801
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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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802
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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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803
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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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804
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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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805
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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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806
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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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807
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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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808
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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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809
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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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810
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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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811
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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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812
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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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813
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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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814
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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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815
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Hantos Z, Rimensberger PC. Measurement of respiratory system admittance: a straightforward method, but a difficult interpretation. Pediatr Res 2007; 62:246-7. [PMID: 17622946 DOI: 10.1203/pdr.0b013e318126bfe0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zoltán Hantos
- Department of Medical Informatics and Engineering, University of Szeged, Szeged, Hungary.
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816
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Beydon N, M'buila C, Bados A, Peiffer C, Bernard A, Zaccaria I, Denjean A. Interrupter resistance short-term repeatability and bronchodilator response in preschool children. Respir Med 2007; 101:2482-7. [PMID: 17720469 DOI: 10.1016/j.rmed.2007.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 07/04/2007] [Accepted: 07/11/2007] [Indexed: 11/22/2022]
Abstract
UNLABELLED Interrupter resistance (Rint) technique can be easily and successfully performed in preschool children. The establishment of Rint short-term repeatability is essential to interpret any Rint change after a pharmacological intervention. AIMS OF THE STUDY In preschool children with asthma or chronic cough: (1) to assess two indices of short-term repeatability: (a) intra-measurement and (b) within-occasion between-test repeatability; (2) to study the relationship between short-term repeatability and bronchodilator response (BDR). RESULTS Rint intra-measurement repeatability assessed by the coefficient of variation was similar at baseline and after bronchodilator in asthmatics and in coughers (median 10% and 12%, respectively). There was no significant difference between asthmatics and coughers for both coefficient of repeatability (CR) (0.25 kPa L(-1)s and 32% of predicted vs 0.16 kPa L(-1) s and 21% of predicted, respectively) and BDR (median -14.7% vs -21.1% of predicted, respectively). However, in 20% of the study children, baseline variability of Rint modified the significance of the BDR. CONCLUSION In the present study, Rint short-term repeatability was similar to that of previous studies. Similar Rint repeatability in coughers and in asthmatic children favored the use of asthmatic CR for both populations, and a -35% cut-off as a positive BDR. In 20% of study children, baseline Rint variability could influence the significance of the BDR. In order to improve assessment of BDR using Rint, further studies are needed (1) to compare the variability of Rint to other resistance measurement techniques and (2) to define the best method for Rint calculation and for expression of BDR.
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Affiliation(s)
- Nicole Beydon
- Physiology Department, Robert Debré Hospital, 48 Bd Sérurier, 75019 Paris, France.
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817
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Davis SD, Brody AS, Emond MJ, Brumback LC, Rosenfeld M. Endpoints for clinical trials in young children with cystic fibrosis. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2007; 4:418-30. [PMID: 17652509 PMCID: PMC2647606 DOI: 10.1513/pats.200703-041br] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 05/03/2007] [Indexed: 11/20/2022]
Abstract
The availability of sensitive, reproducible, and feasible outcome measures for quantifying lung disease in children with cystic fibrosis (CF) younger than 6 years is critical to the conduct of clinical trials in this important population. Historically, identifying and quantifying the presence of lung disease in very young children with CF was hampered by a lack of reproducible measures of lung function or lung pathology. Over the past 10 years, significant progress has led to physiologic, anatomic, and bronchoscopic measures that may serve as endpoints for future intervention trials. These endpoints include infant and preschool lung function testing, computed tomography of the chest, and bronchoalveolar lavage markers of inflammation and infection. Much progress has occurred in standardizing lung function testing, which is essential for multicenter collaboration. Pulmonary exacerbation has the potential to serve as a clinical endpoint; however, there is currently no standardized definition in children with CF younger than 6 years. Further development of these outcomes measures will enable clinical trials in the youngest CF population with the objective of improving long-term prognosis.
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Affiliation(s)
- Stephanie D Davis
- Division of Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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818
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Vilozni D, Bentur L, Efrati O, Barak A, Szeinberg A, Shoseyov D, Yahav Y, Augarten A. Exercise challenge test in 3- to 6-year-old asthmatic children. Chest 2007; 132:497-503. [PMID: 17573494 DOI: 10.1378/chest.07-0052] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
RATIONALE The exercise challenge test (ECT) is a common tool to assess exercise-induced asthma (EIA) in school-aged children. EIA has not been explored in the early childhood setting. OBJECTIVE To assess the existence of EIA in children in this age group. MEASUREMENTS AND MAIN RESULTS A 6-min, controlled, free-run test was performed in 55 children (age range, 3 to 6 years old) who were classified into the following groups: 30 children in whom asthma had been previously diagnosed (group A); and 25 children with prolonged coughing (group B). Spirometry measurements were obtained before the run, and at 1, 2, 3, 5, 10, and 20 min after the run. A positive finding of EIA was defined as a 13% decrease from baseline FEV(1) or baseline forced expiratory volume in the first 0.5 s (FEV(0.5)). The actual duration of each run was age-related (mean [+/- SD] duration, 4.8 +/- 0.8 min). The nadir in indexes occurred after a mean time of 2.98 +/- 1.31 min. A positive EIA finding determined by FEV(1) was present in 15 children, and by FEV(0.5) in 34 children. Twenty-six children were from group A, but only 8 children were from group B. Wheezing and/or prolonged expiration were associated with a positive test result in 31 of 34 children. Coughing was frequent in children with both negative and positive ECT findings. CONCLUSION The present study documents for the first time the presence of EIA in response to a free-run test in early childhood. Our findings suggest that a free-run test for the presence of EIA is suitable, but that the running duration is limited by age. The duration of airflow limitation after exercise is significantly earlier and shorter in young children with asthma compared with older children. FEV(0.5) is a better index than the traditional FEV(1) for describing positive ECT results in young children. The association of wheezing and/or prolonged expiration may help in defining EIA in early childhood in the absence of a spirometer.
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Affiliation(s)
- Daphna Vilozni
- Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Ramat-Gan 52621, Israel.
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