1
|
Smith EF, Bradshaw TK, Urs RC, Evans DJ, Hemy NR, Hall GL, Wilson AC, Simpson SJ. Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm. Pediatr Pulmonol 2023; 58:3122-3132. [PMID: 37539845 PMCID: PMC10947568 DOI: 10.1002/ppul.26632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The European Respiratory Society Oscillometry Taskforce identified that clinical correlates of bronchodilator responses are needed to advance oscillometry in clinical practice. The understanding of bronchodilator-induced oscillometry changes in preterm lung disease is poor. Here we describe a comparison of bronchodilator assessments performed using oscillometry and spirometry in a population born very preterm and explore the relationship between bronchodilator-induced changes in respiratory function and clinical outcomes. METHODS Participants aged 6-23 born ≤32 (N = 288; 132 with bronchopulmonary dysplasia) and ≥37 weeks' gestation (N = 76, term-born controls) performed spirometry and oscillometry. A significant bronchodilator response (BDR) to 400 μg salbutamol was classified according to published criteria. RESULTS A BDR was identified in 30.9% (n = 85) of preterm-born individuals via spirometry and/or oscillometry, with poor agreement between spirometry and oscillometry definitions (k = 0.26; 95% confidence interval [CI] 0.18-0.40, p < .001). Those born preterm with a BDR by oscillometry but not spirometry had increased wheeze (33% vs. 11%, p = .010) and baseline resistance (Rrs5 z-score mean difference (MD) = 0.86, 95% CI 0.07-1.65, p = .025), but similar baseline spirometry to the group without a BDR (forced expiratory volume in 1 s [FEV1 ] z-score MD = -0.01, 95% CI -0.66 to 0.68, p > .999). Oscillometry was more feasible than spirometry (95% success rate vs. 85% (FEV1 ), 69% (forced vital capacity) success rate, p < .001), however being born preterm did not affect test feasibility. CONCLUSION In the preterm population, oscillometry is a feasible and clinically useful supportive test to assess the airway response to inhaled salbutamol. Changes measured by oscillometry reflect related but distinct physiological changes to those measured by spirometry, and thus these tests should not be used interchangeably.
Collapse
Affiliation(s)
- Elizabeth F. Smith
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Tiffany K. Bradshaw
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Rhea C. Urs
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Denby J. Evans
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Naomi R. Hemy
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Graham L. Hall
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Andrew C. Wilson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
- Child and Adolescent Health ServicePerth Children's HospitalNedlandsAustralia
| | - Shannon J. Simpson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| |
Collapse
|
2
|
Minsky RC, Bobbio T, Mucha FC, Schivinski CIS. Impact of Forced Exhalation Maneuvers During Spirometry on Airway Resistance Measured by Oscillometry in Healthy Children. Indian J Pediatr 2022; 89:1180-1186. [PMID: 35771348 DOI: 10.1007/s12098-022-04198-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the impact of repeated forced spirometry maneuvers on oscillometry parameters of healthy children. METHODS This is a cross-sectional study with healthy children (6-12 y old) from schools in Florianopolis-SC/Brazil. Good health condition was confirmed through questionnaires, health history, and normal spirometry. Spirometry maneuvers and impulse oscillometry were conducted according to the American Thoracic Society guidelines. The school children were grouped according to the number of spirometry maneuvers performed: 1) 3 maneuvers; 2) 4 maneuvers and 3) 5 to 8 maneuvers. The following oscillometry values were considered: at rest (T0); after the first spirometry maneuver (T1); and after the last maneuver (T2), according to the groups' allocation. The mixed model ANOVA was applied to verify the interaction of oscillometry parameters in all 3 moments and groups. The Friedman test was used for analysis of Fres (p < 0.05). RESULTS In 149 school children (mean age: 9.13 y old ± 1.98), there was a significant increase in Z5, R5, R20, and X5 values at rest and after the first spirometry maneuver, and values at rest and after the last maneuver in all groups. The effects on analyzed variables were significant in Z5 (F: 12.35; gl: 2; p < 0.001), R5 (F: 11.14; df: 2, p < 0.001), R20 (F: 7.53; df: 2, p < 0.001), and X5 (F: 4.30; df: 2, p = 0.014). CONCLUSION There were changes in respiratory mechanics after spirometry, like the increase in baseline Z5, R5, R20, and X5 after the first forced spirometry maneuver, and in comparison to the last maneuver obtained.
Collapse
Affiliation(s)
- Rafaela Coelho Minsky
- Department of Physiotherapy, State University of Santa Catarina, Santa Catarina, Florianopolis, 88080-350, Brazil
| | - Tatiana Bobbio
- Department of Physiotherapy, University of St. Augustine, Miami, FL, USA
| | - Francieli Camila Mucha
- Department of Physiotherapy, State University of Santa Catarina, Santa Catarina, Florianopolis, 88080-350, Brazil
| | | |
Collapse
|
3
|
Bokov P, Jallouli-Masmoudi D, Amat F, Houdouin V, Delclaux C. Small airway dysfunction is an independent dimension of wheezing disease in preschool children. Pediatr Allergy Immunol 2022; 33:e13647. [PMID: 34378250 DOI: 10.1111/pai.13647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whether small airway dysfunction (SAD), which is prevalent in asthma, helps to characterize wheezing phenotypes is undetermined. The objective was to assess whether SAD parameters obtained from impedance measurement and asthma probability are linked. METHODS One hundred and thirty-nine preschool children (mean age 4.7 years, 68% boys) suffering from recurrent wheezing underwent impulse oscillometry that allowed calculating peripheral resistance and compliance of the respiratory system (markers of SAD) using the extended RIC model (central and peripheral resistance, inertance, and peripheral compliance). Children were classified using the probability-based approach of GINA guidelines (few, some, and most having asthma). A principal component analysis (PCA) that determined the dimensions of wheezing disease evaluated the links between SAD and asthma probability. RESULTS Forty-seven children belonged to the few, 28 to the some, and 64 to the most having asthma groups. Whereas their anthropometrics and measured parameters were similar, the most having asthma group exhibited the lowest mean value of airway inertance after bronchodilator probably due to airway inhomogeneities. PCA characterized four independent dimensions including a peripheral resistance (constituted by baseline peripheral compliance, Frs, R5Hz, R5-20Hz, X5Hz, and AX), a central resistance (baseline central resistance, R20Hz), anthropometrics (age and height), and asthma probability (wheezing patterns and therapeutic steps). Thus, PCA showed that the SAD markers were independent from clinical dimensions and were unable to differentiate wheezing phenotypes. CONCLUSIONS Lung function parameters obtained from impulse oscillometry and asthma probability were belonging to independent dimensions of the wheezing disease.
Collapse
Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Donies Jallouli-Masmoudi
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Flore Amat
- Service de Pneumopédiatrie, INSERM UMR S 1136, AP-HP, Hôpital Robert Debré, Paris, France
| | - Véronique Houdouin
- Service de Pneumopédiatrie, INSERM UMR S 976, AP-HP, Hôpital Robert Debré, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| |
Collapse
|
4
|
King GG, Bates J, Berger KI, Calverley P, de Melo PL, Dellacà RL, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, Kaminsky DA, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oppenheimer BW, Simpson SJ, Thamrin C, van den Berge M, Oostveen E. Technical standards for respiratory oscillometry. Eur Respir J 2020; 55:13993003.00753-2019. [PMID: 31772002 DOI: 10.1183/13993003.00753-2019] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
Oscillometry (also known as the forced oscillation technique) measures the mechanical properties of the respiratory system (upper and intrathoracic airways, lung tissue and chest wall) during quiet tidal breathing, by the application of an oscillating pressure signal (input or forcing signal), most commonly at the mouth. With increased clinical and research use, it is critical that all technical details of the hardware design, signal processing and analyses, and testing protocols are transparent and clearly reported to allow standardisation, comparison and replication of clinical and research studies. Because of this need, an update of the 2003 European Respiratory Society (ERS) technical standards document was produced by an ERS task force of experts who are active in clinical oscillometry research.The aim of the task force was to provide technical recommendations regarding oscillometry measurement including hardware, software, testing protocols and quality control.The main changes in this update, compared with the 2003 ERS task force document are 1) new quality control procedures which reflect use of "within-breath" analysis, and methods of handling artefacts; 2) recommendation to disclose signal processing, quality control, artefact handling and breathing protocols (e.g. number and duration of acquisitions) in reports and publications to allow comparability and replication between devices and laboratories; 3) a summary review of new data to support threshold values for bronchodilator and bronchial challenge tests; and 4) updated list of predicted impedance values in adults and children.
Collapse
Affiliation(s)
- Gregory G King
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Jason Bates
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Kenneth I Berger
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Pedro L de Melo
- Institute of Biology and Faculty of Engineering, Department of Physiology, Biomedical Instrumentation Laboratory, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB, Politecnico di Milano University, Milano, Italy
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Iulia Ioan
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Charles G Irvin
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - David W Kaczka
- Depts of Anesthesia, Biomedical Engineering and Radiology, University of Iowa, Iowa City, IA, USA
| | - David A Kaminsky
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Hajime Kurosawa
- Dept of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Pediatric University Hospital, Florence, Italy
| | - Geoffrey N Maksym
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - François Marchal
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Beno W Oppenheimer
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Shannon J Simpson
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Cindy Thamrin
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| |
Collapse
|
5
|
Starczewska-Dymek L, Bozek A, Mielnik M. The sensitivity and specificity of the forced oscillation technique in the diagnosis of bronchoconstriction in children. J Asthma 2019; 58:334-339. [PMID: 31868051 DOI: 10.1080/02770903.2019.1702054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The forced oscillation technique (FOT) is a useful diagnostic respiratory system for children. However, the final value of the FOT in the diagnosis of bronchoconstriction is still open. The aim of the study was to evaluate the sensitivity and specificity of the FOT vs. body plethysmography tests in the measure of bronchoconstriction in asthmatic children. MATERIALS AND METHODS A total of 102 children aged 2 to 6 years diagnosed with early-onset asthma and 52 healthy controls were included in this prospective, randomized study. All asthmatic patients and healthy controls underwent a basic FOT as one measurement, according to the recommendation of the Resmon Pro FOT. Then, the reversibility test was performed 20 min after the administration of 200 mg salbutamol using the FOT and body plethysmography in all patients. RESULTS The mean basic Rrs, Xrs and sRaw in asthmatic patients were, respectively, 11.13 ± 1.28 kPa sL-1, -4.6 ± 1.18 kPa sL-1 and 1.72 ± 0.58 kPa s. Similar parameters were significantly better in the control group (p < 0.05). A total of 73 (71.6%) asthmatic patients had a positive test using the FOT according to Calogero. In 4 (7.7%) patients in the control group, a positive test was obtained. In body plethysmography, similar results were reached, with a positive test in 76 (74.5%) study patients and 5 (9.6%) control patients. CONCLUSIONS A bronchial reversibility test with the use of the FOT is useful for the diagnosis of bronchial asthma, especially with the use of an Rrs parameter, such as the body plethysmography test.
Collapse
Affiliation(s)
| | - A Bozek
- Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia, Katowice, Poland
| | - M Mielnik
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Sląskie, Poland
| |
Collapse
|
6
|
Veneroni C, Dahl MJ, Lavizzari A, Dawson E, Rebentisch A, Studstill S, Bowen S, Albertine KH, Dellaca RL. Non-invasive measurements of respiratory system mechanical properties by the forced oscillation technique in spontaneously breathing, mixed-breed, normal term lambs from birth to five months of age. Physiol Meas 2019; 40:105007. [PMID: 31341100 DOI: 10.1088/1361-6579/ab3493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide a non-invasive approach to monitoring lung function in spontaneously breathing lambs, from birth to five months of life, by the forced oscillation technique (FOT). This report describes the experimental set-up, data processing, and identification of normal predicted values of resistance (Rrs) and reactance (Xrs) of the respiratory system, along with normal bronchodilator response for bronchial reversibility testing. APPROACH Rrs and Xrs at 5, 11, and 19 Hz were measured monthly for five months in 20 normal term lambs that breathed spontaneously. In seven lambs, repeated measurements also were made within the first month of life (at 3, 7, 14, and 21 d of life). We determined the repeatability and reproducibility of the measurements and characterized the relationship between lung mechanics and age, sex, and body dimensions, using regression analysis, and measured changes in lung mechanics in response to inhaled bronchodilator. MAIN RESULTS The measurements provided repeatable and reproducible data. Rrs decreased, whereas Xrs increased, with growth from birth through the first two months of life, after which no statistically significant differences were detected. We identified normal value equations for Rrs and Xrs and for each of the measured anthropometric variables. Respiratory system mechanics were not affected by the bronchodilator. SIGNIFICANCE The FOT provides reliable non-invasive measurement of respiratory system mechanics in spontaneously breathing term lambs from birth to five months of age. The methods and normal reference values defined in this study will facilitate testing of the pathophysiological consequences of preterm birth and prolonged respiratory support on respiratory system mechanics.
Collapse
Affiliation(s)
- Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy. Co-first and co-last authors. Author to whom any correspondence should be addressed
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Lombardi E, Fainardi V, Calogero C, Puglia M, Voller F, Cuttini M, Rusconi F. Lung function in a cohort of 5-year-old children born very preterm. Pediatr Pulmonol 2018; 53:1633-1639. [PMID: 30345653 DOI: 10.1002/ppul.24179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We assessed lung function and respiratory health in an area-based prospective cohort of preschool children born very preterm. DESIGN Lung function was measured by interrupter respiratory resistance (Rint) and forced oscillation technique (FOT) (respiratory resistance (Rrs8), reactance (Xrs8), and area under the reactance curve (AX)) at a median age of 5.2 years in a cohort of 194 children born at 22-31 weeks of gestational age (GA) in Tuscany, Italy. Respiratory symptoms and hospitalizations were also assessed. RESULTS Mean (SD) lung function Z-scores were impaired in preterm children for Rint (0.72 (1.13)), Xrs8 (-0.28 (1.34)), and AX (0.29 (1.41)). However, only a relatively small proportion of children (14.5-17.4%) had values beyond the 95th centile or below the 5th. Children with bronchopulmonary dysplasia (BPD) (n = 24) had slightly but not significantly impaired lung function indices in comparison with those without BPD (n = 170). In a multivariable analysis, lower GA was associated with worse lung function indices. Fifty-five percent of children had a history of wheezing ever and 21% had been hospitalized in their lifetime because of lower respiratory infections; 31% had wheezing in the last 12 months and this was associated with increased Rrs8 (P = 0.04) and AX (P = 0.08), and with decreased Xrs8 (P = 0.04) Z-scores. CONCLUSIONS Irrespectively of BPD preschool children born very preterm had impaired lung function indices, as measured by Rint and FOT, and a slightly higher burden of respiratory problems than the general population. GA seems to be crucial for lung development.
Collapse
Affiliation(s)
- Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Claudia Calogero
- Pediatric Pulmonary Unit, Meyer Children's University Hospital, Florence, Italy
| | - Monia Puglia
- Unit of Epidemiology, Health Agency of Tuscany, Florence, Italy
| | - Fabio Voller
- Unit of Epidemiology, Health Agency of Tuscany, Florence, Italy
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Franca Rusconi
- Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy
| |
Collapse
|
8
|
Kattan M, Bacharier LB, O'Connor GT, Cohen R, Sorkness RL, Morgan W, Gergen PJ, Jaffee KF, Visness CM, Wood RA, Bloomberg GR, Doyle S, Burton R, Gern JE. Spirometry and Impulse Oscillometry in Preschool Children: Acceptability and Relationship to Maternal Smoking in Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:1596-1603.e6. [PMID: 29449165 PMCID: PMC6089669 DOI: 10.1016/j.jaip.2017.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comparisons of the technical acceptability of spirometry and impulse oscillometry (IOS) and clinical correlations of the measurements have not been well studied in young children. There are no large studies focused on African American and Hispanic children. OBJECTIVES We sought to (1) compare the acceptability of spirometry and IOS in 3- to 5-year-old children and (2) examine the relationship of maternal smoking during pregnancy to later lung function. METHODS Spirometry and IOS were attempted at 4 sites from the Urban Environmental and Childhood Asthma Study birth cohort at ages 3, 4, and 5 years (472, 471, and 479 children, respectively). We measured forced expiratory flow in 0.5 s (forced expiratory volume in 0.5 seconds [FEV0.5]) with spirometry and area of reactance (AX), resistance and reactance at 5 Hz (R5 and X5, respectively) using IOS. RESULTS Children were more likely to achieve acceptable maneuvers with spirometry than with IOS at age 3 (60% vs 46%, P < .001) and 5 years (89% vs 84%, P = .02). Performance was consistent among the 4 study sites. In children without recurrent wheeze, there were strong trends for higher FEV0.5 and lower R5 and AX over time. Maternal smoking during pregnancy was associated with higher AX at ages 4 and 5 years (P < .01 for both years). There was no significant difference in FEV0.5 between children with and without in utero exposure to smoking. CONCLUSION There is a higher rate of acceptable maneuvers with spirometry compared with IOS, but IOS may be a better indicator of peripheral airway function in preschool children.
Collapse
Affiliation(s)
- Meyer Kattan
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo
| | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Robyn Cohen
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Ronald L Sorkness
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Wayne Morgan
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Ariz
| | - Peter J Gergen
- Division of Allergy, Immunology, and Transplantation, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | | | - Robert A Wood
- Department of Pediatric Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Gordon R Bloomberg
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo
| | - Susan Doyle
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ryan Burton
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - James E Gern
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| |
Collapse
|
9
|
The Usefulness of the Forced Oscillation Technique in the Diagnosis of Bronchial Asthma in Children. Can Respir J 2018; 2018:7519592. [PMID: 30140327 PMCID: PMC6081498 DOI: 10.1155/2018/7519592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/16/2018] [Accepted: 06/26/2018] [Indexed: 01/11/2023] Open
Abstract
The forced oscillation technique (FOT) requires minimal patient cooperation and is useful for children. However, comprehensive values of respiratory impedance at baseline and after the reversibility test have not been definitively confirmed. The aim of this study was to evaluate the basic parameters of FOT reactance (Xrs) and resistance (Rrs) in groups of healthy children and children with controlled and uncontrolled asthma. The second aim was the assessment of the reversibility bronchial test using the forced oscillation method in children with bronchial asthma. Materials and Methods. One hundred and six children aged from 2 to 6 years diagnosed with early-onset controlled or uncontrolled asthma and healthy controls were included in this single-center, prospective, randomized study. All asthmatic patients and healthy controls underwent basic FOT as one measurement according to the recommendation of Resmon Pro FOT. The reversibility test was then performed 15 min after the administration of 200 mcg salbutamol by MDI in all patients. Results. Basic Rrs showed significantly higher mean values in patients with uncontrolled asthma compared to patients with controlled asthma, which were in turn higher than the values for patients in the control group (11.14 ± 1.29 versus 15.71 ± 2.6 versus 9.21 ± 0.98, resp.; p < 0.05). The data analysis showed similar relationships in terms of the Xrs between the studied groups (−4.76 ± 1.19 versus −7.31 ± 2.33 versus −2.11 ± 0.48, resp.; p < 0.05). According to the changes in the Rrs values, 35 (66%) positive bronchial reversibility tests were obtained in 53 subjects with controlled asthma and in 39 (74%) subjects with uncontrolled asthma. Conclusions. Rrs and Xrs obtained by FOT well-discriminate patients with asthma from healthy children. A bronchial reversibility test involving the use of FOT is valuable for the diagnosis of bronchial asthma.
Collapse
|
10
|
AlBlooshi A, AlKalbani A, Narchi H, Al-Hamad S, Al-Houqani M, AlBadi G, Souid AK, Hall GL. Respiratory function in healthy Emirati children using forced oscillations. Pediatr Pulmonol 2018. [PMID: 29528572 DOI: 10.1002/ppul.23985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The forced oscillation technique (FOT) allows the quantification of respiratory function, does not require active cooperation and as such is ideally suited for use in young children. The application of the FOT in non-Caucasian populations is limited and it remains unclear if current reference ranges for the FOT in Caucasian children are appropriate for children in the Arabian Peninsula. This study explored the use of the FOT in healthy school-aged children in the United Arab Emirates (UAE). METHODS Lung function using FOT was assessed in healthy Emirati children aged 4-12 years. Using a validated questionnaires general medical and respiratory histories were obtained. Prediction equations for resistance (Rrs), reactance (Xrs), and area under reactance curve (AX) were calculated and compared to previous studies. RESULTS FOT was successfully obtained in 291 healthy Emirati children. Linear regression modelling including weight, height, age, and gender in transformed FOT outcomes demonstrated that height was the strongest predictor of FOT outcomes (P < 0.001). Using the equated prediction equation Z-scores were calculated. FOT outcomes in Emirati children did not match previously published reference equations in Caucasians children (P < 0.001). CONCLUSION FOT measurements were feasible in Emirati school-children. New FOT reference equation in Emirati children were derived. FOT reference equation in Emirati children was different from published equations in Caucasians.
Collapse
Affiliation(s)
- Afaf AlBlooshi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, UAE
| | | | - Hassib Narchi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, UAE
| | - Sania Al-Hamad
- Department of Pediatrics, United Arab Emirates University, Al-Ain, UAE
| | | | - Ghaya AlBadi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, UAE
| | - Abdul-Kader Souid
- Department of Pediatrics, United Arab Emirates University, Al-Ain, UAE
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute and School of Physiotherapy and Exercise Science, Curtin University and Centre of Child Health Research, University of Western Australia, Perth, Australia
| |
Collapse
|
11
|
Fainardi V, Lombardi E. Lung function tests to monitor respiratory disease in preschool children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:148-156. [PMID: 29957746 PMCID: PMC6179029 DOI: 10.23750/abm.v89i2.7155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/06/2018] [Indexed: 01/22/2023]
Abstract
Pulmonary function tests are routinely used in the diagnosis and follow-up of respiratory diseases. In preschool children assessment and evaluation of lung function has always been challenging but improved techniques that require only minimal collaboration allowed obtaining reliable and useful results even in this group of patients. In this review we will describe the different techniques used in clinical practice to measure lung function in preschool children.(www.actabiomedica.it)
Collapse
Affiliation(s)
| | - Enrico Lombardi
- Paediatric Pulmonary Unit, "Anna Meyer" Paediatric University Hospital, Florence, Italy.
| |
Collapse
|
12
|
Narchi H, AlBlooshi A. Prediction equations of forced oscillation technique: the insidious role of collinearity. Respir Res 2018; 19:48. [PMID: 29587758 PMCID: PMC5869763 DOI: 10.1186/s12931-018-0745-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/13/2018] [Indexed: 12/23/2022] Open
Abstract
Many studies have reported reference data for forced oscillation technique (FOT) in healthy children. The prediction equation of FOT parameters were derived from a multivariable regression model examining the effect of age, gender, weight and height on each parameter. As many of these variables are likely to be correlated, collinearity might have affected the accuracy of the model, potentially resulting in misleading, erroneous or difficult to interpret conclusions. The aim of this work was: To review all FOT publications in children since 2005 to analyze whether collinearity was considered in the construction of the published prediction equations. Then to compare these prediction equations with our own study. And to analyse, in our study, how collinearity between the explanatory variables might affect the predicted equations if it was not considered in the model. The results showed that none of the ten reviewed studies had stated whether collinearity was checked for. Half of the reports had also included in their equations variables which are physiologically correlated, such as age, weight and height. The predicted resistance varied by up to 28% amongst these studies. And in our study, multicollinearity was identified between the explanatory variables initially considered for the regression model (age, weight and height). Ignoring it would have resulted in inaccuracies in the coefficients of the equation, their signs (positive or negative), their 95% confidence intervals, their significance level and the model goodness of fit. In Conclusion with inaccurately constructed and improperly reported models, understanding the results and reproducing the models for future research might be compromised.
Collapse
Affiliation(s)
- Hassib Narchi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, P O Box 17666, United Arab Emirates
| | - Afaf AlBlooshi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, P O Box 17666, United Arab Emirates.
| |
Collapse
|
13
|
Sly PD, Shackleton C, Czovek D, Hantos Z. Systematic Error in Respiratory Impedance Using Commercial Equipment Calibrated according to the Manufacturer’s Instructions. Am J Respir Crit Care Med 2018; 197:532-534. [DOI: 10.1164/rccm.201704-0713le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter D. Sly
- The University of QueenslandBrisbane, Australiaand
| | | | | | - Zoltan Hantos
- The University of QueenslandBrisbane, Australiaand
- The University of SzegedDeszk, Hungary
| |
Collapse
|
14
|
Alblooshi A, Alkalbani A, Albadi G, Narchi H, Hall G. Is forced oscillation technique the next respiratory function test of choice in childhood asthma. World J Methodol 2017; 7:129-138. [PMID: 29354485 PMCID: PMC5746666 DOI: 10.5662/wjm.v7.i4.129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/08/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023] Open
Abstract
Respiratory diseases, especially asthma, are common in children. While spirometry contributes to asthma diagnosis and management in older children, it has a limited role in younger children whom are often unable to perform forced expiratory manoeuvre. The development of novel diagnostic methods which require minimal effort, such as forced oscillation technique (FOT) is, therefore, a welcome and promising addition. FOT involves applying external, small amplitude oscillations to the respiratory system during tidal breathing. Therefore, it requires minimal effort and cooperation. The FOT has the potential to facilitate asthma diagnosis and management in pre-school children by faciliting the objective measurement of baseline lung function and airway reactivity in children unable to successfully perform spirometry. Traditionally the use of FOT was limited to specialised centres. However, the availability of commercial equipment resulted in its use both in research and in clinical practice. In this article, we review the available literature on the use of FOT in childhood asthma. The technical aspects of FOT are described followed by a discussion of its practical aspects in the clinical field including the measurement of baseline lung function and associated reference ranges, bronchodilator responsiveness and bronchial hyper-responsiveness. We also highlight the difficulties and limitations that might be encountered and future research directions.
Collapse
Affiliation(s)
- Afaf Alblooshi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Alia Alkalbani
- Department of Pediatrics, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Ghaya Albadi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Graham Hall
- Department of Children’s Lung Health, Telethon Kids Institute, Perth 6000, Australia
- School of Physiotherapy and Exercise Science, Curtin University and Centre of Child Health Research, University of Western Australia, Perth 6000, Australia
| |
Collapse
|
15
|
Shackleton C, Czovek D, Grimwood K, Ware RS, Radics B, Hantos Z, Sly PD. Defining 'healthy' in preschool-aged children for forced oscillation technique reference equations. Respirology 2017; 23:406-413. [PMID: 28981187 DOI: 10.1111/resp.13186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/13/2017] [Accepted: 08/28/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Selecting 'healthy' preschool-aged children for reference ranges may not be straightforward. Relaxing inclusion criteria for normative data does not affect spirometry z-scores. We therefore investigated the effect of similarly relaxing inclusion criteria in preschoolers on reference ranges for respiratory impedance (Zrs) using a modified forced oscillation technique (FOT). METHODS The International Study of Asthma and Allergies in Childhood questionnaire classified 585 children into a healthy and five mutually exclusive groups. Zrs was measured between 4 and 26 Hz and resistance (R) and compliance (C) obtained by model fitting. Prediction models were determined using mixed effect models and z-scores compared between healthy children and the five groups. RESULTS Zrs data were obtained for 494 participants (4.30 ± 0.7 years) on 587 occasions. Comparison of the Zrs z-scores between the healthy children and the health groups found significant differences in children with asthma, current wheeze and respiratory symptoms, but not in children born preterm or with early-life wheeze. Adding these two groups to the healthy dataset had no significant effect on the distribution of z-scores and increased the size of the dataset by 22.3%. CONCLUSION Our data suggest that preschool-aged children born preterm or with early-life wheeze can be included in FOT reference equations, while those with asthma, current wheeze and respiratory symptoms within 4 weeks of testing should be excluded. This more inclusive approach results in more robust FOT reference ranges.
Collapse
Affiliation(s)
- Claire Shackleton
- Children's Lung Environment and Asthma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Dorottya Czovek
- Children's Lung Environment and Asthma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
| | - Robert S Ware
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Bence Radics
- Department of Pulmonology, University of Szeged, Deszk, Hungary
| | - Zoltan Hantos
- Children's Lung Environment and Asthma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Department of Pulmonology, University of Szeged, Deszk, Hungary
| | - Peter D Sly
- Children's Lung Environment and Asthma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
16
|
Yon DK, Jee HM, Ha EK, Lee SJ, Jung YH, Lee KS, Han MY. Small airway bronchodilator response to different doses of salbutamol in 7-year-old children. Respir Res 2017; 18:148. [PMID: 28774310 PMCID: PMC5543428 DOI: 10.1186/s12931-017-0632-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/26/2017] [Indexed: 11/10/2022] Open
Abstract
The Global Initiative for Asthma (GINA) guidelines do not specify a bronchodilator range for bronchodilator response (BDR) testing and simply recommend a salbutamol dose of 200 to 400 μg. We determined the oscillometric BDR results of children given low-dose (2 puffs, 200 μg) and standard-dose (4 puffs, 400 μg) salbutamol to compare the small airway responses of healthy controls (defined using criteria based on the guidelines developed at the American Thoracic Society) and exclusion subjects (defined as any child that did not meet the inclusion criteria for healthy controls). The oscillometric reactance of small airways is significantly associated with the dose of salbutamol used for BDR testing in exclusion children. We suggest use of the standard-dose of salbutamol for oscillometric BDR testing.
Collapse
Affiliation(s)
- Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Eun Kyo Ha
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Seung Jin Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Young-Ho Jung
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Kyung Suk Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
| |
Collapse
|
17
|
Udomittipong K, Srisukhon W, Nimmannit A, Komoltri C. Respiratory Impedance Reference Values for Forced Oscillation Technique Predicted by Arm Span and Height in Thai Preschool Children. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2017. [DOI: 10.1089/ped.2017.0747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kanokporn Udomittipong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wichuta Srisukhon
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Akarin Nimmannit
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chulaluk Komoltri
- Division of Clinical Epidemiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
18
|
Raywood E, Lum S, Aurora P, Pike K. The bronchodilator response in preschool children: A systematic review. Pediatr Pulmonol 2016; 51:1242-1250. [PMID: 27273556 DOI: 10.1002/ppul.23459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The bronchodilator response (BDR) is frequently used to support diagnostic and therapeutic decision-making for children who wheeze. However, there is little evidence-based guidance describing the role of BDR testing in preschool children and it is unclear whether published cut-off values, which are derived from adult data, can be applied to this population. METHODS We searched MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception-September 2015) for studies reporting response to a bronchodilator in healthy preschool children, response following placebo inhalation, and the diagnostic efficacy of BDR compared with a clinical diagnosis of asthma/recurrent wheezing. FINDINGS We included 14 studies. Thirteen studies provided BDR data from healthy preschool children. Two studies reported response to placebo in preschool children with asthma/recurrent wheezing. Twelve studies compared BDR measurements from preschool children with asthma/recurrent wheeze to those from healthy children and seven of these studies reported diagnostic efficacy. Significant differences between the BDR measured in healthy preschool children compared with that in children with asthma/recurrent wheeze were demonstrated in some, but not all studies. Techniques such as interrupter resistance, oscillometry, and plethysmography were more consistently successfully completed than spirometry. Between study heterogeneity precluded determination of an optimum technique. INTERPRETATION There is little evidence to suggest spirometry-based BDR can be used in the clinical assessment of preschool children who wheeze. Further evaluation of simple alternative techniques is required. Future studies should recruit children in whom airways disease is suspected and should evaluate the ability of BDR testing to predict treatment response. Pediatr Pulmonol. 2016;51:1242-1250. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Emma Raywood
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Paul Aurora
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Katharine Pike
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom.
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
19
|
Fenu G, Calogero C, Lombardi E. Lung Function Tests in Preschool Children. Turk Thorac J 2015; 16:185-188. [PMID: 29404101 DOI: 10.5152/ttd.2015.5038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/15/2015] [Indexed: 11/22/2022]
Abstract
The measurement of lung function by spirometry is routinely used to monitor and adequately treat children with asthma. The assessment and evaluation of lung function in children aged 3-5 years has been neglected for a long time because of the difficulty to perform forced expiratory maneuvers. However, the use of techniques such as the interrupter technique and the forced oscillation technique, which only require passive collaboration and where the only request to the child is to breathe at tidal volume, has overcome this limitation. Other techniques such as the measurement of specific airway resistance by plethysmography or the measurement of the lung clearance index using the multiple-breath washout might be helpful in this regard, although these techniques are less standardized in preschool children.
Collapse
Affiliation(s)
- Grazia Fenu
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University-Hospital, Florence, Italy
| | - Claudia Calogero
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University-Hospital, Florence, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University-Hospital, Florence, Italy
| |
Collapse
|
20
|
Le Tuan T, Nguyen NM, Demoulin B, Bonabel C, Nguyen-Thi PL, Ioan I, Schweitzer C, Nguyen HTT, Varechova S, Marchal F. Specific airway resistance in healthy young Vietnamese and Caucasian adults. Respir Physiol Neurobiol 2015; 211:17-21. [PMID: 25796614 DOI: 10.1016/j.resp.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 11/28/2022]
Abstract
In healthy Vietnamese children the respiratory resistance has been suggested to be similar at 110 cm height but larger at 130 cm when compared with data in Caucasians from the literature, suggesting smaller airways in older Vietnamese children (Vu et al., 2008). The hypothesis tested here is whether the difference in airway resistance remains consistent throughout growth, and if it is larger in adult Vietnamese than in Caucasians. Airway resistance and Functional Residual Capacity were measured in healthy young Caucasian and Vietnamese adults in their respective native country using identical equipment and protocols. Ninety five subjects in Vietnam (60 males) and 101 in France (41 males) were recruited. Airway resistance was significantly larger in Vietnamese than in Caucasians and in females than in males, consistent with difference in body dimensions. Specific airway resistance however was not different by ethnicity or gender. The findings do not support the hypothesis that airway size at adult age - once normalized for lung volume - differs between Vietnamese and Caucasians.
Collapse
Affiliation(s)
- Thanh Le Tuan
- Department of Physiology, Hanoi Medical University , Hanoi, Vietnam
| | - Ngoc Minh Nguyen
- Department of Physiology, Hanoi Medical University , Hanoi, Vietnam
| | - Bruno Demoulin
- Department of Physiology, University of Lorraine, Vandoeuvre les Nancy, France
| | - Claude Bonabel
- Department of Paediatric Lung Function Testing, University Hospital of Nancy, Children's Hospital, Vandoeuvre les Nancy, France
| | - Phi Linh Nguyen-Thi
- Department of Epidemiology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Iulia Ioan
- Department of Paediatric Lung Function Testing, University Hospital of Nancy, Children's Hospital, Vandoeuvre les Nancy, France
| | - Cyril Schweitzer
- Department of Paediatric Lung Function Testing, University Hospital of Nancy, Children's Hospital, Vandoeuvre les Nancy, France; Department of Epidemiology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - H T T Nguyen
- Department of Physiology, Hanoi Medical University , Hanoi, Vietnam
| | - Silvia Varechova
- Department of Paediatric Lung Function Testing, University Hospital of Nancy, Children's Hospital, Vandoeuvre les Nancy, France; Department of Epidemiology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Francois Marchal
- Department of Paediatric Lung Function Testing, University Hospital of Nancy, Children's Hospital, Vandoeuvre les Nancy, France; Department of Epidemiology, University Hospital of Nancy, Vandoeuvre les Nancy, France.
| |
Collapse
|
21
|
Calogero C, Simpson SJ, Lombardi E, Parri N, Cuomo B, Palumbo M, de Martino M, Shackleton C, Verheggen M, Gavidia T, Franklin PJ, Kusel MMH, Park J, Sly PD, Hall GL. Respiratory impedance and bronchodilator responsiveness in healthy children aged 2-13 years. Pediatr Pulmonol 2013; 48:707-15. [PMID: 23169525 DOI: 10.1002/ppul.22699] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/03/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND The forced oscillation technique (FOT) can be used in children as young as 2 years of age and in those unable to perform routine spirometry. There is limited information on changes in FOT outcomes in healthy children beyond the preschool years and the level of bronchodilator responsiveness (BDR) in healthy children. We aimed to create reference ranges for respiratory impedance outcomes collated from multiple centers. Outcomes included respiratory system resistance (R(rs)) and reactance (X(rs)), resonant frequency (Fres), frequency dependence of R(rs) (Fdep), and the area under the reactance curve (AX). We also aimed to define the physiological effects of bronchodilators in a large population of healthy children using the FOT. METHODS Respiratory impedance was measured in 760 healthy children, aged 2-13 years, from Australia and Italy. Stepwise linear regression identified anthropometric predictors of transformed R(rs) and X(rs) at 6, 8, and 10 Hz, Fres, Fdep, and AX. Bronchodilator response (BDR) was assessed in 508 children after 200 µg of inhaled salbutamol. RESULTS Regression analysis showed that R(rs), X(rs), and AX outcomes were dependent on height and sex. The BDR cut-offs by absolute change in R(rs8), X(rs8), and AX were -2.74 hPa s L(-1), 1.93 hPa s L(-1), and -33 hPa s L(-1), respectively. These corresponded to relative and Z-score changes of -32%; -1.85 for R(rs8), 65%; 1.95 for X(rs8), and -82%; -2.04 for AX. CONCLUSIONS We have established generalizable reference ranges for respiratory impedance and defined cut-offs for a positive bronchodilator response using the FOT in healthy children.
Collapse
Affiliation(s)
- Claudia Calogero
- Unit of Respiratory Medicine, Department of Paediatrics, University of Florence, Anna Meyer University Hospital for Children, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Shackleton C, Barraza-Villarreal A, Chen L, Gangell CL, Romieu I, Sly PD. Reference ranges for Mexican preschool-aged children using the forced oscillation technique. Arch Bronconeumol 2013; 49:326-9. [PMID: 23587799 DOI: 10.1016/j.arbres.2013.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Recently, multi-ethnic reference ranges for spirometry have been created for use worldwide. In comparison, forced oscillation technique (FOT) reference values are limited to specific equipment and study populations, with current FOT reference ranges created in a Caucasian population. We aimed to develop FOT reference ranges for preschool-aged Mexican children and to compare these with current FOT reference ranges. PATIENTS AND METHODS Respiratory resistance (Rrs) and reactance (Xrs) was measured in healthy Mexican children three to five years of age using commercial FOT equipment. The relationship between height and Rrs and Xrs was determined using regression analyses, taking into account age, weight, sex, and exposure to tobacco smoke. Reference equations were calculated for the Mexican children and Z-scores determined for Rrs and Xrs at 6 and 8Hz. A paired t-test assessed the difference in Z-scores between the Australian reference values and those created for the Mexican cohort. RESULTS FOT was successfully measured in 584 children. Height was a significant predictor of Rrs and Xrs at 6 and 8Hz (P<.05). Z-scores calculated using the Australian reference equations overestimated lung function in Mexican children for both Rrs and Xrs at 6 and 8Hz (P<.001). CONCLUSION The development of FOT reference ranges specific to Mexican preschool-aged children will allow for the correct interpretation of FOT measurements. This study also showed that current FOT reference ranges overestimate lung function in Mexican children. Highlighting, the importance of using ethnic appropriate reference ranges for interpreting lung function.
Collapse
Affiliation(s)
- Claire Shackleton
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
| | | | | | | | | | | |
Collapse
|