in young children with CF have not reported longitudinal data and therefore the prognostic potential of existing lung function methods to track disease progression is poorly understood. This review aims to describe recent research findings in infants and preschool children and to outline currently available lung function techniques, issues around their standardization and their relative advantages and disadvantages in young children with CF.
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787
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Nève V, Matran R, Edmé JL. Quality control for spirometry in preschool children. Am J Respir Crit Care Med 2008; 178:107; author reply 107-8. [PMID: 18565965 DOI: 10.1164/ajrccm.178.1.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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788
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Fuchs SI, Sturz J, Junge S, Ballmann M, Gappa M. A novel sidestream ultrasonic flow sensor for multiple breath washout in children. Pediatr Pulmonol 2008; 43:731-8. [PMID: 18618619 DOI: 10.1002/ppul.20825] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Inert gas multiple breath washout (MBW) for measuring Lung Clearance Index using mass spectrometry and 4% sulfur hexafluoride (SF(6)) as the tracer gas has been shown to be sensitive for detecting early Cystic Fibrosis (CF) lung disease. However, mass spectrometry requires bulky equipment and is expensive to buy and maintain. A novel sidestream ultrasonic device may overcome this problem. The aims of this study were to assess the feasibility and clinical validity of measuring lung volume (functional residual capacity, FRC) and the LCI using the sidestream ultrasonic flow sensor in children and adolescents with CF in relation to spirometry and plain chest radiographs. PATIENTS AND METHODS MBW using the sidestream ultrasonic device and conventional spirometry were performed in 26 patients with CF and 22 healthy controls. RESULTS In the controls (4.7-17.7 years) LCI was similar to that reported using mass spectrometry (mean (SD) 6.7 (0.5)). LCI was elevated in 77% of the CF children (6.8-18.9 years), whereas spirometry was abnormal in only 38.5%, 61.5%, and 26.9% for FEV(1), MEF(25), and FEV(1)/FVC, respectively. This was more marked in children <10 years. LCI correlated with the Crispin-Norman score, whereas FEV(1) did not. CONCLUSIONS Sidestream ultrasonic MBW is a valid and simple alternative to mass spectrometry for assessing ventilation homogeneity in children.
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Affiliation(s)
- Susanne I Fuchs
- Department of Paediatric Pulmonology and Neonatology, Medizinische Hochschule Hannover, Hannover, Germany.
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789
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Beydon N, M'Buila C, Peiffer C, Bernard A, Zaccaria I, Denjean A. Can bronchodilator response predict bronchial response to methacholine in preschool coughers? Pediatr Pulmonol 2008; 43:815-21. [PMID: 18615665 DOI: 10.1002/ppul.20877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of the present study was to determine the relationship between bronchodilator response, assessed by interrupter resistance (Rint), and bronchial reactivity in preschool children with chronic cough. Thirty-eight children coughers (median age 5.0 years, range 2.8-6.4) were tested. Bronchodilator response was recorded within 4 months before methacholine challenge. Response to the latter was assessed using transcutaneous partial pressure of oxygen and Rint. Children were considered responders if a 20% fall in transcutaneous partial pressure of oxygen occurred during the bronchial challenge. Bronchodilator response was not different between responders (n = 24) and nonresponders (n = 14) [median (range) -0.11 (-0.44-0.09) vs. -0.08 (-0.21-0.10) kPa L(-1) sec; respectively]. However, none of the nonresponders had a bronchodilator response larger than -0.21 kPa L(-1) sec, this cutoff had a 100% positive and a 44% negative predictive value to predict a positive methacholine challenge. The relationship between bronchodilator response and bronchial methacholine responsiveness reached the limit of significance (P = 0.048). Furthermore, the magnitude of the bronchodilator response was correlated to the level of methacholine-induced level of bronchoconstriction (P = 0.01), and to the postchallenge bronchodilation (P = 0.04), all values expressed as % predicted. Moreover, the postbronchodilator Rint value obtained with preceding methacholine challenge was lower than the postbronchodilator value without preceding methacholine challenge in 71.4% (10/14) of the nonresponders and in only 33.3% (8/24) of the responders. Conclusions in preschool coughers bronchodilator response, assessed by the interrupter technique, was correlated to the bronchial responsiveness to methacholine. Non responders had a bronchodilator response not larger than -0.21 kPa L(-1) sec.
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Affiliation(s)
- Nicole Beydon
- AP-HP Robert Debré Hospital, Physiology Department, Paris, France.
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790
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Kjaer HF, Eller E, Bindslev-Jensen C, Høst A. Spirometry in an unselected group of 6-year-old children: the DARC birth cohort study. Pediatr Pulmonol 2008; 43:806-14. [PMID: 18618677 DOI: 10.1002/ppul.20871] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study presents reference equations for spirometric parameters in 6-year-old children and evaluates the ability of spirometry to discriminate healthy children from children with asthma. Baseline spirometry and respiratory symptoms were assessed in 404 children participating in a longitudinal birth cohort study. Children with known asthma, possible asthma and a control group also performed bronchodilator measurements. At least two acceptable flow-volume curves at baseline were obtained by 368/404 children (91%). The two best values for FEV1 and FVC were within 5% of each other in 88% and 83% of children, respectively. Linear regression analyses for 242 children included in the reference population demonstrated height to be the main predictor of all spirometric indices except FEV1/FVC. FEV1, FEV75, and FVC correlated reasonably to anthropometric data in contrast to flow parameters. Gender differences were found for FEV1, FVC, and FEV75, but not for flow parameters. Asthma was diagnosed in 25/404 children. Baseline lung function in healthy children and children with asthma overlapped, although asthmatic children could be discriminated to some extent. Bronchodilator tests showed a difference in Delta FEV1(mean) between healthy children and children with asthma (3.1% vs. 6.1%, P < 0.05). At a cut-off point of Delta FEV1 = 7.8%, bronchodilator tests had a sensitivity of 46% and a specificity of 92% for current asthma. Spirometry including bronchodilator measurements was demonstrated to be feasible in 6-year-old children and reference values were determined. Spirometry aids the diagnosis of asthma in young children, but knowledge on sensitivity and specificity of these measurements is a prerequisite.
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791
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Thamrin C, Frey U. Effect of bacterial filter on measurement of interrupter resistance in preschool and school-aged children. Pediatr Pulmonol 2008; 43:781-7. [PMID: 18618618 DOI: 10.1002/ppul.20865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The interrupter technique is increasingly used in preschool children to assess airway resistance (Rint). Use of a bacterial filter is essential for prevention of cross-infection in a clinical setting. It is not known how large an effect this extra resistance and compliance exert upon interrupter measurements, especially on obstructive airways and in smaller children. We aim to determine the contribution of the filter to Rint, in a sample of children attending lung function testing at an asthma clinic. METHODS Interrupter measurements were performed according to ATS/ERS guidelines during quiet normal breathing at an expiratory flow trigger of 200 ml s(-1), with the child seated upright with cheeks supported and wearing a nose clip. A minimum of 10 interrupter measurements was made with and without a bacterial filter. Spirometric and plethysmographic tests were also performed. RESULTS A small but significant difference (0.12 (95% CI 0.06-0.17) kPa s L(-1), P = 0.0002) with 2x SD of 0.34 kPa s L(-1) was observed between Rint with and without filter in 39 children, with a large spread. This difference was not dependent on Rint magnitude, age or height, nor on lung function parameters (effective resistance, forced expiratory volume in 1 sec, and maximal expiratory flow at 50% of expired vital capacity). CONCLUSIONS A bacterial filter causes a small difference but is not clinically significant, with a wide spread comparable to the variability of the technique and recommended cut-offs for assessing repeatability and bronchodilation. Age, height or severity of obstruction need not be corrected for in general.
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Affiliation(s)
- C Thamrin
- Paediatric Respiratory Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
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792
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Papadopoulos NG, Borres M, Gern J, Nieto A. New visions in respiratory allergy (asthma and allergic rhinitis): an iPAC summary and future trends. Pediatr Allergy Immunol 2008; 19 Suppl 19:51-9. [PMID: 18665963 DOI: 10.1111/j.1399-3038.2008.00767.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In many aspects, respiratory allergies, i.e., allergic asthma and rhinitis, represent the hallmarks of allergy. Epidemiologic data highlight their large prevalence of most parts of the world, socioeconomic analysis reveal their large impact on global health and the large number of scientific publications in this field regularly brings to light many new aspects of these diseases. However, the current understanding of respiratory allergies, in particular in children remains scarce. How can we efficiently prevent respiratory allergies in allergy-prone infants? How can we prevent the progression of the disease? What therapeutic strategies could efficiently address efficient immunomodulation? the international Pediatric Allergy and Asthma Consortium, addressed these issues by a thorough review of the literature providing a state-of-the-art current knowledge in respiratory allergy, and identified a series of needs to be addressed in future studies.
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793
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Davis S, Aurora P, Eigen H, Beydon N, Lombardi E. Quality Control for Spirometry in Preschool Children. Am J Respir Crit Care Med 2008. [DOI: 10.1164/ajrccm.178.1.107a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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794
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Ren CL. Assessment and monitoring of cystic fibrosis lung disease in infants and young children. Expert Rev Respir Med 2008; 2:381-90. [PMID: 20477200 DOI: 10.1586/17476348.2.3.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic airway infection and inflammation are the hallmarks of cystic fibrosis (CF) lung disease. As these events occur early in life, it is critical to develop techniques for the assessment and monitoring of early-CF lung disease in infants and young children. In the last several years, there have been major advances in the development of imaging technology to assess structural damage in CF lung disease, noninvasive markers of CF airway inflammation and measurement of lung function in infants and young children with CF. In this article, we will review these advances and techniques, and discuss future directions for research and clinical applications.
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Affiliation(s)
- Clement L Ren
- University of Rochester, Department of Pediatrics, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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795
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Malmberg LP, Mäkelä MJ, Mattila PS, Hammarén-Malmi S, Pelkonen AS. Exercise-induced changes in respiratory impedance in young wheezy children and nonatopic controls. Pediatr Pulmonol 2008; 43:538-44. [PMID: 18433041 DOI: 10.1002/ppul.20805] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Exercise-induced bronchoconstriction (EIB) is a specific sign of active asthma, but its assessment in young children may be difficult with lung function techniques requiring active cooperation. The aim of the study was to assess the normal pattern of exercise-induced responses of respiratory impedance by using impulse oscillometry (IOS), and to investigate how these responses discriminate wheezy children from control subjects. IOS measurements were performed in a consecutive sample of wheezy children aged 3-7 years (n = 130) and in an aged matched control group of nonatopic children without respiratory symptoms (n = 79) before and after a free running test. After exercise, wheezy children showed significantly larger responses in respiratory resistance (Rrs5), reactance (Xrs5), and the resonance frequency (Fr) than the control subjects. In the control group, the upper 95% confidence limit of the maximal change was 32.5% for Rrs5, 85.7% for Xrs5, and 53.1% for Fr. By using analysis of receiver operating characteristics, the change in Rrs5 distinguished the wheezy children from the control subjects more effectively than change in Xrs5 or Fr. In wheezy children, the response was significantly effected by the outdoor temperature and exercise intensity in terms of maximum heart rate. In conclusion, an increase of 35% in Rrs5 after a free running test can be regarded as an abnormal response. Wheezy children show an enhanced airway response, which is clearly distinguishable from the control subjects. IOS is a feasible method to detect EIB in young children.
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Affiliation(s)
- L Pekka Malmberg
- Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
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796
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Kozlowska WJ, Bush A, Wade A, Aurora P, Carr SB, Castle RA, Hoo AF, Lum S, Price J, Ranganathan S, Saunders C, Stanojevic S, Stroobant J, Wallis C, Stocks J. Lung function from infancy to the preschool years after clinical diagnosis of cystic fibrosis. Am J Respir Crit Care Med 2008; 178:42-9. [PMID: 18403721 DOI: 10.1164/rccm.200710-1599oc] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE After recent standardization of forced expiratory maneuvers for both infants and preschool children, longitudinal measurements are now possible from birth. OBJECTIVES The aim of this study was to investigate the evolution of lung function during the first 6 years of life after a clinical diagnosis of cystic fibrosis (CF) in infancy in children with CF and in healthy control subjects. METHODS The raised volume technique was used during infancy and incentive spirometry during the preschool years. MEASUREMENTS AND MAIN RESULTS Forty-eight children with CF and 33 healthy control subjects had up to seven (median, 3) measurements. Over these early years, the diagnosis of CF itself accounted for a significant mean reduction of 7.5% (95% confidence interval, 0.9 - 13.6%) in FEV(0.75) and 15.1% (95% confidence interval, 3.6 - 25.3%) in FEF(25-75). Wheeze on auscultation, recent cough, and Pseudomonas aeruginosa (PsA) infection (even if apparently effectively treated) were all independently associated with further reductions in lung function. Premorbid lung function did not predict infection with PsA. CONCLUSIONS This is the first study to describe physiologic measurements from infancy through the preschool years in subjects with CF and healthy control subjects, the understanding of which is critical for future intervention trials. Airflow obstruction in uncomplicated CF persists through the preschool years despite treatment, with PsA acquisition being associated with further deterioration in lung function, even when apparently eradicated. This suggests that new therapies are needed to treat the airflow obstruction of uncomplicated CF, and rigorous strategies to prevent PsA acquisition.
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Affiliation(s)
- Wanda J Kozlowska
- Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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797
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Affiliation(s)
- Andrew Bush
- F.R.C.P., Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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798
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Al-Saadi MM. Knowledge and practice of spirometry among pediatricians in Riyadh, Kingdom of Saudi Arabia. Ann Thorac Med 2008; 3:52-6. [PMID: 19561906 PMCID: PMC2700458 DOI: 10.4103/1817-1737.39637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 03/01/2008] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Spirometry is the most basic, widely used and effort-dependent pulmonary function test. It assesses the lung volumes and flows, and is ideally suited to describe the effects of restriction or obstruction on lung function. Therefore, keeping in view the clinical applications of spirometry, this study attempts to explore the knowledge and practice about spirometry among pediatricians. MATERIALS AND METHODS A questionnaire-based study was conducted across multiple centers in various hospitals in Riyadh, Saudi Arabia. The structured questionnaire, based upon knowledge and practice of spirometry, was distributed to 150 pediatricians in the various tertiary care hospitals in the metropolitan area of Riyadh. RESULTS Ninety-four percent of 113 pediatricians agreed that spirometry is a valuable tool in pediatric clinical practice. However, knowledge relating to spirometry was lacking among pediatricians, and about 86% of the study population did not demonstrate up-to-date knowledge of spirometry in pediatrics. Only 11% of pediatricians were very confident in interpreting spirometry results. No statistically significant association was observed between the distribution of responses relating to knowledge and practice of spirometry and the study variables including academic position, duration of practicing experience and number of patients attended daily. CONCLUSION The results indicated that pediatricians in Riyadh were lacking adequate knowledge about the clinical applications of spirometry in their daily clinical practice. Hence, it was suggested that pediatricians should attend periodical training, workshops and continuous medical education programmes to enhance their knowledge. This should especially be performed during their pediatric residency training programmes, as spirometry is one of the essential components in clinical practice.
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Affiliation(s)
- Muslim Mohammed Al-Saadi
- Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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799
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Hur HY, Kwak JH, Kim HY, Jung DW, Shin YH, Han MY. A comparison between impulse oscillometry system and spirometry for spirometry for detecting airway obstruction in children. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.8.842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hae Young Hur
- Department of Pediatrics, College of Medicine, Pochon CHA University, Sungnam, Korea
| | - Ji Hee Kwak
- Department of Pediatrics, College of Medicine, Pochon CHA University, Sungnam, Korea
| | - Hyoung Yun Kim
- Department of Pediatrics, College of Medicine, Pochon CHA University, Sungnam, Korea
| | - Da Wun Jung
- Department of Pediatrics, College of Medicine, Pochon CHA University, Sungnam, Korea
| | - Yoon Ho Shin
- Department of Pediatrics, College of Medicine, Pochon CHA University, Sungnam, Korea
| | - Man Yong Han
- Department of Pediatrics, College of Medicine, Pochon CHA University, Sungnam, Korea
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800
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Stanojevic S, Wade A, Lum S, Stocks J. Reference equations for pulmonary function tests in preschool children: a review. Pediatr Pulmonol 2007; 42:962-72. [PMID: 17726704 DOI: 10.1002/ppul.20691] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent developments in pulmonary function tests (PFTs) in preschool children (2-5 years of age) have meant that objective assessments of respiratory function are now possible for this age group. However, the application and interpretation of these tests may be limited by the relative paucity of appropriate reference equations. This review summarizes available preschool reference equations, identifies the current gaps and limitations in the methodologies and statistics used and proposes future directions for improving reference data. A PubMed search which included the MeSH terms (preschool [2-5years]), (respiratory function test), and (reference value) yielded 214 publications which were screened to identify 34 publications presenting 36 reference equations for seven techniques. There were considerable differences with respect to population characteristics, recruitment strategies, equipment and methodologies and reported parameters both within and between each measurement technique. Despite an increasing number of reference equations for PFT for preschool children, the extent to which these can be generalized to other populations may be limited in some cases by inclusion of relatively few children less than 5 years of age, a lack of details regarding the sample populations and measurement techniques and/or inappropriate statistical analysis. A fresh approach based on large sample sizes, clearly documented population characteristics, equipment and protocols, and more rigorous modern statistical methods both for developing reference equations and interpreting results could enhance clinical application of these tests. This in turn would maximize the tremendous opportunities to detect early lung disease offered by the recent surge in developing suitable tests for preschool children.
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Affiliation(s)
- Sanja Stanojevic
- Portex Respiratory Physiology Unit, UCL, Institute of Child Health, London, United Kingdom.
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