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Martins C, Severo M, Silva D, Barros H, Moreira A. Development and validation of predictive equations for spirometry in Portuguese children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100084. [PMID: 37780790 PMCID: PMC10509892 DOI: 10.1016/j.jacig.2023.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 10/03/2023]
Abstract
Background There are no data on lung function reference values for Portuguese children, and the contribution from the Portuguese data set in the Global Lung Function Initiative (GLI) is scant. Objectives We aimed to estimate new up-to-date reference values for Portuguese children by fitting a multivariable regression model to a general population sample. Further, we intended to assess the external validity of the obtained reference values and to compare them to the GLI reference values. Methods A random sample of 858 children from 20 primary schools were screened by health questionnaire, physical examination, and spirometry. Spirometric parameters recorded were FVC, FEV1, and FEF25-75. Multiple regression models were used to derive reference equations. Results Overall, 481 children, aged between 7 and 12 years, 267 boys (55.5%), were included. Boys had higher values for FVC and FEV1 than girls (P < .05). The strongest correlation was found for FVC with height (r = 0.71 for boys and 0.70 for girls), while the lowest correlation was observed in both sexes for FEF25-75 with age (r = 0.23). Height was the most significant predictor of FVC, FEV1, and FEF25-75 in our models. Weight and body mass index were not significant predictors for boys but had a significant effect on girls' equations for all spirometry parameters. Compared to obtained reference equations with GLI, they performed better for FVC in boys, FEV1 in girls, and FEF25-75 in both boys and girls. Conclusion We offer up-to-date reference values of spirometry for Portuguese children that can be used in clinical practice and research.
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Affiliation(s)
- Carla Martins
- Department of Immunoallergology, Centro Hospitalar de São João, University of Porto, Porto
- EPIUnit, Institute of Public Health, University of Porto, Porto
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto
| | - Milton Severo
- EPIUnit, Institute of Public Health, University of Porto, Porto
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto
| | - Diana Silva
- Department of Immunoallergology, Centro Hospitalar de São João, University of Porto, Porto
- EPIUnit, Institute of Public Health, University of Porto, Porto
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto
| | - Henrique Barros
- EPIUnit, Institute of Public Health, University of Porto, Porto
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto
- Predictive Medicine and Public Health Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto (FMUP), Porto
| | - Andre Moreira
- Department of Immunoallergology, Centro Hospitalar de São João, University of Porto, Porto
- EPIUnit, Institute of Public Health, University of Porto, Porto
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto
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Hopp RJ, Pasha MA. A literature review of the evidence that a 12% improvement in FEV1 is an appropriate cut-off for children. J Asthma 2016; 53:413-8. [PMID: 26786829 DOI: 10.3109/02770903.2015.1108436] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION A well-performed spirometry, using a change in forced expiratory volume in one second (FEV(1)) after albuterol, is commonly used to support the likelihood of an asthma diagnosis. The current standard, accepted by the 2007 National Heart Lung and Blood Institute Asthma Expert Panel Report-3 (EPR-3) guidelines, is a 12% improvement in the FEV(1) after a bronchodilator. OBJECTIVE We sought to determine whether existing studies support or refute using a 12% improvement as a significant change in FEV(1) in children and adolescents. DATA SOURCES We reviewed the literature of children and adolescents using Medline searches to discover pertinent population studies and comparative studies that included FEV(1) measurements. RESULT The majority of the discovered studies suggest a less stringent improvement in FEV(1) in children might be applicable. CONCLUSION Supported by the published literature, we suggest an alternative interpretive strategy of expressing the results of a spirometry measurement when a diagnosis of asthma in a child is being considered using a bronchodilator response.
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Affiliation(s)
- Russell J Hopp
- a Department of Pediatrics , Creighton University , Omaha , NE , USA , and
| | - Muhammad A Pasha
- b Department of Medicine , Albany Medical Center , Albany , NY , USA
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Lee JW, Shim JY, Kwon JW, Kim HY, Seo JH, Kim BJ, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Jung YH, Hong SJ. Exhaled nitric oxide as a better diagnostic indicator for evaluating wheeze and airway hyperresponsiveness in preschool children. J Asthma 2015; 52:1054-9. [PMID: 26287987 DOI: 10.3109/02770903.2015.1046078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Fractional concentration of exhaled nitric oxide (FeNO) is a known marker of airway inflammation. The aims of this study were to evaluate FeNO, impulse oscillometry (IOS), and spirometry in preschool children and to investigate their relationship with wheeze and airway hyperresponsiveness (AHR). METHODS We performed a population-based, cross-sectional study with 561 children aged 5-6 years. A total of 544 children completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and eligible for the study. We measured FeNO, spirometry, methacholine bronchial provocation, and IOS. AHR was defined as the induction of a 20% decrease in FEV(1)(PC(20)) by a methacholine concentration ≤8.0 mg/dL. RESULTS Children who had wheeze or AHR had higher FeNO levels than children without these symptoms. However, neither IOS nor spirometry parameters showed significant differences between children with wheeze or AHR and those without. FeNO was associated with AHR, whereas IOS or spirometry parameters showed no association. Mean FeNO levels were positively correlated with a dose-response slope for methacholine, but neither IOS nor spirometry parameters showed significant correlations. CONCLUSIONS FeNO is a more sensitive measurement of AHR and wheeze than spirometry or IOS in preschool children.
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Affiliation(s)
- Jung-Won Lee
- a Department of Pediatrics , Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Jung Yeon Shim
- a Department of Pediatrics , Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Ji-Won Kwon
- b Department of Pediatrics , Seoul National University Bundang Hospital , Sungnam , Korea
| | - Hyung Young Kim
- c Department of Pediatrics , Pusan National University Yangsan Hospital , Pediatrics , Yangsan , Korea
| | - Ju-Hee Seo
- d Department of Pediatrics , Korea Cancer Center Hospital , Seoul , Korea
| | - Byoung-Ju Kim
- e Department of Environmental Health , College of Medicine University of Cincinnati , Cincinnati , OH , USA
| | - Hyo-Bin Kim
- f Department of Pediatrics , Inje University Sanggye Paik Hospital , Seoul , Korea
| | - So-Yeon Lee
- g Department of Pediatrics , Hallym University Sacred Heart Hospital, Hallym University College of Medicine , Anyang , Korea
| | - Gwang-Cheon Jang
- h Department of Pediatrics , National Health Insurance Corporation Ilsan Hospital , Ilsan , Korea
| | - Dae-Jin Song
- i Department of Pediatrics , Korea University Guro Hospital, Korea University College of Medicine , Seoul , Korea
| | - Woo Kyung Kim
- j Department of Pediatrics , Inje University Seoul Paik Hospital , Seoul , Korea
| | - Young-Ho Jung
- k Department of Pediatrics , Bundang CHA Medical Center, CHA University School of Medicine , Seongnam , Korea , and
| | - Soo-Jong Hong
- l Department of Pediatrics , Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
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Burity EF, Pereira CAC, Rizzo JA, Brito MCA, Sarinho ESC. Reference values for spirometry in preschool children. J Pediatr (Rio J) 2013; 89:374-80. [PMID: 23791023 DOI: 10.1016/j.jped.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 01/09/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Reference values for lung function tests differ in samples from different countries, including values for preschoolers. The main objective of this study was to derive reference values in this population. METHODS A prospective study was conducted through a questionnaire applied to 425 preschool children aged 3 to 6 years, from schools and day-care centers in a metropolitan city in Brazil. Children were selected by simple random sampling from the aforementioned schools. Peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volumes (FEV1, FEV0.50), forced expiratory flow (FEF25-75) and FEV1/FVC, FEV0.5/FVC and FEF25-75/FVC ratios were evaluated. RESULTS Of the 425 children enrolled, 321 (75.6%) underwent the tests. Of these, 135 (42.0%) showed acceptable results with full expiratory curves and thus were included in the regression analysis to define the reference values. Height and gender significantly influenced FVC values through linear and logarithmic regression analysis. In males, R(2) increased with the logarithmic model for FVC and FEV1, but the linear model was retained for its simplicity. The lower limits were calculated by measuring the fifth percentile residues. CONCLUSION Full expiratory curves are more difficult to obtain in preschoolers. In addition to height, gender also influences the measures of FVC and FEV1. Reference values were defined for spirometry in preschool children in this population, which are applicable to similar populations.
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Affiliation(s)
- Edjane F Burity
- Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco, Recife, PE, Brazil.
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Oscillometric and spirometric bronchodilator response in preschool children with and without asthma. Can Respir J 2013; 19:273-7. [PMID: 22891189 DOI: 10.1155/2012/560323] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bronchodilator responses (BDR) are routinely used in the diagnosis and management of asthma; however, their acceptability and repeatability have not been evaluated using quality control criteria for preschool children. OBJECTIVES To compare conventional spirometry with an impulse oscillometry system (IOS) in healthy and asthmatic preschool children. METHODS Data from 30 asthmatic children and 29 controls (two to six years of age) who underwent IOS and spirometry before and after salbutamol administration were analyzed. RESULTS Stable asthmatic subjects significantly differed versus controls in their spirometry-assessed BDR (forced expiratory volume in 1 s [FEV1], forced vital capacity and forced expiratory flow at 25% to 75% of forced vital capacity) as well as their IOS-assessed BDR (respiratory resistance at 5 Hz [Rrs5], respiratory reactance at 5 Hz and area under the reactance curve). However, comparisons based on the area under the ROC curve for ΔFEV1 %initial versus ΔRrs5 % initial were 0.82 (95% CI 0.71 to 0.93) and 0.75 (95% CI 0.62 to 0.87), respectively. Moreover, the sensitivity and specificity for ΔFEV1 >=9% were 0.53 and 0.93, respectively. Importantly, sensitivity increased to 0.63 when either ΔFEV1 >=9% or ΔRrs5 >=29% was considered as an additional criterion for the diagnosis of asthma. CONCLUSION The accuracy of asthma diagnosis in preschool children may be increased by combining spirometry with IOS when measuring BDR.
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Kjaer HF, Eller E, Andersen KE, Høst A, Bindslev-Jensen C. The association between early sensitization patterns and subsequent allergic disease. The DARC birth cohort study. Pediatr Allergy Immunol 2009; 20:726-34. [PMID: 19744222 DOI: 10.1111/j.1399-3038.2009.00862.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prevention of allergic diseases depends on early identification of clinical markers preceding such disorders. This study describes the natural course of sensitization as measured by skin prick test (SPT) and specific immunoglobulin E (S-IgE) and analyses the association between early sensitization patterns and subsequent allergic disease at 6 yr of age. In an ongoing population-based birth cohort study of 562 children, follow-up visits were performed at 0, 3, 6, 9, 12, 18, 36, and 72 months. Visits included an interview, physical examination, SPTs, and S-IgE measurements for 12 food and inhalant allergens. The frequency of S-IgE sensitization to > or = 1 inhalant allergen was constant from 0 to 6 months (9-10%), decreased at 12-18 months before increasing from 36 months onwards. S-IgE sensitization to at least one food allergen remained constant from 0 to 6 yr. SPT sensitization to food and inhalant allergens appeared from 3 and 12 months, respectively. Early food sensitization (S-IgE) between 3 and 18 months was found to be significantly (p < 0.05) associated with atopic dermatitis (OR: 4.0 [1.6-9.9]) and asthma (OR 4.0 [1.1-12.5]) at the age of 6 yr. Children with atopic dermatitis, asthma, or rhinoconjunctivitis, and sensitization at 6 yr, were sensitized to food allergens to a large extent (53%, 42%, and 47%, respectively) already at 6 months. Early inhalant sensitization (S-IgE) did not increase the risk of later allergic disease. Early atopic dermatitis (0-18 months) was also highly associated with subsequent allergic disease. Children with early food sensitization and/or atopic dermatitis would be a proper target group for future interventional studies.
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Affiliation(s)
- Henrik Fomsgaard Kjaer
- Allergy Centre, Department of Dermatology, Odense University Hospital, 5000 Odense C, Denmark.
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Díaz Vázquez C, Carvajal Urueña I, Cano Garcinuño A, Mora Gandarillas I, Mola Caballero de Rodas P, Garcia Merino A, Dominguez Aurrecoechea B. [Feasibility of FeNO measurement in asthmatic children in the primary care setting. CANON Study]. An Pediatr (Barc) 2009; 71:209-14. [PMID: 19608468 DOI: 10.1016/j.anpedi.2009.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/05/2009] [Accepted: 05/19/2009] [Indexed: 11/19/2022] Open
Abstract
AIM Asses the feasibility of exhaled nitric oxide (FeNO) measurement in asthmatic children using a hand-held device in the primary care setting. METHODS Multicentre study performed in the paediatric clinics in seven Spanish primary health care centres. Each centre consecutively included 6-14 year-old children with doctor-diagnosed asthma. Children were asked to obtain two valid measurements of FeNO with the hand-held device NIOX MINO (Aerocrine AB, Solna, Sweden). Feasibility analysis included: (a) percentage of children able to perform the manoeuvre, (b) time required to obtain a successful determination, (c) number of attempts needed, and (d) acceptability of the technical procedure by clinical personnel involved in their guidance. RESULTS The Study enrolled 151 children. A total of 149 (98.7%) were able to perform the FeNO manoeuvre. The majority (55%) of children had previous experience of using the hand-held device. The Overall median (and Interquartile Range, IQR) of attempts needed to reach a first valid measurement was 2 (1-3) and median (IQR) of time taken was 4 min (3-5). Nurses considered the overall procedure was very easy or easy in 87.8% (teaching) and 86.5% (performing) of children. Children with previous experience performed the manoeuvre in less attempts, less time and more easily than children without experience. CONCLUSIONS Measurement of FeNO using NIOX MINO device is technically feasible and acceptable for children and staff in the clinical context of asthma management in primary health care. Previous experience had a positive, learning effect, in teaching and performing the FeNO manoeuvre.
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Affiliation(s)
- Rajesh Kumar
- Division of Allergy and Immunology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, USA.
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