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Shavit S, Cohen S, Goldman A, Ben-Dov L, Avital A, Springer C, Hevroni A. Bronchodilator responsiveness in wheezy infants predicts continued early childhood respiratory morbidity. J Asthma 2016; 53:707-13. [PMID: 27042758 DOI: 10.3109/02770903.2016.1154071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Spirometry including bronchodilator responsiveness is considered routine in the workup of asthma in older children. However, in wheezy infants the existence of bronchodilator responsiveness and its prognostic significance remain unclear. METHODS Infants (< 2 years) with chronic or recurrent wheezing or coughing were evaluated by infant pulmonary function testing (PFT). Maximal expiratory flow at the point of functional residual capacity (V̇maxFRC) was measured before and 20 minutes after salbutamol administration. Only infants with an obstructive profile (V̇maxFRC < 80% predicted) were included. The infants were divided into two groups with regard to whether or not a response to salbutamol was observed on PFT. A response was defined as a mean V̇maxFRC after salbutamol administration exceeding the upper confidence interval limit of individual pre-bronchodilator V̇maxFRC measurements. Follow-up data was gathered after a mean of 2 years. MEASUREMENTS AND MAIN RESULTS Sixty infants were included in the study of which 32 (53%) demonstrated responsiveness to bronchodilators. The infants in the responsive group had a significantly higher frequency of physician visits for wheezing than the non-responders (3.0 mean visits/yr vs. 1.5 respectively, P = 0.03), and had a higher likelihood of having received asthma medication in the last year of the follow-up period (84% vs. 50% respectively, RR: 1.68[1.10-2.56]). At the end of the follow-up period, more parents in the responsive group reported continued respiratory disease (71% vs. 22%, RR:3.21[1.30-7.95]). CONCLUSIONS Bronchodilator responsiveness can be demonstrated by infant PFT in infants with recurrent wheezing and can predict increased respiratory morbidity until 3 years of age.
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Affiliation(s)
- Solomon Shavit
- a Department of Pediatrics - Mount Scopus, Hadassah University Hospital , Jerusalem , Israel
| | - Shlomo Cohen
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Aliza Goldman
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Lior Ben-Dov
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Avraham Avital
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Chaim Springer
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Avigdor Hevroni
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
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Subbarao P, Lu Z, Kowalik K, Brown M, Balkovec S, Gustafsson P, Lou W, Ratjen F. Changes in multiple breath washout measures after raised volume rapid thoracoabdominal compression maneuvers in infants. Pediatr Pulmonol 2016; 51:183-8. [PMID: 26383784 DOI: 10.1002/ppul.23220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/13/2015] [Accepted: 05/08/2015] [Indexed: 11/08/2022]
Abstract
Multiple breath inert gas washout (MBW) measurements in infants are performed supine and often obtained under sedation and thus are combined with other lung function tests such as raised volume rapid thoracoabdominal compression (RVRTC). In this study, we sought to determine the effects of RVRTC maneuvers on MBW measures. Compared with tests performed prior to RVRTC, MBW measured after RVRTC was associated with a small reduction in functional residual capacity and a more pronounced decrease in cumulative expired volume in both healthy children and children with obstructive lung disease (cystic fibrosis or recurrent wheeze) indicating a more efficient washout after the raised volume maneuvers. Lung Clearance Index (LCI) decreased significantly in infants with respiratory disease (change in LCI of -0.24 units post RVRTC; standard error (SE) ± 0.07 units; P = 0.0004), but not in healthy infants (change in LCI of -0.08 units; SE ± 0.11 units; P = 0.44). As the RVRTC maneuver affects MBW measurements in infants, the timing of testing procedures needs to be standardized in longitudinal studies.
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Affiliation(s)
- Padmaja Subbarao
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Zihang Lu
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Krzysztof Kowalik
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Meghan Brown
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Susan Balkovec
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Per Gustafsson
- Department of Pediatrics, Central Hospital, Skövde, Sweden
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Felix Ratjen
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
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Pittman JE. Assessment and Detection of Early Lung Disease in Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:212-219. [DOI: 10.1089/ped.2015.0568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jessica E. Pittman
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Missouri
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Davis SD, Ratjen F, Brumback LC, Johnson RC, Filbrun AG, Kerby GS, Panitch HB, Donaldson SH, Rosenfeld M. Infant lung function tests as endpoints in the ISIS multicenter clinical trial in cystic fibrosis. J Cyst Fibros 2015; 15:386-91. [PMID: 26547590 DOI: 10.1016/j.jcf.2015.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Infant Study of Inhaled Saline (ISIS) in CF was the first multicenter clinical trial to utilize infant pulmonary function tests (iPFTs) as an endpoint. METHODS Secondary analysis of ISIS data was conducted in order to assess feasibility of iPFT measures and their associations with respiratory symptoms. Standard deviations were calculated to aid in power calculations for future clinical trials. RESULTS Seventy-three participants enrolled, 70 returned for the final visit; 62 (89%) and 45 (64%) had acceptable paired functional residual capacity (FRC) and raised volume measurements, respectively. Mean baseline FEV0.5, FEF75 and FRC z-scores were 0.3 (SD: 1.2), -0.2 (SD: 2.0), and 1.8 (SD: 2.0). CONCLUSIONS iPFTs are not appropriate primary endpoints for multicenter clinical trials due to challenges of obtaining acceptable data and near-normal average raised volume measurements. Raised volume measures have potential to serve as secondary endpoints in future clinical CF trials.
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Affiliation(s)
- Stephanie D Davis
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lyndia C Brumback
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Robin C Johnson
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy G Filbrun
- Pediatric Pulmonary Division, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Gwendolyn S Kerby
- Department of Pediatrics, The Breathing Institute, University of Colorado and Children's Hospital, Aurora, CO, USA
| | - Howard B Panitch
- Division of Pulmonary Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott H Donaldson
- Division of Pulmonary and Critical Care, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret Rosenfeld
- Division of Pulmonary Medicine, Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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de Mir Messa I, Sardón Prado O, Larramona H, Salcedo Posadas A, Villa Asensi J. Body plethysmography (i): Standardisation and quality criteria. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Topalovic M, Derom E, Osadnik CR, Troosters T, Decramer M, Janssens W. Airways resistance and specific conductance for the diagnosis of obstructive airways diseases. Respir Res 2015; 16:88. [PMID: 26194099 PMCID: PMC4509748 DOI: 10.1186/s12931-015-0252-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Airway resistance (RAW) and specific airway conductance (sGAW) are measures that reflect the patency of airways. Little is known of the variability of these measures between different lung diseases. This study investigated the contribution of RAW and sGAW to a diagnosis of obstructive airways disease and their role in differentiating asthma from COPD. METHODS 976 subjects admitted for the first time to a pulmonary practice in Belgium were included. Clinical diagnoses were based on complete pulmonary function tests and supported by investigations of physicians' discretion. 651 subjects had a final diagnosis of obstructive diseases, 168 had another respiratory disease and 157 subjects had no respiratory disease (healthy controls). RESULTS RAW and sGAW were significantly different (p < 0.0001) between obstructive and other groups. Abnormal RAW and sGAW were found in 39 % and 18 % of the population, respectively, in which 81 % and 90 % had diagnosed airway obstruction. Multiple regression revealed sGAW to be a significant and independent predictor of an obstructive disorder. To differentiate asthma from COPD, RAW was found to be more relevant and statistically significant. In asthma patients with normal FEV1/FVC ratio, both RAW and sGAW were more specific than sensitive diagnostic tests in differentiating asthma from healthy subjects. CONCLUSIONS RAW and sGAW are significant factors that contribute to the diagnosis and differentiation of obstructive airways diseases.
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Affiliation(s)
- Marko Topalovic
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eric Derom
- Respiratory Division, University Hospital Ghent, University of Ghent, Ghent, Belgium
| | - Christian R Osadnik
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physiotherapy, Monash University, Victoria, Australia
- Institute for Breathing and Sleep, Victoria, Australia
- Monash Health, Monash Lung and Sleep, Victoria, Australia
| | - Thierry Troosters
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marc Decramer
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Wim Janssens
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Greenough A, Pahuja A. Updates on Functional Characterization of Bronchopulmonary Dysplasia - The Contribution of Lung Function Testing. Front Med (Lausanne) 2015; 2:35. [PMID: 26131449 PMCID: PMC4469111 DOI: 10.3389/fmed.2015.00035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/14/2015] [Indexed: 11/24/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that predominantly affects prematurely born infants. Initially, BPD was described in infants who had suffered severe respiratory failure and required high pressure, mechanical ventilation with high concentrations of supplementary oxygen. Now, it also occurs in very prematurely born infants who initially had minimal or even no signs of lung disease. These differences impact the nature of the lung function abnormalities suffered by “BPD” infants, which are also influenced by the criteria used to diagnose BPD and the oxygen saturation level used to determine the supplementary oxygen requirement. Key also to interpreting lung function data in this population is whether appropriate lung function tests have been used and in an adequately sized population to make meaningful conclusions. It should also be emphasized that BPD is a poor predictor of long-term respiratory morbidity. Bearing in mind those caveats, studies have consistently demonstrated that infants who develop BPD have low compliance and functional residual capacities and raised resistances in the neonatal period. There is, however, no agreement with regard to which early lung function measurement predicts the development of BPD, likely reflecting different techniques were used in different populations in often underpowered studies. During infancy, lung function generally improves, but importantly airflow limitation persists and small airway function appears to decline. Improvements in lung function following administration of diuretics or bronchodilators have not translated into long-term improvements in respiratory outcomes. By contrast, early differences in lung function related to different ventilation modes have led to investigation and demonstration that prophylactic, neonatal high-frequency oscillation appears to protect small airway function.
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Affiliation(s)
- Anne Greenough
- Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London , London , UK ; NIHR Biomedical Research Centre, Guy's and St. Thomas NHS Foundation Trust , London , UK
| | - Anoop Pahuja
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust , London , UK
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Tutor JD, Srinivasan S, Gosa MM, Spentzas T, Stokes DC. Pulmonary function in infants with swallowing dysfunction. PLoS One 2015; 10:e0123125. [PMID: 25978396 PMCID: PMC4433327 DOI: 10.1371/journal.pone.0123125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/24/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Swallowing dysfunction can lead to recurring aspiration and is frequently associated with chronic symptoms such as cough and wheezing in infants. Our objective was to describe the characteristics of infants with swallowing dysfunction, determine if pulmonary function abnormalities are detectable, and if they improve after therapy. METHODS We studied 38 infants with a history of coughing and wheezing who had pulmonary function tests performed within two weeks of their diagnosis of swallowing dysfunction. The raised lung volume rapid thoracoabdominal compression technique was used. After 6 months of therapy, 17 of the infants repeated the tests. RESULTS Initially, 25 had abnormal spirometry, 18 had abnormal plethysmography, and 15 demonstrated bronchodilator responsiveness. Six months later test were repeated for seventeen patients. Ten patients had continued abnormal spirometry, two patients remained normal, three patients' abnormal spirometry had normalized, and two patients' previously normal studies became abnormal. Eight of the 17 patients had continued abnormal plethysmography, six had continued normal plethysmography, and three patients' normal plethysmography became abnormal. After 6 months of treatment, eight patients demonstrated bronchodilator responsiveness, of which five continued to demonstrate bronchodilator responsiveness and three developed responsiveness. The remainder either continued to be non- bronchodilator responsive (two) or lost responsiveness (three.) The findings of the abnormal tests in most infants tested is complicated by frequent occurrence of other co-morbidities in this population, including gastroesophageal reflux in 23 and passive smoke exposure in 13 of the infants. CONCLUSIONS The interpretation of lung function changes is complicated by the frequent association of swallowing dysfunction with gastroesophageal reflux and passive smoke exposure in this population. Six months of medical therapy for swallowing dysfunction/gastroesophageal reflux did not significantly improve pulmonary function in these infants. Long-term studies will be necessary to determine which of these changes persists into adulthood.
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Affiliation(s)
- James D. Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, TN, United States of America
- * E-mail:
| | - Saumini Srinivasan
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Memorie M. Gosa
- Rehabilitation Services—Department of Speech-Language Pathology, Le Bonheur Children’s Hospital, Memphis, TN, United States of America
- Department of Communicative Disorders, The University of Alabama, Tuscaloosa, AL, United States of America
| | - Thomas Spentzas
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN, United States of America
| | - Dennis C. Stokes
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, TN, United States of America
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Pryhuber GS, Maitre NL, Ballard RA, Cifelli D, Davis SD, Ellenberg JH, Greenberg JM, Kemp J, Mariani TJ, Panitch H, Ren C, Shaw P, Taussig LM, Hamvas A. Prematurity and respiratory outcomes program (PROP): study protocol of a prospective multicenter study of respiratory outcomes of preterm infants in the United States. BMC Pediatr 2015; 15:37. [PMID: 25886363 PMCID: PMC4407843 DOI: 10.1186/s12887-015-0346-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/11/2015] [Indexed: 12/17/2022] Open
Abstract
Background With improved survival rates, short- and long-term respiratory complications of premature birth are increasing, adding significantly to financial and health burdens in the United States. In response, in May 2010, the National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute (NHLBI) funded a 5-year $18.5 million research initiative to ultimately improve strategies for managing the respiratory complications of preterm and low birth weight infants. Using a collaborative, multi-disciplinary structure, the resulting Prematurity and Respiratory Outcomes Program (PROP) seeks to understand factors that correlate with future risk for respiratory morbidity. Methods/Design The PROP is an observational prospective cohort study performed by a consortium of six clinical centers (incorporating tertiary neonatal intensive care units [NICU] at 13 sites) and a data-coordinating center working in collaboration with the NHLBI. Each clinical center contributes subjects to the study, enrolling infants with gestational ages 23 0/7 to 28 6/7 weeks with an anticipated target of 750 survivors at 36 weeks post-menstrual age. In addition, each center brings specific areas of scientific focus to the Program. The primary study hypothesis is that in survivors of extreme prematurity specific biologic, physiologic and clinical data predicts respiratory morbidity between discharge and 1 year corrected age. Analytic statistical methodology includes model-based and non-model-based analyses, descriptive analyses and generalized linear mixed models. Discussion PROP incorporates aspects of NICU care to develop objective biomarkers and outcome measures of respiratory morbidity in the <29 week gestation population beyond just the NICU hospitalization, thereby leading to novel understanding of the nature and natural history of neonatal lung disease and of potential mechanistic and therapeutic targets in at-risk subjects. Trial registration Clinical Trials.gov NCT01435187. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0346-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gloria S Pryhuber
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Nathalie L Maitre
- Monroe Carrell Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Roberta A Ballard
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
| | - Denise Cifelli
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Stephanie D Davis
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Jonas H Ellenberg
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - James M Greenberg
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - James Kemp
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Thomas J Mariani
- Department of Pediatrics and Pediatric Molecular and Personalized Medicine Program, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Howard Panitch
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Clement Ren
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Pamela Shaw
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Lynn M Taussig
- Department of Pediatrics, University of Colorado, Provost's Office, University of Denver, Denver, CO, USA.
| | - Aaron Hamvas
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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de Mir Messa I, Sardón Prado O, Larramona H, Salcedo Posadas A, Villa Asensi JR. [Body plethysmography (I): Standardisation and quality criteria]. An Pediatr (Barc) 2015; 83:136.e1-7. [PMID: 25797588 DOI: 10.1016/j.anpedi.2014.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 10/29/2014] [Indexed: 11/24/2022] Open
Abstract
Whole body plethysmography is used to measure lung volumes, capacities and resistances. It is a well standardised technique, and although it is widely used in paediatric chest diseases units, it requires specific equipment, specialist staff, and some cooperation by the patient. Plethysmography uses Boyle's law in order to measure the intrathoracic gas volume or functional residual capacity, and once this is determined, the residual volume and total lung capacity is extrapolated. The measurement of total lung capacity is necessary for the diagnosis of restrictive diseases. Airway resistance is a measurement of obstruction, with the total resistance being able to be measured, which includes chest wall, lung tissue and airway resistance, as well as the specific airway resistance, which is a more stable parameter that is determined by multiplying the measured values of airway resistance and functional residual capacity. The complexity of this technique, the reference equations, the differences in the equipment and their variability, and the conditions in which it is performed, has led to the need for its standardisation. Throughout this article, the practical aspects of plethysmography are analysed, specifying recommendations for performing it, its systematic calibration and the calculations that must be made, as well as the interpretation of the results obtained. The aim of this article is to provide a better understanding of the principles of whole body plethysmography with the aim of optimising the interpretation of the results, leading to improved management of the patient, as well as a consensus among the speciality.
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Affiliation(s)
- I de Mir Messa
- Sección de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d́Hebron, Barcelona, España.
| | - O Sardón Prado
- Sección de Neumología Pediátrica, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España; Departamento de Pediatría, Facultad de Medicina y Odontología, UPV/EHU, San Sebastián, España
| | - H Larramona
- Sección de Neumología Pediátrica, Consorci Hospitalari Parc Taulí, Sabadell, Barcelona, España
| | - A Salcedo Posadas
- Sección de Neumología, Hospital Maternoinfantil Gregorio Marañón, Madrid, España
| | - J R Villa Asensi
- Sección de Neumología, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Sheikh SI, Long FR, Flucke R, Ryan-Wenger NA, Hayes D, McCoy KS. Changes in Pulmonary Function and Controlled Ventilation-High Resolution CT of Chest After Antibiotic Therapy in Infants and Young Children with Cystic Fibrosis. Lung 2015; 193:421-8. [PMID: 25762451 DOI: 10.1007/s00408-015-9706-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants with cystic fibrosis (CF) develop early progressive lung disease which may be asymptomatic. Infant pulmonary function tests (IPFT) and controlled ventilation-high resolution computed tomography (CV-HRCT) of chest can detect early asymptomatic lung disease. It is not well established that these objective measures can detect changes in lung disease after clinical interventions. OBJECTIVE The purpose of this study was to evaluate usefulness of IPFT and CV-HRCT to detect changes in lung disease after intravenous (IV) antibiotic therapy in infants with early CF-related lung disease. STUDY DESIGN IPFTs and CV-HRCT done before and after 2 weeks of IV antibiotics in infants at our institution over the last 12 years were compared. CV-HRCTs were compared using the modified Brody scoring system. RESULTS The sample included 21 infants, mean age 85.2 ± 47.6 weeks. Mean change in weight was 0.4 ± 0.38 kg (p = 0.001). Significant changes in IPFT included mean % predicted FEV(0.5) (+13.5 %, p = 0.043), mean %FEF(25-75) (+30.2 %, p = 0.008), mean %RV/TLC (-11.2 %, p = 0.008), and mean %FRC/TLC (-4.5 %, p = 0.001). Total Brody scores improved from a median of 10 to 5 (p < 0.001) as did mean scores for airway wall thickening (p = 0.050), air trapping (p < 0.001), and parenchymal opacities (p = 0.003). CONCLUSION IPFT and CV-HRCT can be used as objective measures of improvement in lung disease for infants with CF treated with antibiotics.
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Affiliation(s)
- Shahid I Sheikh
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,
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Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, Hedlin G, Kulkarni N, Lex C, Mäkelä MJ, Mantzouranis E, Moeller A, Pavord I, Piacentini G, Price D, Rottier BL, Saglani S, Sly PD, Szefler SJ, Tonia T, Turner S, Wooler E, Lødrup Carlsen KC. Monitoring asthma in children. Eur Respir J 2015; 45:906-25. [PMID: 25745042 DOI: 10.1183/09031936.00088814] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Paul L P Brand
- Dept of Paediatrics/Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Kai-Håkon Carlsen
- Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - Gunilla Hedlin
- Depart of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Eva Mantzouranis
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, Oxford, UK
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, USA
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Karin C Lødrup Carlsen
- Dept of Paediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway
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van den Wijngaart LS, Roukema J, Merkus PJFM. Respiratory disease and respiratory physiology: putting lung function into perspective: paediatric asthma. Respirology 2015; 20:379-88. [PMID: 25645369 DOI: 10.1111/resp.12480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/03/2014] [Accepted: 08/03/2014] [Indexed: 01/27/2023]
Abstract
Dealing with paediatric asthma in daily practice, we are mostly interested in the airway function: the hallmark of asthma is the variability of airway patency. Various pulmonary function tests (PFT) can be used to quantify airway caliber in asthmatic children. The choice of the test is based on the developmental age of the child, knowledge of the diagnosis/underlying pathophysiology, clinical questions and reasoning, and treatment. PFT is performed to monitor the severity of asthma and the response to therapy, but can also be used as a diagnostic tool, and to study growth and development of the lungs and airways. This review aims to provide clinicians an overview of the differences in assessing PFT in infants and preschool children compared with older cooperative children, which tests are feasible in infants and young children, the limitations of and usefulness of these tests, and of their interpretation in these age groups.
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Affiliation(s)
- Lara S van den Wijngaart
- Department of Pediatrics, Division of Respiratory Medicine, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
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Setting the Ventilator in the NICU. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7122498 DOI: 10.1007/978-3-642-01219-8_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Success in providing respiratory support to the neonate requires a clear understanding of the context in which it is being applied. Perhaps more than for any other age group, the array of different situations in which ventilation is applied to the newborn infant is extremely broad, with in each case different pathophysiological disturbances and often the need to use a specific approach to apply ventilation optimally. Table 42.1 provides a list of the more common situations in which conventional ventilation is used in the neonate and includes some considerations regarding ventilator settings for each situation. For each situation, a suggested mode of ventilation is indicated, along with target ranges for positive end-expiratory pressure (PEEP) and tidal volume (VT). Further discussion of the physiological rationale and available evidence for ventilator settings is set out below.
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Hoo AF, Gupta A, Lum S, Costeloe KL, Huertas-Ceballos A, Marlow N, Stocks J. Impact of ethnicity and extreme prematurity on infant pulmonary function. Pediatr Pulmonol 2014; 49:679-87. [PMID: 24123888 PMCID: PMC4285893 DOI: 10.1002/ppul.22882] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/06/2013] [Indexed: 11/11/2022]
Abstract
The impact of birth before 27 completed weeks of gestation on infant pulmonary function (PF) was explored in a multi-ethnic population in comparison to more mature preterm controls (PTC) and healthy fullterm infants. Plethysmographic lung volume (FRCpleth ) and forced expired volume (FEV0.5 ) were obtained at ∼12 months post-term age in 52 extremely preterm (EP) infants (median [range] gestational age [GA]: 26 [23-27] weeks; 40% White mothers; 79% with BPD), 41 PTC (GA:35 [30-36] weeks; 37% White mothers) and 95 fullterm infants (GA:40 [37-42] weeks; 86% White mothers). Using reference equations based on identical equipment and techniques, results were expressed as z-scores to adjust for age, sex and body size. FEV0.5 was significantly lower in EP infants when compared with PTC (mean difference [95% CI]: -1.02[-1.60; -0.44] z-scores, P < 0.001), as was forced vital capacity (FVC) but there were no significant differences in FRCpleth or FEV0.5 /FVC ratio. FEV0.5 , FVC, and FEV0.5 /FVC were significantly lower in both preterm groups when compared with fullterm controls. On multivariable analyses of the combined preterm dataset: FEV0.5 at ∼1 year was 0.11 [0.05; 0.17] z-scores higher/week GA, and 1.28 (0.49; 2.08) z-scores lower in EP infants with prior BPD. Among non-white preterm infants, FEV0.5 was 0.70 (0.17; 1.24) z-scores lower, with similar reductions in FVC, such that there were no ethnic differences in FEV0.5 /FVC. Similar ethnic differences were observed among fullterm infants. These results confirm the negative impact of preterm birth on subsequent lung development, especially following a diagnosis of BPD, and emphasize the importance of taking ethnic background into account when interpreting results during infancy as in older subjects.
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Affiliation(s)
- Ah-Fong Hoo
- Portex Respiratory Unit, UCL Institute of Child Health, London, WC1N 1EH, UK; Paediatric Respiratory Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
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Abstract
Assessments of pulmonary function play an integral part in the clinical management of school age children as well as providing objective outcome measures in clinical and epidemiological research studies. Pulmonary function tests (PFTs) can also be undertaken in sleeping infants and in awake young children from 3 years of age. However, the clinical utility of such assessments, which are generally confined to specialist centres, has yet to be established. Whether requesting or undertaking paediatric PFTs, or simply reading about how these tests have been applied in research studies, it is essential to question whether results have been interpreted in a meaningful way. This review summarises some of the issues that need to be considered, including: why the tests are being performed; which tests are most likely to detect the suspected pathophysiology; how often such tests should be repeated; whether results are likely to be reliable (in terms of data quality, repeatability and the availability of suitable reference equations with which to distinguish the effects of disease from those of growth and development), and whether the selected tests are likely to be feasible in the individual child or study group under investigation.
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Vogt B, Falkenberg C, Weiler N, Frerichs I. Pulmonary function testing in children and infants. Physiol Meas 2014; 35:R59-90. [PMID: 24557323 DOI: 10.1088/0967-3334/35/3/r59] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pulmonary function testing is performed in children and infants with the aim of documenting lung development with age and making diagnoses of lung diseases. In children and infants with an established lung disease, pulmonary function is tested to assess the disease progression and the efficacy of therapy. It is difficult to carry out the measurements in this age group without disturbances, so obtaining results of good quality and reproducibility is challenging. Young children are often uncooperative during the examinations. This is partly related to their young age but also due to the long testing duration and the unpopular equipment. We address a variety of examination techniques for lung function assessment in children and infants in this review. We describe the measuring principles, examination procedures, clinical findings and their interpretation, as well as advantages and limitations of these methods. The comparability between devices and centres as well as the availability of reference values are still considered a challenge in many of these techniques. In recent years, new technologies have emerged allowing the assessment of lung function not only on the global level but also on the regional level. This opens new possibilities for detecting regional lung function heterogeneity that might lead to a better understanding of respiratory pathophysiology in children.
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Affiliation(s)
- B Vogt
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Peterson-Carmichael SL, Rosenfeld M, Ascher SB, Hornik CP, Arets HGM, Davis SD, Hall GL. Survey of clinical infant lung function testing practices. Pediatr Pulmonol 2014; 49:126-31. [PMID: 23765632 DOI: 10.1002/ppul.22807] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/16/2013] [Accepted: 03/14/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data supporting the clinical use of infant lung function (ILF) tests are limited making the interpretation of clinical ILF measures difficult. OBJECTIVES To evaluate current ILF testing practices and to survey users regarding the indications, limitations and perceived clinical benefits of ILF testing. METHODS We created a 26-item survey hosted on the European Respiratory Society (ERS) website between January and May 2010. Notifications were sent to members of the ERS, American Thoracic Society and the Asian Pacific Society of Respirology. Responses were sought from ILF laboratory directors and pediatric respirologists. The survey assessed the clinical indications, patient populations, equipment and reference data used, and perceived limitations of ILF testing. RESULTS We received 148 responses with 98 respondents having ILF equipment and performing testing in a clinical capacity. Centers in North America were less likely to perform ≥50 studies/year than centers in Europe or other continents (13% vs. 41%). Most respondents used ILF data to either "start a new therapy" (78%) or "help decide about initiation of further diagnostic workup such as bronchoscopy, chest CT or serological testing" (69%). Factors reported as limiting clinical ILF testing were need for sedation, uncertainty regarding clinical impact of study results and time intensive nature of the study. CONCLUSIONS Clinical practices associated with ILF testing vary significantly; centers that perform more studies are more likely to use the results for clinical purposes and decision making. The future of ILF testing is uncertain in the face of the limitations perceived by the survey respondents.
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El Falaki MM, Girgis MY, Ali AA, Elmonem MA, Ismail HM. Assessment of respiratory involvement in children with mucoplysaccharidosis using pulmonary function tests. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2014. [DOI: 10.1016/j.ejmhg.2013.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
The increasing evidence that asthma begins very early in childhood leads the need for having outcome's measures able to identify the early damage and its evolution both for research than for clinical purposes. The current available methods are clinical questionnaires, pulmonary function tests, airway reactivity tests and direct or indirect inflammation markers' measures. Among the first, ISAAC questionnaire, for epidemiological purpose, Asthma Control Test, for clinical monitoring and Health Related Quality of Life questionnaire are the most used. There are many pulmonary function tests that may be used in all age for functional evaluation, but airway responsiveness measures may be commonly performed only in school age children. As regards respiratory inflammation measures the only currently useful is the exhaled nitric oxide evaluation. The complexity of the pathogenic mechanisms, molecular, cellular and inflammatory that realize the asthmatic syndrome and the effects of the disease on respiratory function, on the activity of the child, on the quality of life of the family and on the economic costs to society show that there is no a single outcome measure that can evaluate all these effects simultaneously.
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Affiliation(s)
- Marcello Verini
- Department of Pediatric, Clinical Hospital and Pediatric School of Medicine, University "G. D'Annunzio", Chieti, Italy.
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Kerby GS, Wagner BD, Popler J, Hay TC, Kopecky C, Wilcox SL, Quinones RR, Giller RH, Accurso FJ, Deterding RR. Abnormal infant pulmonary function in young children with neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2013; 48:1008-15. [PMID: 23169677 DOI: 10.1002/ppul.22718] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 08/27/2012] [Indexed: 11/06/2022]
Abstract
RATIONALE Lung function in children with neuroendocrine cell hyperplasia of infancy (NEHI) and correlations with future clinical outcomes are needed to guide clinical management. OBJECTIVE To compare results of infant pulmonary function tests (IPFTs) in children with NEHI to disease control (DC) subjects and to correlate NEHI IPFTs with future outcomes. METHODS We performed a retrospective, single center study of IPFT in subjects diagnosed by lung biopsy (NEHI) or clinically (NEHI syndrome) and in DC subjects evaluated for cancer or pre-hematopoietic stem cell transplantation (HSCT). Raised volume rapid thoracoabdominal compression (RVRTC) and plethysmography were performed on all infants and evaluated for quality. Standard spirometry measures, room air oxygen saturations (RA O2 sat), and weight percentiles were collected during follow up. MEASUREMENTS AND MAIN RESULTS Fifty-seven IPFTs were performed in 15 NEHI, 22 NEHI syndrome, and 20 DC subjects. RVRTC and FRC measurements were obtained in 85% or more of subjects in all groups. Significant airflow limitation (FEV0.5 P-value ≤ 0.01) and air trapping (FRC P-value ≤ 0.01) were seen in NEHI and NEHI syndrome subjects compared to DCs. No significant correlations were found between IPFT, oxygen use, RA O2 sat, and weight at the time of the IPFTs. Initial FEV0.5 and FRC z-scores correlated with RA O2 sat (r = 0.60 and -0.49) at short-term follow up (6-12 months). Most measurements of RVRTC correlated with FEV1 (n = 5) measured 4-5 years later (r > 0.50). CONCLUSIONS IPFTs in NEHI subjects are feasible, demonstrate significant obstruction and air trapping, and correlate with future RA O2 sat and FEV1 . IPFTs may provide valuable clinical information when caring for NEHI patients. Pediatr Pulmonol. 2013; 48:1008-1015. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Gwendolyn S Kerby
- Department of Pediatrics, Section of Pulmonary Medicine, University of Colorado School of Medicine and The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado
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Nguyen TTD, Thia LP, Hoo AF, Bush A, Aurora P, Wade A, Chudleigh J, Lum S, Stocks J. Evolution of lung function during the first year of life in newborn screened cystic fibrosis infants. Thorax 2013; 69:910-7. [PMID: 24072358 PMCID: PMC4174068 DOI: 10.1136/thoraxjnl-2013-204023] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rationale Newborn screening (NBS) for cystic fibrosis (CF) allows early intervention. Design of randomised controlled trials (RCT) is currently impeded by uncertainty regarding evolution of lung function, an important trial end point in such infants. Objective To assess changes in pulmonary function during the first year of life in CF NBS infants. Methods Observational longitudinal study. CF NBS infants and healthy controls were recruited between 2009 and 2011. Lung Clearance Index (LCI), plethysmographic lung volume (plethysmographic functional residual capacity (FRCpleth)) and forced expired volume (FEV0.5) were measured at 3 months and 1 year of age. Main results Paired measurements were obtained from 72 CF infants and 44 controls. At 3 months, CF infants had significantly worse lung function for all tests. FEV0.5 improved significantly (0.59 (95% CI 0.18 to 0.99) z-scores; p<0.01) in CF infants between 3 months and 1 year, and by 1 year, FEV0.5 was only 0.52 (0.89 to 0.15) z-scores less than in controls. LCI and FRCpleth remained stable throughout the first year of life, being on average 0.8 z-scores higher in infants with CF. Pulmonary function at 1 year was predicted by that at 3 months. Among the 45 CF infants with entirely normal LCI and FEV0.5 at 3 months, 80% remained so at 1 year, while 74% of those with early abnormalities remained abnormal at 1 year. Conclusions This is the first study reporting improvements in FEV0.5 over time in stable NBS CF infants treated with standard therapy. Milder changes in lung function occurred by 1 year than previously reported. Lung function at 3 months predicts a high-risk group, who should be considered for intensification of treatment and enrolment into RCTs.
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Affiliation(s)
- The Thanh-Diem Nguyen
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Department of Respiratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Lena P Thia
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK
| | - Ah-Fong Hoo
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial College & Royal Brompton & Harefield Hospital NHS Foundation Trust, London, UK
| | - Paul Aurora
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Angie Wade
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, MRC Centre for Epidemiology of Child Health, London, UK
| | - Jane Chudleigh
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sooky Lum
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK
| | - Janet Stocks
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK
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Rosenfeld M, Farrell PM, Kloster M, Swanson JO, Vu T, Brumback L, Acton JD, Castile RG, Colin AA, Conrad CK, Hart MA, Kerby GS, Hiatt PW, Mogayzel PJ, Johnson RC, Davis SD. Association of lung function, chest radiographs and clinical features in infants with cystic fibrosis. Eur Respir J 2013; 42:1545-52. [PMID: 23722613 DOI: 10.1183/09031936.00138412] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The optimal strategy for monitoring cystic fibrosis lung disease in infancy remains unclear. Our objective was to describe longitudinal associations between infant pulmonary function tests, chest radiograph scores and other characteristics. Cystic fibrosis patients aged ≤24 months were enrolled in a 10-centre study evaluating infant pulmonary function tests four times over a year. Chest radiographs ∼1 year apart were scored using the Wisconsin and Brasfield systems. Associations of infant pulmonary function tests with clinical characteristics were evaluated with mixed effects models. The 100 participants contributed 246 acceptable flow/volume (forced expiratory volume in 0.5 s (FEV0.5) and forced expiratory flow at 75% of the forced vital capacity (FEF75%)), 303 functional residual capacity measurements and 171 chest radiographs. Both Brasfield and Wisconsin chest radiograph scores worsened significantly over the 1-year interval. Worse Wisconsin chest radiograph scores and Staphylococcus aureus were both associated with hyperinflation (significantly increased functional residual capacity), but not with diminished FEV0.5 or FEF75%. Parent-reported cough was associated with significantly diminished forced expiratory flow at 75% but not with hyperinflation. In this infant cohort in whom we previously reported worsening in average lung function, chest radiograph scores also worsened over a year. The significant associations detected between both Wisconsin chest radiograph score and S. aureus and hyperinflation, as well as between cough and diminished flows, reinforce the ability of infant pulmonary function tests and chest radiographs to detect early cystic fibrosis lung disease.
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Chudleigh J, Hoo AF, Ahmed D, Prasad A, Sheehan D, Francis J, Buckingham S, Cowlard J, Thia L, Nguyen TTD, Stocks J. Positive parental attitudes to participating in research involving newborn screened infants with CF. J Cyst Fibros 2013; 12:234-40. [DOI: 10.1016/j.jcf.2012.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/30/2012] [Accepted: 09/03/2012] [Indexed: 11/17/2022]
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Nguyen TTD, Hoo AF, Lum S, Wade A, Thia LP, Stocks J. New reference equations to improve interpretation of infant lung function. Pediatr Pulmonol 2013; 48:370-80. [PMID: 22949414 DOI: 10.1002/ppul.22656] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/30/2012] [Indexed: 11/07/2022]
Abstract
RATIONALE With increasing use of infant pulmonary function tests (IPFTs) in both clinical and research studies, appropriate interpretation of results is essential. OBJECTIVES To investigate the potential bias associated with "normalising" IPF by expressing results as a ratio of body size and to develop reference ranges for tidal breathing parameters, passive respiratory mechanics (compliance [Crs] and resistance [Rrs]) and plethysmographic functional residual capacity (FRCp ) for white infants during the first 2 years of life. METHODS IPFTs were measured using the Jaeger BabyBody system and standardized protocols. Reference equations, adjusted for body size, age, and sex where appropriate, were created using multilevel modeling. RESULTS The ratio of lung function to body length changes markedly with growth, thereby precluding its use for any outcome. While the ratio of tidal volume and Crs to body weight remained relatively constant with growth, this was not the case for FRCp . Even in healthy infants, a strong inverse relationship was observed between lung function/body weight and weight z-score which could distort interpretation of results in growth-restricted infants with lung disease, such as cystic fibrosis. Reference equations were derived from 153 healthy white infants on 232 test occasions (median age 35.5 weeks [range: 2.6-104.7]). Crown-heel length was the strongest predictor of IPF. CONCLUSIONS When reporting IPF, use of size-corrected ratios should be discouraged, with interpretation instead based on appropriate reference equations. The current equations are applicable to white infants and young children up to 2 years of age, studied using the same commercially available equipment. The extent to which these equations are applicable to infants and young children of other ethnic backgrounds or who are tested with different equipment needs to be established.
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Affiliation(s)
- The Thanh Diem Nguyen
- Portex Respiratory Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Patel K, Davis SD, Johnson R, Esther CR. Exhaled breath condensate purines correlate with lung function in infants and preschoolers. Pediatr Pulmonol 2013; 48:182-7. [PMID: 22615171 PMCID: PMC3434248 DOI: 10.1002/ppul.22573] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 03/01/2012] [Indexed: 11/06/2022]
Abstract
RATIONALE Although airway inflammation begins early in life in children with chronic respiratory diseases, current methods to assess this inflammation are invasive and entail significant risk. Measurement of exhaled breath condensate (EBC) purines and other biomarkers offers a less invasive method to assess airway inflammation; however, the feasibility and utility of EBC biomarkers in young children has not been established. METHODS EBC was collected from children <3 years old with cystic fibrosis or other lung diseases during clinically indicated infant pulmonary function tests (iPFTs). EBC concentrations of the purine biomarkers adenosine (Ado), adenosine monophosphate (AMP), and the dilution marker urea were measured using mass spectrometry. RESULTS EBC was successfully collected (average volume 330 ± 170 µl) from preschool children (age 2.3 ± 0.8 years) in 15 of 17 iPFTs. No significant changes in oxygen saturation (96.9 ± 1.6 start, 96.8 ± 1.7 end, P = 0.389) or respiratory rate (35.2 ± 7.5 start, 34.6 ± 7.9 end, P = 0.443) were observed during collection. Ado and AMP were successfully measured in 13/15 samples [8 cystic fibrosis (CF)]. EBC AMP to Ado ratio (AMP/Ado) negatively correlated with forced expiratory volume at 0.5 sec (FEV(0.5) , r = -0.71, P < 0.01) and positively with the ratio of residual volume to total lung capacity (RV/TLC, r = 0.66, P = 0.015). These correlations remained statistically significant in the subset with CF. CONCLUSIONS EBC can be safely collected and analyzed in preschool children using commercially available equipment. The EBC AMP/Ado ratio correlates with measures of infant lung function and may be a less invasive means of monitoring airway inflammation in this population.
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Affiliation(s)
- Kavita Patel
- Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
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77
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Lungenfunktionsdiagnostik. PÄDIATRISCHE PNEUMOLOGIE 2013. [PMCID: PMC7123361 DOI: 10.1007/978-3-642-34827-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lungenfunktionsdiagnostik beinhaltet eine Vielzahl von Messmethoden, mit denen jeweils bestimmte Qualitten der Lungen in verschiedenen Altersgruppen überwiegend nichtinvasiv untersucht werden können.
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Spoel M, Meeussen CJHM, Gischler SJ, Hop WCJ, Bax NMA, Wijnen RMH, Tibboel D, de Jongste JC, Ijsselstijn H. Respiratory morbidity and growth after open thoracotomy or thoracoscopic repair of esophageal atresia. J Pediatr Surg 2012; 47:1975-83. [PMID: 23163986 DOI: 10.1016/j.jpedsurg.2012.07.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/10/2012] [Accepted: 07/15/2012] [Indexed: 01/03/2023]
Abstract
BACKGROUND Respiratory morbidity has been described in patients who underwent repair of esophageal atresia as a neonate. We compared the influence of open thoracotomy or thoracoscopy on lung function, respiratory symptoms, and growth. METHODS Functional residual capacity (FRC(p)), indicative of lung volume, and maximal expiratory flow at functional residual capacity (V'max(FRC)), indicative of airway patency, of 37 infants operated for esophageal atresia were measured with Masterscreen Babybody at 6 and 12 months. SD scores were calculated for V'max(FRC). RESULTS Repair was by thoracotomy in 21 cases (57%) and by thoracoscopy in 16 cases (43%). Lung function parameters did not differ between the types of surgery (FRC(p); P = .384 and V'max(FRC); P = .241). FRC(p) values were in the upper normal range and increased from 6 to 12 months (22.5 and 25.4 mL/kg respectively, P = .010). Mean (SD) V'max(FRC) was below the norm without significant change in SD scores from 6 to 12 months (-1.9 and -2.3, respectively, P = .248). Neither lung function nor type of repair was associated with clinical evolution up to 2 years. CONCLUSION Lung function during the first year was similar in EA infants repaired by thoracotomy or thoracoscopy. Ongoing follow-up including pulmonary function testing is needed to determine whether differences occur at a later age in this cohort.
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Affiliation(s)
- Marjolein Spoel
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam, The Netherlands.
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79
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Prendergast M, Rafferty GF, Milner AD, Broughton S, Davenport M, Jani J, Nicolaides K, Greenough A. Lung function at follow-up of infants with surgically correctable anomalies. Pediatr Pulmonol 2012; 47:973-8. [PMID: 22328362 DOI: 10.1002/ppul.22515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/13/2011] [Indexed: 11/07/2022]
Abstract
Infants with congenital diaphragmatic hernia (CDH) or anterior wall defects (AWD) can suffer abnormal antenatal lung growth, the risk, however, may be greater for CDH infants. The objectives of this study were to test the hypothesis that following surgical correction, CDH infants would have worse lung function at follow-up than AWD infants and to determine whether fetal lung volume (FLV) results correlated with the lung function results at follow-up. Thirteen infants with CDH and 13 infants with AWD had lung function measurements at a median age of 11 (range 6-24) months; 17 of the infants had had their FLV assessed. Lung function was assessed by plethysmographic measurement of lung volume (FRCpleth) and airway resistance (Raw). In addition, functional residual capacity was assessed by a helium gas dilution technique (FRCHe); tidal breathing parameters (T(PTEF) :Te) and compliance and resistance of the respiratory system (Crs and Rrs, respectively) were also determined. FLV was assessed using three-dimensional (3D) ultrasound and virtual organ computer aided analysis. The CDH compared to the AWD infants had a higher median FRCpleth (41 ml/kg vs. 37 ml/kg, P = 0.043) and a lower median Crs (1.45 ml/cm H(2) O/kg vs. 2.78 ml/cm H(2) O/kg, P = 0.041). FRCpleth results correlated significantly with FLV results (r = 0.721, P < 0.001). In conclusion, infants with CDH had significantly different lung function at follow-up than AWD infants. Our findings suggest FLV results may predict lung function abnormalities at follow-up in infants with surgically correctable anomalies.
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Affiliation(s)
- Michael Prendergast
- Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, United Kingdom
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Pittman JE, Johnson RC, Davis SD. Improvement in pulmonary function following antibiotics in infants with cystic fibrosis. Pediatr Pulmonol 2012; 47:441-6. [PMID: 22009796 DOI: 10.1002/ppul.21575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 07/14/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent studies have shown the presence of lung disease in even asymptomatic infants with cystic fibrosis (CF). While pulmonary function testing (PFT) is often used to follow progression of lung disease and guide treatment in older children with CF, little data is available on change in infant PFTs in young children with CF. OBJECTIVE To determine change in infant PFTs before and after antibiotic therapy for pulmonary exacerbation in infants with CF. METHODS Retrospective cohort study of infants with CF who underwent clinically indicated infant PFTs before and after antibiotic therapy for CF pulmonary exacerbation at the University of North Carolina at Chapel Hill. RESULTS Pre- and post-antibiotics PFT data was available on 11 infants with CF, with a mean age of 102 weeks at time of first PFT. The majority of infants were symptomatic prior to antibiotics, and showed statistically significant improvement in clinical parameters following treatment. Prior to antibiotics, PFTs showed evidence of substantial obstructive disease (mean z-scores for FVC, FEV(0.5) , and FEF(25-75) of -1.81, -3.06, and -4.5, respectively) and air-trapping/hyperinflation (mean z-scores for FRCpleth, RV, and RV/TLC of 8.86, 7.1, and 3.31, respectively). Following antibiotics, all of the above parameters showed statistically significant improvement. DISCUSSION We have shown a statistically significant improvement in infant PFT measures following antibiotic therapy in a cohort of 11 infants with CF, which paralleled improvement in clinical parameters. Though infant PFTs showed improvement, they remained abnormal in the majority of subjects, with persistent air-trapping and hyperinflation after antibiotic therapy. Our findings suggest that infant PFTs are sensitive to acute clinical changes in children with CF, and may be a useful tool in managing infants with CF.
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Affiliation(s)
- Jessica E Pittman
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC 27599, USA.
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81
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Prospective longitudinal evaluation of lung function during the first year of life after repair of congenital diaphragmatic hernia. Pediatr Crit Care Med 2012; 13:e133-9. [PMID: 21666527 DOI: 10.1097/pcc.0b013e3182231872] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate lung function and respiratory morbidity prospectively during the first year of life in patients with congenital diaphragmatic hernia and to study the effect of extracorporeal membrane oxygenation therapy. DESIGN Prospective longitudinal cohort study. SETTING Outpatient clinic of a tertiary-level pediatric hospital. PATIENTS The cohort of 43 infants included 12 patients treated with extracorporeal membrane oxygenation. Evaluation was at 6 and 12 months; 33 infants were evaluated at both time points. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Maximal expiratory flow at functional residual capacity and functional residual capacity were measured with Masterscreen Babybody. Z-scores were calculated for maximal expiratory flow at functional residual capacity. Mean maximal expiratory flow at functional residual capacity values at 6 and 12 months were significantly below the expected values (mean z-score -1.4 and -1.5, respectively) without a significant change between both time points. Values did not significantly differ between extracorporeal membrane oxygenation and nonextracorporeal membrane oxygenation-treated patients. Functional residual capacity values were generally high, 47% were above the suggested normal range, and did not change significantly over time. Mean functional residual capacity values in extracorporeal membrane oxygenation-treated patients were significantly higher than in nonextracorporeal membrane oxygenation-treated patients (p = .006). The difference (5.1 mL/kg ± 1.8 SE) did not change significantly between the two time points. Higher mean airway pressure and longer duration of ventilation were associated with higher functional residual capacity. None of the perinatal characteristics was associated with maximal expiratory flow at functional residual capacity. Mean weight z-scores were significantly below zero at both time points (p < .001). Mean weight z-score in extracorporeal membrane oxygenation-treated patients were lower than in nonextracorporeal membrane oxygenation-treated patients (p = .046). CONCLUSIONS Infants with congenital diaphragmatic hernia have decreased expiratory flows and increased functional residual capacity within the first year of life. Extracorporeal membrane oxygenation-treated patients with congenital diaphragmatic hernia may have more respiratory morbidity and concomitant growth impairment. Close follow-up beyond the neonatal period is therefore required.
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82
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Roehr CC, Wilitzki S, Opgen-Rhein B, Kalache K, Proquitté H, Bührer C, Schmalisch G. Early lung function testing in infants with aortic arch anomalies identifies patients at risk for airway obstruction. PLoS One 2011; 6:e24903. [PMID: 21966379 PMCID: PMC3179483 DOI: 10.1371/journal.pone.0024903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 08/19/2011] [Indexed: 11/20/2022] Open
Abstract
Background Aortic arch anomalies (AAA) are rare cardio-vascular anomalies. Right-sided and double-sided aortic arch anomalies (RAAA, DAAA) are distinguished, both may cause airway obstructions. We studied the degree of airway obstruction in infants with AAA by neonatal lung function testing (LFT). Patients and Methods 17 patients (10 RAAA and 7 DAAA) with prenatal diagnosis of AAA were investigated. The median (range) post conception age at LFT was 40.3 (36.6–44.1) weeks, median body weight 3400 (2320–4665) g. Measurements included tidal breathing flow-volume loops (TBFVL), airway resistance (Raw) by bodyplethysmography and the maximal expiratory flow at functional residual capacity (V′maxFRC) by rapid thoracic-abdominal compression (RTC) technique. V′maxFRC was also expressed in Z-scores, based on published gender-, age and height-specific reference values. Results Abnormal lung function tests were seen in both RAAA and DAAA infants. Compared to RAAA infants, infants with DAAA had significantly more expiratory flow limitations in the TBFVL, (86% vs. 30%, p<0.05) and a significantly increased Raw (p = 0.015). Despite a significant correlation between Raw and the Z-score of V′maxFRC (r = 0.740, p<0.001), there were no statistically significant differences in V′maxFRC and it's Z-scores between RAAA and DAAA infants. 4 (24%) infants (2 RAAA, 2 DAAA) were near or below the 10th percentile of V′maxFRC, indicating a high risk for airway obstruction. Conclusion Both, infants with RAAA and DAAA, are at risk for airway obstruction and early LFT helps to identify and to monitor these infants. This may support the decision for therapeutic interventions before clinical symptoms arise.
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83
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Clinical Applications of Pediatric Pulmonary Function Testing: Lung Function in Recurrent Wheezing and Asthma. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2011; 24:69-76. [DOI: 10.1089/ped.2010.0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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84
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Malmberg LP, von Wright L, Kotaniemi-Syrjänen A, Malmström K, Pelkonen AS, Mäkelä MJ. Methacholine-induced lung function changes measured with infant body plethysmography. Pediatr Pulmonol 2011; 46:362-8. [PMID: 20967846 DOI: 10.1002/ppul.21375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 09/03/2010] [Accepted: 09/03/2010] [Indexed: 11/07/2022]
Abstract
Several techniques have been applied to measure airway responsiveness (AR) in infants, but there are limited data on lung function changes measured by body plethysmography during induced bronchoconstriction. The aim of this study was to compare changes in maximum forced expiratory flow measured at functional residual capacity (V'(maxFRC)) by rapid thoracoabdominal compression (RTC) technique with plethysmographic measurements of specific airway conductance (sG(aw) ), and to investigate whether changes in functional residual capacity (FRC) occur during methacholine-induced bronchoconstriction in infants. We examined 94 infants with recurrent airway symptoms using methacholine airway challenge test including RTC and plethysmographic measurements. A significant association between changes in V'(maxFRC) and sG(aw) (r = 0.30; P = 0.004) was observed, but after adjustments with baseline variability the changes in V'(maxFRC) were greater and showed a closer association with changes in oxygen saturation. At the point of maximal airway obstruction, there was a poor agreement between V'(maxFRC) and sG(aw) to indicate a significant methacholine-induced bronchoconstriction. Airway challenge was also associated with a significant increase in FRC (P < 0.001), with decreasing V'(maxFRC). We conclude that in infants undergoing airway challenge with methacholine, plethysmographic measurements of sG(aw) correlate with the changes in V(maxFRC), but the agreement is poor and the methods cannot be used interchangeably. V(maxFRC) is also more sensitive to detect airway obstruction than sG(aw). However, methacholine-induced bronchoconstriction was associated with significant increases in FRC, which may affect the validity of V(maxFRC) measurements during the test.
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Affiliation(s)
- L Pekka Malmberg
- Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
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85
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Prospective longitudinal evaluation of lung function during the first year of life after extracorporeal membrane oxygenation. Pediatr Crit Care Med 2011; 12:159-64. [PMID: 20581733 DOI: 10.1097/pcc.0b013e3181e8946e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To collect longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation and to evaluate relationships between lung function and perinatal factors. Longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation are lacking. DESIGN Prospective longitudinal cohort study. SETTING Outpatient clinic of a tertiary level pediatric hospital. PATIENTS The cohort consisted of 64 infants; 33 received extracorporeal membrane oxygenation for meconium aspiration syndrome, 14 for congenital diaphragmatic hernia, four for sepsis, six for persistent pulmonary hypertension of the neonate, and seven for respiratory distress syndrome of infancy. Evaluation was at 6 mos and 12 mos; 39 infants were evaluated at both time points . INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Functional residual capacity and forced expiratory flow at functional residual capacity were measured and expressed as z score. Mean (sem) functional residual capacities in z score were 0.0 (0.2) and 0.2 (0.2) at 6 mos and 12 mos, respectively. Mean (sem) forced expiratory flow was significantly below average (z score = 0) (p < .001) at 6 mos and 12 mos: -1.1 (0.1) and -1.2 (0.1), respectively. At 12 mos, infants with diaphragmatic hernia had a functional residual capacity significantly above normal: mean (sem) z score = 1.2 (0.5). CONCLUSIONS Infants treated with extracorporeal membrane oxygenation have normal lung volumes and stable forced expiratory flows within normal range, although below average, within the first year of life. There is reason to believe, therefore, that extracorporeal membrane oxygenation either ameliorates the harmful effects of mechanical ventilation or somehow preserves lung function in the very ill neonate.
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86
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Criée CP, Sorichter S, Smith HJ, Kardos P, Merget R, Heise D, Berdel D, Köhler D, Magnussen H, Marek W, Mitfessel H, Rasche K, Rolke M, Worth H, Jörres RA. Body plethysmography--its principles and clinical use. Respir Med 2011; 105:959-71. [PMID: 21356587 DOI: 10.1016/j.rmed.2011.02.006] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/07/2011] [Accepted: 02/06/2011] [Indexed: 01/14/2023]
Abstract
Body plethysmography allows to assess functional residual capacity (FRC(pleth)) and specific airway resistance (sRaw) as primary measures. In combination with deep expirations and inspirations, total lung capacity (TLC) and residual volume (RV) can be determined. Airway resistance (Raw) is calculated as the ratio of sRaw to FRC(pleth). Raw is a measure of airway obstruction and indicates the alveolar pressure needed to establish a flow rate of 1 L s(-1). In contrast, sRaw can be interpreted as the work to be performed by volume displacement to establish this flow rate. These measures represent different functional aspects and should both be considered. The measurement relies on the fact that generation of airflow needs generation of pressure. Pressure generation means that a mass of air is compressed or decompressed relative to its equilibrium volume. This difference is called "shift volume". As the body box is sealed and has rigid walls, its free volume experiences the same, mirror image-like shift volume as the lung. This shift volume can be measured via the variation of box pressure. The relationship between shift volume and alveolar pressure is assessed in a shutter maneuver, by identifying mouth and alveolar pressure under zero-flow conditions. These variables are combined to obtain FRC(pleth), sRaw and Raw. This presentation aims at providing the reader with a thorough and precise but non-technical understanding of the working principle of body plethysmography. It also aims at showing that this method yields significant additional information compared to spirometry and even bears a potential for further development.
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Affiliation(s)
- C P Criée
- Evangelisches Krankenhaus Göttingen-Weende gGmbH, Department of Pneumology, Respiratory Care, Sleep Medicine, Pappelweg 5, D-37120 Bovenden-Lenglern, Germany.
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87
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Davis SD, Rosenfeld M, Kerby GS, Brumback L, Kloster MH, Acton JD, Colin AA, Conrad CK, Hart MA, Hiatt PW, Mogayzel PJ, Johnson RC, Wilcox SL, Castile RG. Multicenter evaluation of infant lung function tests as cystic fibrosis clinical trial endpoints. Am J Respir Crit Care Med 2010; 182:1387-97. [PMID: 20622043 DOI: 10.1164/rccm.200908-1236oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The conducting of clinical trials in infants with cystic fibrosis (CF) has been hindered by lack of sensitive outcome measures. OBJECTIVES To evaluate safety, feasibility, and ability to detect abnormalities in lung function of serial pulmonary function tests (PFTs) in infants with CF. METHODS Multicenter observational study using a commercial device, rigorous training, ongoing quality control, and over-reading of data by an independent panel. Raised volume rapid thoracoabdominal compression technique and plethysmography were performed at enrollment and at 6 and 12 months, with an additional 1-month reproducibility visit. MEASUREMENTS AND MAIN RESULTS A total of 342 procedures were performed in 100 infants with CF at 10 centers. FRC measurements were acceptable at a higher proportion of study visits (89%) than raised volume (72%) or fractional lung volume (68%) measurements. Average Z scores for many parameters differed significantly from historical control values. Mean (95% confidence interval) Z scores were: -0.52 (-0.78 to -0.25) for forced expiratory flow at 75% (FEF₇₅) for FVC; 1.92 (1.39-2.45) for FRC; 1.22 (0.68-1.76) for residual volume; 0.87 (0.60-1.13) for FRC/total lung capacity; and 0.66 (0.27-1.06) for residual volume/total lung capacity. For future multicenter clinical trials using infant PFTs as primary endpoints, minimum detectable treatment effects are presented for several sample sizes. CONCLUSIONS In this 10-center study, key PFT measures were significantly different in infants with CF than in historical control subjects. However, infant PFTs do not yet appear ready as primary efficacy endpoints for multicenter clinical trials, particularly at inexperienced sites, based on acceptability rates, variability, and potentially large sample sizes required to detect reasonable treatment effects.
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Affiliation(s)
- Stephanie D Davis
- Department of Pediatrics, North Carolina Children’s Hospital, University of North Carolina at Chapel Hill, USA.
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88
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Verini M, Consilvio NP, Di Pillo S, Cingolani A, Spagnuolo C, Rapino D, Scaparrotta A, Chiarelli F. FeNO as a Marker of Airways Inflammation: The Possible Implications in Childhood Asthma Management. J Allergy (Cairo) 2010; 2010:691425. [PMID: 20948878 PMCID: PMC2948939 DOI: 10.1155/2010/691425] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 01/30/2010] [Accepted: 03/01/2010] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to verify FeNO usefulness, as a marker of bronchial inflammation, in the assessment of therapeutic management of childhood asthma. We performed a prospective 1-year randomized clinical trial evaluating two groups of 32 children with allergic asthma: "GINA group", in which therapy was assessed only by GINA guidelines and "FeNO group", who followed a therapeutic program assessed also on FeNO measurements. Asthma Severity score (ASs), Asthma Exacerbation Frequency (AEf), and Asthma Therapy score (ATs) were evaluated at the start of the study (T1), 6 months (T2), and 1 year after (T3). ASs and AEf significantly decreased only in the FeNO group at times T2 and T3 (p[T1-T2] = 0.0001, and p[T1-T3] = 0.01; p[T1-T2] = 0.0001; and p[T1-T3] < 0.0001, resp.). After six months of follow-up, we found a significant increase of patients under inhaled corticosteroid and/or antileukotrienes in the GINA group compared to the FeNO group (P = .02). Our data show that FeNO measurements, might be a very useful additional parameter for management of asthma, which is able to avoid unnecessary inhaled corticosteroid and antileukotrienes therapies, however, mantaining a treatment sufficient to obtain a meaningful improvement of asthma.
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Affiliation(s)
- Marcello Verini
- Allergological and Pneumological Service, Department of Pediatric, University “G. D'Annunzio”, 66100 Chieti, Italy
| | - Nicola Pietro Consilvio
- Allergological and Pneumological Service, Department of Pediatric, University “G. D'Annunzio”, 66100 Chieti, Italy
| | - Sabrina Di Pillo
- Allergological and Pneumological Service, Department of Pediatric, University “G. D'Annunzio”, 66100 Chieti, Italy
| | - Anna Cingolani
- Allergological and Pneumological Service, Department of Pediatric, University “G. D'Annunzio”, 66100 Chieti, Italy
| | - Cynzia Spagnuolo
- Allergological and Pneumological Service, Department of Pediatric, University “G. D'Annunzio”, 66100 Chieti, Italy
| | - Daniele Rapino
- Allergological and Pneumological Service, Department of Pediatric, University “G. D'Annunzio”, 66100 Chieti, Italy
| | - Alessandra Scaparrotta
- Allergological and Pneumological Service, Department of Pediatric, University “G. D'Annunzio”, 66100 Chieti, Italy
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89
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Concordancia en niños entre las resistencias de la vía aérea medidas mediante pletismografía con y sin cierre del oclusor. Arch Bronconeumol 2010; 46:160-4. [DOI: 10.1016/j.arbres.2010.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 12/20/2009] [Accepted: 01/02/2010] [Indexed: 11/19/2022]
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90
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Morris MG. Comprehensive integrated spirometry using raised volume passive and forced expirations and multiple-breath nitrogen washout in infants. Respir Physiol Neurobiol 2010; 170:123-40. [PMID: 19897058 PMCID: PMC2858579 DOI: 10.1016/j.resp.2009.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 10/29/2009] [Accepted: 10/29/2009] [Indexed: 12/15/2022]
Abstract
With the rapid somatic growth and development in infants, simultaneous accurate measurements of lung volume and airway function are essential. Raised volume rapid thoracoabdominal compression (RTC) is widely used to generate forced expiration from an airway opening pressure of 30 cmH(2)O (V(30)). The (dynamic) functional residual capacity (FRC(dyn)) remains the lung volume most routinely measured. The aim of this study was to develop comprehensive integrated spirometry that included all subdivisions of lung volume at V(30) or total lung capacity (TLC(30)). Measurements were performed on 17 healthy infants aged 8.6-119.7 weeks. A commercial system for multiple-breath nitrogen washout (MBNW) to measure lung volumes and a custom made system to perform RTC were used in unison. A refined automated raised volume RTC and the following two novel single maneuvers with dual volume measurements were performed from V(30) during a brief post-hyperventilation apneic pause: (1) the passive expiratory flow was integrated to produce the inspiratory capacity (IC) and the static (passive) FRC (FRC(st)) was estimated by initiating MBNW after end-passive expiration; (2) RTC was initiated late during passive expiration, flow was integrated to produce the slow vital capacity ((j)SVC) and the residual volume (RV) was measured by initiating MBNW after end-expiration while the jacket (j) was inflated. Intrasubject FRC(dyn) and FRC(st) measurements overlapped (p=0.6420) but neither did with the RV (p<0.0001). Means (95% confidence interval) of FRC(dyn), IC, FRC(st), (j)SVC, RV, forced vital capacity and tidal volume were 21.2 (19.7-22.7), 36.7 (33.0-40.4), 21.2 (19.6-22.8), 40.7 (37.2-44.2), 18.1 (16.6-19.7), 40.7 (37.1-44.2) and 10.2 (9.6-10.7)ml/kg, respectively. Static lung volumes and capacities at V(30) and variables from the best forced expiratory flow-volume curve were dependent on age, body length and weight. In conclusion, we developed a comprehensive physiologically integrated approach for in-depth investigation of lung function at V(30) in infants.
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Affiliation(s)
- Mohy G Morris
- Department of Pediatrics, Pulmonary Medicine Section, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Research Institute, Little Rock, AR 72202, USA.
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91
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Dargaville PA, Rimensberger PC. Lung volume measurement in the neonate-throwing light on the subject: commentary on the article by Dellaca' et al. on page 11. Pediatr Res 2010; 67:9-10. [PMID: 20010379 DOI: 10.1203/pdr.0b013e3181c9170d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Peter A Dargaville
- Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart TAS 7000, Australia.
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92
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Vilozni D, Efrati O, Hakim F, Adler A, Livnat G, Bentur L. FRC measurements using body plethysmography in young children. Pediatr Pulmonol 2009; 44:885-91. [PMID: 19639626 DOI: 10.1002/ppul.21072] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Measurement of FRC in whole body plethysmography (FRCpleth) is not performed in young children (aged 3-5 years) because it involves sitting alone in a closed box and breathing attempts against occlusion. OBJECTIVE To assess the feasibility of measuring FRCpleth in young children. METHODS AND RESULTS Seventy-one of 102 children (age range 3.3-6.9 years) performed spirometry and FRCpleth measurements. Twenty-six children had controlled asthma (Group-A); 26 children were tested during asthma exacerbation had uncontrolled asthma (Group-UA), and 19 children were tested after receiving chemotherapy treatment (Group-C). Tests according to adult recommendations were first taught outside the plethysmograph and then performed with minor technical adaptations. Each test included two consecutive FRC measurements obtained during 2-3 sec of occlusion. Total lung capacity (TLC) and residual volume (RV) were calculated. Values were compared to FRC measured by Helium-dilution (FRC-He) in healthy preschool children and to extrapolated FRCpleth values of school children, and between the groups. RESULTS Group-A showed normal spirometry and normal TLC values, with mildly elevated FRCpleth and RV values (125 +/- 20 and 153 +/- 33 %predicted, respectively; P < 0.0001 for both values). Group-UA showed obstructed flows combined with high FRCpleth and RV (146 +/- 26 and 189 +/- 38 %predicted; P < 0.0001) and normal TLC. Group-C showed a restrictive spirometry pattern combined with lower than normal TLC (86 +/- 15 %predicted; P < 0.0251). CONCLUSIONS Measuring absolute lung volumes by plethysmography in young children is feasible and can detect abnormal lung volumes. It is essential to study a larger group of healthy children for reference values and to allow for standardization of the procedure.
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Affiliation(s)
- Daphna Vilozni
- Pediatric Pulmonary Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, Haifa, Israel.
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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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Abstract
OBJECTIVE Morbidity and mortality in preterm infants is significantly determined by the development of pulmonary complications. We thus investigated the impact of obstructive ventilatory disorders on lung function in very preterm infants with a history of respiratory distress syndrome and/or bronchopulmonary dysplasia using repeated body plethysmographic measurements before and after bronchodilation. DESIGN Lung function, including effective airway resistance (Raw), specific conductance (SGaw), functional residual capacity (FRCbox), and total respiratory system compliance (Crs, multiple occlusion technique) was assessed in 27 preterm infants pound31 wks gestational age at a median postmenstrual age of 38 wks after mild oral sedation before and after inhalation of nebulized salbutamol (1.25 mg/2.5 mL; PARI JuniorBOY N) using the MasterScreen Baby Body (Jaeger, Hoechberg, Germany). RESULTS In preterm infants median Raw was initially found to be within the normal range as determined for healthy term newborns, but decreased significantly after administration of salbutamol; SGaw changed accordingly. FRCbox was significantly reduced compared with healthy term newborns (16.6 vs. 19.6 mL/kg, mean) and decreased further after bronchodilation, whereas Crs was not significantly altered. CONCLUSIONS This is the first report quantifying the important impact of obstructive ventilatory disorders on lung function in very preterm infants at term. Besides its important role in preterm lung function consecutive overinflation could furthermore be shown to mask reduction of lung volume in these infants. Thus, body plethysmographic measurements seem to be an important diagnostic tool in preterm infants at term before hospital discharge in order to quantify ventilation disorders and to define therapeutic strategies.
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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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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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Stern G, Latzin P, Thamrin C, Frey U. How can we measure the impact of pollutants on respiratory function in very young children? Methodological aspects. Paediatr Respir Rev 2007; 8:299-304. [PMID: 18005898 DOI: 10.1016/j.prrv.2007.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is increasing evidence that air pollution particularly affects infants and small preschool children. However, detecting air pollution effects on lung function in small children is technically difficult and requires non-invasive methods that can assess lung function and inflammatory markers in larger cohorts. This review discusses the principles, usefulness and shortcomings of various lung function techniques used to detect pollution effects in small children. The majority of these techniques have been used to detect effects of the dominant indoor pollutant, tobacco exposure. However there is increasing evidence that non-invasive lung function techniques can also detect the effects of outdoor air pollution.
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Affiliation(s)
- Georgette Stern
- Department of Paediatric Respiratory Medicine, University Children's Hospital, University Hospital of Berne, Inselspital, 3010 Berne, Switzerland
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Broughton S, Rafferty GF, Milner AD, Greenough A. Effect of electronic compensation on plethysmographic airway resistance measurements. Pediatr Pulmonol 2007; 42:764-72. [PMID: 17659604 DOI: 10.1002/ppul.20661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To compare the performance of a plethysmograph which incorporated electronic compensation (Jaeger) to one which incorporated a heated humidified breathing system (Hammersmith plethysmograph). WORKING HYPOTHESIS The performance of a plethysmograph which incorporated electronic compensation would be impaired compared to that which incorporated a heated humidified system. STUDY DESIGN In vitro and in vivo comparison. PATIENT SELECTION Eleven children, median postnatal age 13 (range 5-15) months. METHODS In vitro, the plethysmographs were assessed using known resistances (1.94, 4.85, and 6.80 kPa, equivalent to 20, 50, and 70 cm H(2)O/L/sec, respectively). In vivo, comparison was made of the results of children studied in both plethysmographs. RESULTS In vitro, the resistance results of the two plethysmographs were similar to each other and to the known resistances. In vivo, the median "effective" airways resistance result of the Jaeger (4.15 kPa/L/sec) was significantly higher than the inspiratory resistance of the Hammersmith plethysmograph (3.0 kPa/L/sec), but the median inspiratory resistances of the Jaeger were significantly lower than those of the Hammersmith plethysmograph (2.8 kPa/L/sec vs. 3.0 kPa/L/sec). The mean within patient coefficient of variability for inspiratory resistance of the Jaeger plethysmograph (16.7%) was significantly higher than that of the Hammersmith plethysmograph (11.6%) (P = 0.014). CONCLUSION These results suggest plethysmographs which incorporate electronic compensation may be inappropriate for use in infants and very young children.
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Affiliation(s)
- Simon Broughton
- Division of Asthma, Allergy and Lung Biology, King's College London-MRC Asthma Centre, London, United Kingdom
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