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Wong MD, Condon K, Robinson PD, Suresh S, Zahir SF, Sly PD, Blake TL. Assessment of bronchodilator response in preschoolers: A systematic review. Pediatr Pulmonol 2024. [PMID: 38953717 DOI: 10.1002/ppul.27112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Several techniques can be used to assess bronchodilator response (BDR) in preschool-aged children, including spirometry, respiratory oscillometry, the interrupter technique, and specific airway resistance. However, there has not been a systematic comparison of BDR thresholds across studies yet. METHODS A systematic review was performed on all studies up to May 2023 measuring a bronchodilator effect in children 2-6 years old using one of these techniques (PROSPERO CRD42021264659). Studies were identified using MEDLINE, Cochrane, EMBASE, CINAHL via EBSCO, Web of Science databases, and reference lists of relevant manuscripts. RESULTS Of 1224 screened studies, 43 were included. Over 85% were from predominantly European ancestry populations, and only 22 studies (51.2%) calculated a BDR cutoff based on a healthy control group. Five studies included triplicate testing with a placebo to account for the within-subject intrasession repeatability. A relative BDR was most consistently reported by the included studies (95%) but varied widely across all techniques. Various statistical methods were used to define a BDR, with six studies using receiver operating characteristic analyses to measure the discriminative power to distinguish healthy from wheezy and asthmatic children. CONCLUSION A BDR in 2- to 6-year-olds cannot be universally defined based on the reviewed literature due to inconsistent methodology and cutoff calculations. Further studies incorporating robust methods using either distribution-based or clinical anchor-based approaches to define BDR are required.
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Affiliation(s)
- Matthew D Wong
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathleena Condon
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul D Robinson
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sadasivam Suresh
- Department of Paediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Syeda Farah Zahir
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Tamara L Blake
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Meoli A, Trischler J, Hutter M, Dressler M, Esposito S, Blümchen K, Zielen S, Schulze J. Impulse oscillometry bronchodilator response in preschool children. Pediatr Pulmonol 2024; 59:1321-1329. [PMID: 38353391 DOI: 10.1002/ppul.26909] [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: 02/16/2023] [Revised: 01/03/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND In preschoolers, performing an acceptable spirometry and measuring bronchodilator response (BDR) is challenging; in this context, impulse oscillometry (IOS) represents a valid alternative. However, more studies on the standardization of BDR for IOS in young children are required. OBJECTIVE The objective of the study was to identify optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma. METHODS Children aged 3-6 years with suspected asthma and their lung function investigated with both IOS and spirometry pre- and post-BDR were retrospectively analyzed. The spirometric BDR was defined as positive when the change of FEV1 was ≥12% or ≥200 mL. The oscillometric BDR was defined as positive in case of change of at least -40% in R5, +50% in X5, and -80% in AX. RESULTS Among 72 patients, 36 (age 5.2 ± 1 years; 64% boys) were selected for the subsequent analysis according to ATS/ERS quality criteria of measurements; specifically, 19 patients did not meet IOS and 36 did not meet spirometry criteria. The spirometric BDR was found positive in seven subjects (19.4%); conversely, a positive oscillometric BDR was identified in four patients (11.1%). No patient presented a positive BDR response with both methods. In IOS, the mean decrease in R5 and AX was 19.9% ± 10% and 44% ± 22.1%, and the mean increase in X5 was 23.3% ± 17.8%, respectively. A decrease in R5 of 25.7% (AUC 0.77, p = .03) and an increase in X5 of 25.7% (AUC 0.75, p = .04) showed the best combination of sensitivity and specificity to detect an increase of FEV1 ≥ 12% and/or ≥200 mL. CONCLUSION The IOS represents a valid alternative to spirometry to measure BDR in preschool children and should be the gold standard in this age group. We are considering a decrease of 26% in R5 and an increase of 26% in X5 as diagnostic threshold for BDR.
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Affiliation(s)
- Aniello Meoli
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Jordis Trischler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Martin Hutter
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Melanie Dressler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Katharina Blümchen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
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Gunawardana S, Harris C, Greenough A. Use of impulse oscillometry to assess lung function in prematurely born children and young people: Comparisons with spirometry. Paediatr Respir Rev 2023; 45:52-57. [PMID: 36270894 DOI: 10.1016/j.prrv.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
Premature birth is a risk factor for bronchopulmonary dysplasia (BPD); both of which are associated with obstructive airway disease throughout childhood. Impulse oscillometry (IOS) is an effort-independent, passive measure of tidal breathing, which could have benefits in assessing lung function amongst younger patients unable to perform valid spirometry. A literature search was conducted to investigate the use of IOS in prematurely born children and young people. IOS results correlate with those of spirometry. Reversibility of airway obstruction in children with BPD is variable. IOS could have benefits in assessing individual patient response and suitability for bronchodilator therapy. More work, however, is required to establish multi-ethnic reference ranges and standardise commercially available devices prior to its routine incorporation into clinical practice.
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Affiliation(s)
- Shannon Gunawardana
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK.
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, UK.
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Correia Junior MADV, Filho EDAR, Tenório RCE, Albuquerque CGD, Barbosa LC, Quirino PGC, Sarinho E, Medeiros D, Rizzo JÂ. Comparison between impulse oscillometry parameters and spirometry for the diagnosis of exercise-induced bronchoconstriction in asthmatic children and adolescents. Pediatr Pulmonol 2022; 57:2398-2404. [PMID: 35791702 DOI: 10.1002/ppul.26046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/31/2022] [Accepted: 06/25/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Impulse oscillometry (IOS) parameters are obtained more easily and effortlessly in comparison to forced expiratory volume in the first second (FEV1). OBJECTIVE To compare IOS parameters to FEV1 in exercise-induced bronchoconstriction (EIB) diagnosis. METHODS Seventy-four (60.8% male; 39.2 female) young asthmatics aged between 7 and 17 years (mean 12.6 ± 2.8 years) were evaluated. EIB was defined as a reduction in FEV1 ≥ 10% compared with basal after standardized challenge by treadmill running (TR). IOS parameters and FEV1 were obtained at baseline and 5,15, and 30 min after TR. The area under the receiver operator characteristic curve (AUC) was calculated from the reduction in FEV1 ≥ 10% to evaluate the best psychometric characteristics of IOS parameters. RESULTS Twenty-four individuals (32.4%) were diagnosed with EIB. A moderate inverse correlation was found between the IOS and FEV1 variables immediately after the TR, with resistance at 5 Hz (R5Hz), resonant frequency (Fres), and reactance area (AX), (r = -0.64, r = -0.53 and r = -0.69, respectively, all with p < 0.05). An increase of 25 kPa/l/s in R5 Hz, of 19k Pa/l/s in AX and 21 Hz in Fres were found to best correlate with EIB diagnosis by FEV1 (sensitivity 67% and specificity 62%, sensitivity 84% and specificity 50%, and sensitivity 84% and specificity 60%, respectively). CONCLUSION IOS parameters have a significant inverse correlation with FEV1. This study presents cut-off points for EIB diagnosis for R5Hz, AX, and Fres, however, the findings in IOS parameters should be used and interpreted carefully if the goal is to replace spirometry.
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Affiliation(s)
- Marco Aurélio de Valois Correia Junior
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Edil de Albuquerque Rodrigues Filho
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil.,Multicenter Postgraduate Program in Physiological Sciences, Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Vitória de Santo Antão, Brazil
| | | | - Claudio Gonçalves de Albuquerque
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Laienne Carla Barbosa
- Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Polyanna Guerra Chaves Quirino
- Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Emanuel Sarinho
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Décio Medeiros
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - José Ângelo Rizzo
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Bokov P, Gerardin M, Brialix G, Da Costa Noble E, Juif R, Foucher AV, Le Clainche L, Houdouin V, Mauroy B, Delclaux C. Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease. BMC Pulm Med 2022; 22:241. [PMID: 35729620 PMCID: PMC9210656 DOI: 10.1186/s12890-022-02039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Airway clearance techniques are supposed to be a necessary adjunct for the enhancement of impaired peripheral clearance in cystic fibrosis (CF). The objective was to assess the effect of one physiotherapy session (autogenic drainage: AD) on mucus clearance (sputum wet weight) and impulse oscillometry system (IOS) indices, including those obtained from extended Resistance-Inertance-Compliance (eRIC) modelling, considering the degree of bronchial congestion. Methods Thirty children with CF (median age: 12.7 years) in a stable condition prospectively underwent IOS measurements at baseline and after AD. They were divided in two groups: with (visual analog scale of bronchial congestion by the physiotherapist ≥ 5/10) and without (scale < 5/10) bronchial congestion. Paired-comparison of the effects of AD on airway resistance measurements was done with Wilcoxon test. Results The congestion scale correlated with the wet weight of sputum production during the session (Pearson test: p < 0.0001, R = 0.66). Ten children had bronchial congestion and 20 were without congestion. In the whole group, R5–20 Hz significantly decreased after AD (P = 0.049), which was related to a decrease in the children with congestion (P = 0.025), whereas it was not significantly modified in the children without congestion (P = 0.327). The eRIC model allowed the calculation of the peripheral resistance of the respiratory system, which also decreased in the children with congestion (P = 0.037), however, not modified in the children without congestion (P = 0.390). Conclusion One session of autogenic drainage has the ability to decrease peripheral resistance obtained from IOS measurements, more specifically in children with CF with moderate to severe bronchial congestion. Trial registration ClinicalTrials.gov Identifier: NCT04094441.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France
| | - Michèle Gerardin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Géraldine Brialix
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Emmanuelle Da Costa Noble
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Romain Juif
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Antonia Vital Foucher
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Laurence Le Clainche
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Véronique Houdouin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Benjamin Mauroy
- Laboratoire JA Dieudonné, CNRS, Université Nice Côte d'Azur, 06108, Nice, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France.
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Chawes B, Elenius V. Pulmonary function testing for the diagnosis of asthma in preschool children. Curr Opin Allergy Clin Immunol 2022; 22:101-106. [DOI: 10.1097/aci.0000000000000815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wamosy RMG, Assumpção MS, Parazzi PLF, Ribeiro JD, Roesler H, Schivinski CIS. Reliability of impulse oscillometry parameters in healthy children and in children with cystic fibrosis. Int J Clin Pract 2021; 75:e13715. [PMID: 32955781 DOI: 10.1111/ijcp.13715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION & AIMS Impulse oscillometry system (IOS) is an instrument developed to evaluate the mechanical lung properties. It has been reported that to analyse the exam in a proper way it is necessary to carry out more than one measure. However, studies addressing the standardisation are still scarce. The objective was to determine within trial reliability of three measures in IOS parameters in healthy children and children with cystic fibrosis (CF). METHOD Weight, height, body mass index, forced spirometric and the oscillometric parameters (resistance, respiratory impedance, respiratory reactance and resonance frequency) data were collected, in a way that all participants performed three IOS measures. To evaluate, the reproducibility was used the intraclass correlation coefficient [two-way mixed model, absolute agreement definition, ICC]. The response stability was appraised using the standard error of measurements (SEM) in three repetitions of the IOS in the healthy children group (HCG) and in the cystic fibrosis group (CFG). RESULTS About 95 subjects participated, in each group with a mean age of 10.89 ± 2.21 years old in the HCG and 9.73 ± 2.43 years old in the CFG, having been 41 and 43 boys and 54 and 52 girls, in the respectively group. In both groups, all IOS parameters evaluated in the three measures presented an ICC of 0.9, which is a high reproducibility. CONCLUSION The IOS parameters are reproducible for healthy children and CF children in three measures. However, according to the population studied, the performance of only one measure is sufficient to assess respiratory mechanics, whereas the SEM were low, except for Fres, in both groups.
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Kim JH, Lee S, Shin YH, Ha EK, Lee SW, Kim MA, Yoon JW, Baek HS, Choi SH, Han MY. Airway mechanics after withdrawal of a leukotriene receptor antagonist in children with mild persistent asthma: Double-blind, randomized, cross-over study. Pediatr Pulmonol 2020; 55:3279-3286. [PMID: 32965787 DOI: 10.1002/ppul.25085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To determine the response of airway mechanics and the changes in asthma symptoms to stepping down of leukotriene receptor antagonist (LTRA) therapy. METHODS Thirty children (mean age: 7.1 years) with mild, well-controlled, and persistent asthma who took LTRA as maintenance treatment were randomized into a double-blind, placebo-controlled, cross-over study. Each group received an LTRA (montelukast) or placebo daily for 2 weeks, followed by a 1-week washout period, and then the alternate treatment for 2 weeks. Spirometry and impulse oscillation system (IOS) measurements before and after four puffs of salbutamol inhalation, fractional exhaled nitric oxide (FeNO), and the childhood asthma control test (C-ACT) were evaluated at baseline, the end of placebo treatment, and the end of LTRA treatment. RESULTS Changes of FEV1 /FVC (p = .113) and FEV1 (p = .109) from baseline to posttreatment did not differ significantly between the placebo and montelukast groups. In the placebo group, prebronchodilator (pre-) FEV1 /FVC was decreased (83% vs. 86%) and bronchodilator response (BDR) in FEV1 was diminished (10.7% vs. 6.4%) at posttreatment compared with baseline. However, the montelukast group had no significant changes in pre-FEV1 /FVC (p = .865) and BDR in FEV1 (p = .461). In addition, compared with the montelukast group, the placebo group showed no significant changes in Rrs5 (total airway resistance), Rrs5-20 (peripheral airway resistance), FeNO, and symptoms by the C-ACT. CONCLUSION In children with well-controlled mild persistent asthma, changes in spirometry, IOS, FeNO, and C-ACT results did not differ between the placebo and montelukast groups within 2 weeks.
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Affiliation(s)
- Ju Hee Kim
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Shinhae Lee
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
| | - Mi-Ae Kim
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Seonam University College of Medicine, Goyang, Republic of Korea
| | - Hey Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sun-Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Man Yong Han
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Hopp RJ, Wilson MC, Pasha MA. Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary. Clin Rev Allergy Immunol 2020; 62:145-159. [PMID: 33241492 DOI: 10.1007/s12016-020-08818-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.
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Affiliation(s)
- Russell J Hopp
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA.
| | - Mark C Wilson
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA
| | - M Asghar Pasha
- Division of Allergy and Immunology, Albany Medical College, 176 Washington Avenue Extension, Suite 102, Albany, NY, 12203, USA
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Virus-Induced Asthma/Wheeze in Preschool Children: Longitudinal Assessment of Airflow Limitation Using Impulse Oscillometry. J Clin Med 2019; 8:jcm8091475. [PMID: 31527510 PMCID: PMC6780792 DOI: 10.3390/jcm8091475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022] Open
Abstract
: Several researchers have assessed the utility of Impulse Oscillometry System (IOS) in diagnosing and evaluating the severity of respiratory diseases in childhood, but none has investigated the impact of the fluctuations of IOS parameters in an individualized manner. In this two-year prospective study, we aimed to longitudinally evaluate changes in airflow limitation and bronchodilator responsiveness in steroid-naïve four- to six-year-old children during a virus-induced wheezing episode, with IOS pulmonary resistance parameters set at 5 (R5) and 20 (R20) Hz. Moreover, feasibility and reproducibility, in addition to the diagnostic properties of these parameters were examined. Lung function was assessed every six weeks (baseline), within the first 48 hours following an acute wheezing episode (Day 0), after 10, and after 30 days. Forty-three out of 93 recruited children (4.5 ± 0.4 years old) experienced a wheezing episode during the study period. All children were able to perform the IOS effort in an acceptable and highly reproducible manner. R5 and R20 fluctuated independently of atopy, age, height, and weight. On Day 0, R5 values were significantly lower than the respective baseline values and returned to individual baseline levels within 10 days. Post-bronchodilation R5 values were similar to the baseline ones, reflecting a reversible airway obstruction on Day 0. Response to bronchodilation (ΔR5) was significantly more pronounced on Day 0. ΔR5 values lower than -20.5% had a sensitivity of 70% and a specificity of 76% and could accurately identify up to 75% of the examined preschoolers. This study provides evidence in favor of the objective utility of IOS as an easy, highly reproducible, and sensitive technique to assess clinically significant fluctuations and bronchodilation responses suggestive of airflow limitation. Reference values although necessary are suboptimal, utilizing the personal best values as personal reference is useful and reliable.
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de Oliveira Jorge P, de Lima J, Chong e Silva D, Medeiros D, Solé D, Wandalsen G. Impulse oscillometry in the assessment of children's lung function. Allergol Immunopathol (Madr) 2019; 47:295-302. [PMID: 29983239 DOI: 10.1016/j.aller.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To review available evidence in the literature on impulse oscillometry in the assessment of lung function in children with respiratory diseases, especially asthma. DATA COLLECTION Research in the Medline, PubMed, and Lilacs databases, with the keywords forced oscillation, impulse oscillometry, asthma and impulse oscillometry. RESULTS The Impulse Oscillometry System (IOS) allows the measurement of resistance and reactance of airways and is used as a diagnostic resource. A significant association between the findings of the IOS and those of spirometry is observed. In asthma, the IOS has already been used to assess the bronchodilator response and the therapeutic response to different drugs and has shown to be a sensitive technique to evaluate disease control. There are limitations to this assessment, such as children with attention deficit and in some cases it is difficult to interpret the results from a clinical point of view. CONCLUSION The IOS is a useful tool for the measurement of the lung function of children. It is an easy test, although its interpretation is not straightforward.
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Ren CL, Muston HN, Yilmaz O, Noah TL. Pediatric Pulmonology year in review 2017: Part 3. Pediatr Pulmonol 2018; 53:1152-1158. [PMID: 29806188 DOI: 10.1002/ppul.24052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022]
Abstract
Pediatric Pulmonology publishes original research, reviews, and case reports related to a wide range of children's respiratory disorders. We here summarize the past year's publications in our major topic areas, in the context of selected literature in these areas from other journals relevant to our discipline. This review (Part 3 of a 5-part series) covers selected articles on asthma, physiology/lung function testing, and respiratory infections.
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Affiliation(s)
- Clement L Ren
- Riley Children's Hospital, Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Heather N Muston
- Riley Children's Hospital, Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Small airway function in children with mild to moderate asthmatic symptoms. Ann Allergy Asthma Immunol 2018; 121:451-457. [PMID: 30059790 DOI: 10.1016/j.anai.2018.07.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Clinical significance of small airway obstruction in mild pediatric asthma is unclear. OBJECTIVE To evaluate small airway properties in children with mild to moderate asthmatic symptoms and the association of small airway function with asthma control and exercise-induced bronchoconstriction (EIB). METHODS Children (5-10 years old) with recurrent wheezing (n = 42) or persistent troublesome cough (n = 16) and healthy controls (n = 19) performed impulse oscillometry (IOS), spirometry, and a multiple-breath nitrogen washout (MBNW) test. Exhaled nitric oxide (NO) was measured at multiple flow rates to determine alveolar NO concentration (Calv). Asthma control was evaluated with the Childhood Asthma Control Test (C-ACT), short-acting β2-agonist (SABA) use within the past month, and asthma exacerbations within the past year. RESULTS IOS, spirometry, and exhaled NO indexes that are related to small airway function differed between children with recurrent wheezing and healthy controls, whereas only forced expiratory flow at 25% to 75% of the forced vital capacity was associated with persistent cough. The MBNW indexes showed no difference between the groups. Among symptomatic children, conducting airway ventilation inhomogeneity and Calv were associated with asthma exacerbations (P = .03 and P = .002, respectively), and lung clearance index and Calv were associated with EIB (P = .04 and P = .004, respectively). None of the proposed small airway indexes was associated with the C-ACT score or SABA use. CONCLUSION Subtle changes were observed in the proposed small airway indexes of IOS, spirometry, and exhaled NO among children with mild to moderate recurrent wheezing. Small airway dysfunction, expressed as ventilation inhomogeneity indexes and Calv, was also associated with asthma exacerbations and EIB.
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