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Lee JX, Ryan M, Mukharesh L, Dahlberg SE, Sun BZ, Hayden L, Phipatanakul W, Gaffin J. Comparison of home-based spirometry and oscillometry measurements in school-age children with bronchopulmonary dysplasia. Pediatr Pulmonol 2024. [PMID: 38804690 DOI: 10.1002/ppul.27072] [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: 01/08/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION This study compares home-based oscillometry and spirometry for characterizing respiratory system disease in school-aged children with bronchopulmonary dysplasia (BPD) in clinical research. We hypothesized higher rates of successful completion and abnormal cases identified through oscillometry, with correlations between device measurements. METHODS Participants 6-12 years old with BPD in the ongoing Air Quality, Environment and Respiratory Outcomes in BPD (AERO-BPD) study performed oscillometry followed by spirometry at two separate home visits. Parameters measured included airway resistance at 5 Hz(R5), resistance from 5 to 19 Hz(R5-19), resonance frequency(Fres), reactance at 5 Hz(X5), area under the curve between Fres and X5(AX), forced expiratory volume in 1 second(FEV1), forced vital capacity(FVC), and FEV1/FVC. Descriptive statistics identified the proportion of successful tests, correlation in measurements, and rate of lung disease for each device. RESULTS Among 76 subjects with 120 paired observations, 95% and 71% of participants successfully performed oscillometry and spirometry, respectively, at home visit one. 98% and 77% successfully performed oscillometry and spirometry, respectively, at home visit two. Odds ratios favored oscillometry (range 5.31-10.13, p < 0.01). FEV1 correlated with AX (correlation coefficient r = -0.27, p = 0.03); FEV1/FVC with AX (r = -0.32, p = 0.02); and FEV1/FVC with R5 (r = -0.37, p = 0.01). AX exhibited the highest prevalence of abnormality at 25%; other oscillometry parameters ranged from 5%-22%. Forty-five to sixty-four percent of participants had abnormal spirometry. Oscillometry assessments had significantly lower odds of capturing lung disease (odds ratios 0.07-0.24, p < 0.0001). CONCLUSIONS School-aged children with BPD demonstrated higher success rates in field-based oscillometry than spirometry. Spirometry exhibited higher rates of abnormality than oscillometry. Moderate correlation exists between device measurements.
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Affiliation(s)
- Julia X Lee
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Morgan Ryan
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lana Mukharesh
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Suzanne E Dahlberg
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Bob Z Sun
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lystra Hayden
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Barreto M, Veneroni C, Caiulo M, Evangelisti M, Pompilio PP, Mazzuca MC, Raponi G, Pagani J, Parisi P. Within-breath oscillometry for identifying exercise-induced bronchoconstriction in pediatric patients reporting symptoms with exercise. Front Pediatr 2024; 11:1324413. [PMID: 38274467 PMCID: PMC10808442 DOI: 10.3389/fped.2023.1324413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background Evaluating oscillometry parameters separately for the inspiratory and expiratory breath phases and their within-breath differences can help to identify exercise-induced bronchoconstriction (EIB) in pediatric outpatients disclosing exercise-induced symptoms (EIS). Aims To assess the response in impedance parameters following an exercise challenge in patients reporting EIS. Methods Sixty-eight patients reporting EIS (34 asthmatics and 34 suspected of asthma, age mean = 10.8 years, range = 6.0-16.0) underwent an incremental treadmill exercise test. Spirometry was performed at baseline and 1, 5-, 10-, 15-, and 20-min post exercise. Oscillometry was performed at baseline and at 3- and 18-min post exercise. Bronchodilator response to 200 µg albuterol was then assessed. EIB was defined as a forced expiratory volume in 1 s (FEV1) fall ≥10% from baseline. Expiratory and inspiratory resistance (Rrs) and reactance (Xrs), their z-score (Ducharme et al. 2022), and their mean within-breath differences (ΔRrs = Rrsexp-Rrsinsp, ΔXrs = Xrsexp-Xrsinsp) were calculated. Receiver operating characteristic (ROC) curves and their areas (AUCs) were used to evaluate impedance parameters' performances in classifying EIB. Results Asthmatic patients developed EIB more frequently than those suspected of asthma [18/34 (52.9%) vs. 2/34 (5.9%), p < 0.001]. In the 20 subjects with EIB, Rrsinsp, Rrsexp, Xrsinsp, and Xrsexp peaked early (3'), and remained steady except for Xrsinsp, which recovered faster afterward. ΔXrs widened 18 min following the exercise and reversed sharply after bronchodilation (BD) (-1.81 ± 1.60 vs. -0.52 ± 0.80 cmH2O × s/L, p < 0.001). Cutoffs for EIB leading to the highest AUCs were a rise of 0.41 in z-score Rrsinsp (Se: 90.0%, Sp: 66.7%), and a fall of -0.64 in z-score Xrsinsp (Se: 90.0%, Sp: 75.0%). Accepting as having "positive" postexercise oscillometry changes those subjects who had both z-scores beyond respective cutoffs, sensitivity for EIB was 90.0% (18/20) and specificity, 83.3% (40/48). Conclusion Oscillometry parameters and their within-breath differences changed markedly in pediatric patients presenting EIB and were restored after the bronchodilator. Strong agreement between z-scores of inspiratory oscillometry parameters and spirometry supports their clinical utility, though larger studies are required to validate these findings in a broader population.
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Affiliation(s)
- Mario Barreto
- NESMOS Department, Pediatric Unit Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy
| | - Chiara Veneroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milano, Italy
| | - Mariaclaudia Caiulo
- NESMOS Department, Pediatric Unit Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy
| | - Melania Evangelisti
- NESMOS Department, Pediatric Unit Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy
| | | | - Maria Cristina Mazzuca
- NESMOS Department, Pediatric Unit Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy
| | - Giorgia Raponi
- NESMOS Department, Pediatric Unit Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy
| | - Jacopo Pagani
- NESMOS Department, Pediatric Unit Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Pediatric Unit Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy
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Fouzas S, Kogias C, Gioulvanidou M, Bertzouanis A, Chrysochoou EA, Anthracopoulos MΒ, Tsanakas J, Hatziagorou E. Low-frequency oscillometry indices to assess ventilation inhomogeneity in CF patients. Pediatr Pulmonol 2023; 58:3147-3155. [PMID: 37555768 DOI: 10.1002/ppul.26635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The utility of the forced oscillations technique (FOT) in cystic fibrosis (CF) remains uncertain. The aim of this study was to explore the ability of lower-frequency FOT indices, alone and after adjustment for the lung volume, to assess the extent of ventilation inhomogeneity in CF patients with varying disease severity. METHODS Forty-five children, adolescents, and adults with CF (age 6.9-27 years) underwent spirometry, FOT, and nitrogen multiple-breath washout (N2-MBW) measurements. The respiratory resistance and reactance at 5 Hz (Rrs5 and Xrs5, respectively) were recorded, and a novel FOT index, the specific respiratory conductance (sGrs), was computed as the reciprocal of Rrs5 divided by the functional residual capacity. RESULTS The sGrs correlated well with the lung clearance index (LCI) (Spearman's r: -.797), whereas the correlation of Rrs5 and Xrs5 with the LCI, albeit significant, was weaker (r: .643 and -.631, respectively). The sGrs emerged as the most robust predictor of LCI regardless of the severity of lung disease, as reflected by patients' age and lung function measurements. Most importantly, the relationship between sGrs and LCI remained unaffected by lung hyperinflation, as opposed to that of the LCI with the spirometric and standard FOT indices. CONCLUSIONS In CF patients, the FOT indices at 5 Hz and the novel, volume-adjusted parameter sGrs, reflect the extent of lung involvement and the underlying ventilation inhomogeneity in a way comparable to N2-MBW. Future research should explore the role of lower-frequency FOT in assessing the severity and monitoring the progression of CF lung disease.
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Affiliation(s)
- Sotirios Fouzas
- Pediatric Respiratory Unit, Pediatric Department, University Hospital of Patras, Patras, Greece
| | - Christos Kogias
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Gioulvanidou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Bertzouanis
- Pediatric Respiratory Unit, Pediatric Department, University Hospital of Patras, Patras, Greece
| | - Elisavet-Anna Chrysochoou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - John Tsanakas
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elpis Hatziagorou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Alshlowi M, Hakizimana A, Alraimi A, Devani P, Lundblad LKA, Beardsmore CS, Gaillard EA. Differences in respiratory oscillometry measurements using mouthpiece, mouth, and nasal mask in healthy adults. J Appl Physiol (1985) 2023; 134:142-146. [PMID: 36476160 DOI: 10.1152/japplphysiol.00491.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Airway resistance measurements using oscillometry provide a potential alternative to spirometry in assessing airway obstruction and dynamics due to measurements taken during tidal breathing. Oscillometry typically requires participants to form a tight seal around a mouthpiece that can prove challenging for some people. To address this challenge, we conducted a prospective study to evaluate the effect of different interfaces like mouthpiece, mouth mask, and nasal mask on respiratory impedance results from oscillometry in a cohort of healthy adults. Ten healthy adults [7 females; mean age: 38.9 yr (SD ±15.5)] underwent oscillometry using each of the three interfaces. We measured resistance at 5 Hz (Rrs5), frequency dependence of resistance at 5-20 Hz (Rrs5-20), and reactance area (Ax). Rrs5 was not different when using the mouthpiece compared with the mouth mask [mean 2.98 cmH2O/L/s (SD ±0.68) vs. mean 3.2 cmH2O/L/s (SD ±0.81); P = 0.92; 95% CI -0.82 to +0.38], respectively. Nasal mask Rrs5 measurements were significantly higher than mouthpiece measurements (mean 7.31 cmH2O/L/s; SD ±2.62; P < 0.01; 95%CI -6.91 to -1.75). With Ax5, we found a mean of 4.01 cmH2O/L (SD ±2.04) with the mouth mask compared with a mean of 4.02 cmH2O/L (SD ±1.87; P = 1.0 95% CI -1.86 to +1.87) for the mouthpiece, however, we found a significant difference between the mouthpiece and nasal mask for Ax (mean = 10.71; SD ±7.0 H2O/L; P = 0.04, 95% CI -12.96 to -0.43). Our findings show that oscillometry using a mouth mask may be just as effective as using a mouthpiece in assessing airway dynamics and resistance.NEW & NOTEWORTHY This is the first study to compare the use of different interfaces: mouthpiece, mouth mask, and nasal mask, for oscillometry in an adult population. We report that using a mouth mask in oscillometry may provide a valid alternative to a mouthpiece in cohorts who may struggle to form the required tight seal that is typically required in oscillometry or spirometry.
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Affiliation(s)
- Malak Alshlowi
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, United Kingdom
| | - Ali Hakizimana
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, United Kingdom.,Department of Paediatric Respiratory Medicine, Leicester Children's Hospital, University Hospitals Leicester, Leicester, United Kingdom
| | - Afnan Alraimi
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, United Kingdom
| | - Pooja Devani
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, United Kingdom.,Department of Paediatric Respiratory Medicine, Leicester Children's Hospital, University Hospitals Leicester, Leicester, United Kingdom
| | | | - Caroline S Beardsmore
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, United Kingdom.,Department of Paediatric Respiratory Medicine, Leicester Children's Hospital, University Hospitals Leicester, Leicester, United Kingdom
| | - Erol A Gaillard
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, United Kingdom.,Department of Paediatric Respiratory Medicine, Leicester Children's Hospital, University Hospitals Leicester, Leicester, United Kingdom
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Veldhoen ES, Roos JH, Bekkema R, van der Pol LW, Tinnevelt MHB, Verweij-van den Oudenrijn LP, Wösten-van Asperen RM, Hulzebos EHJ, Wijngaarde CA, van der Ent CK. Oscillometry: A substitute of spirometry in children with neuromuscular diseases? Pediatr Pulmonol 2022; 57:1618-1624. [PMID: 35441830 PMCID: PMC9322586 DOI: 10.1002/ppul.25923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Spirometry plays an important role in the assessment of possible respiratory failure in children with neuromuscular diseases (NMDs). However, obtaining reliable spirometry results is a major challenge. We studied the relation between oscillometry and spirometry results. Oscillometry is an easy, noninvasive method to measure respiratory resistance R and reactance X. We hypothesized an increased R and reduced X in patients with more reduced lung function. METHODS In this prospective single-center study, we included all children with NMDs able to perform spirometry. We consecutively measured R and X at 5, 11, and 19 Hz and (forced) vital capacity, peak expiratory flow. Spearman correlation coefficients and positive and negative predictive values were calculated. Regression curves were estimated. RESULTS We included 148 patients, median age 13 years (interquartile range: 8-16). A negative correlation was found between R and spirometry outcomes (Spearman correlation coefficient [ρ]: -0.5 to -0.6, p < 0.001). A positive correlation was found between X (i.e., less negative outcomes) and spirometry outcomes (ρ: 0.4-0.6, p < 0.001). Highest correlation was found at lower frequencies. Regression analysis showed a nonlinear relation. Measurement of inspiratory and expiratory R and X did not provide added value. Positive predictive values of 80%-85% were found for z-scores of R measured at 5 Hz versus (F)VC ≤ 60%. CONCLUSION We found a nonlinear relation between oscillometry and spirometry results with increased R and reduced X in patients with more restrictive lung function decline. Given the difficulties with performing spirometry, oscillometry may be a promising substitute.
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Affiliation(s)
- Esther S Veldhoen
- Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johan H Roos
- Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rolien Bekkema
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ludo W van der Pol
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marcel H B Tinnevelt
- Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laura P Verweij-van den Oudenrijn
- Pediatric Intensive Care Unit and Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roelie M Wösten-van Asperen
- Pediatric Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik H J Hulzebos
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Camiel A Wijngaarde
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Andrenacci B, Ferrante G, Roberto G, Piacentini G, La Grutta S, Marseglia GL, Licari A. Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician. Expert Rev Clin Immunol 2022; 18:807-821. [PMID: 35730635 DOI: 10.1080/1744666x.2022.2093187] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite symptoms control being the primary focus of asthma management according to guidelines, uncontrolled asthma is still an issue worldwide, leading to huge costs and asthma deaths at all ages. In childhood, poor asthma control can be even more harmful, as it can irreversibly compromise the children's lung function and the whole family's well-being. AREAS COVERED Given the problem extent, this review aims to discuss the leading modifiable causes of uncontrolled asthma in Pediatrics, giving some practical insights regarding the critical role of families and the main tools for monitoring control and drug adherence, even at a distance. The most recent GINA documents were used as the primary reference, along with the latest evidence regarding the management of asthma control and the impact of the COVID-19 pandemic on asthma. EXPERT OPINION In managing pediatric asthma, a multidisciplinary, multi-determinant, personalized approach is needed, actively involving families, schools, and other specialists. In addition to current strategies for implementing control, electronic health strategies, new validated asthma control tools, and the identification of novel inflammatory biomarkers could lead to increasingly tailored therapies with greater effectiveness in reaching asthma control.
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Affiliation(s)
- Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Pakhale S, Visentin C, Tariq S, Kaur T, Florence K, Bignell T, Jama S, Huynh N, Boyd R, Haddad J, Alvarez GG. Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study. BMC Pulm Med 2022; 22:235. [PMID: 35710334 PMCID: PMC9202668 DOI: 10.1186/s12890-022-02030-x] [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: 10/28/2021] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Rationale Oscillometry is an emerging technique that offers some advantages over spirometry as it does not require forced exhalation and may detect early changes in respiratory pathology. Obstructive lung disease disproportionately impacts people experiencing homelessness with a high symptoms burden, yet oscillometry is not studied in this population. Objectives To assess lung disease and symptom burden using oscillometry in people experiencing homelessness or at-risk of homelessness using a community-based participatory action research approach (The Bridge Model™).
Methods Of 80 recruited, 55 completed baseline oscillometry, 64 completed spirometry, and all completed patient-reported outcomes with demographics, health, and respiratory symptom related questionnaires in the Participatory Research in Ottawa: Management and Point-of-Care for Tobacco Dependence project. Using a two-tail t-test, we compared mean oscillometry values for airway resistance (R5–20), reactance area under the curve (Ax) and reactance at 5 Hz (X5) amongst individuals with fixed-ratio method (FEV1/FVC ratio < 0.70) and LLN (FEV1/FVC ratio ≤ LLN) spirometry diagnosed chronic obstructive pulmonary disease (COPD). We compared mean oscillometry parameters based on participants’ COPD assessment test (CAT) scores using ANOVA test. Results There was no significant difference between the pre- and post- bronchodilator values of R5–20 and Ax for the fixed ratio method (p = 0.63 and 0.43) and the LLN method (p = 0.45 and 0.36). There was a significant difference in all three of the oscillometry parameters, R5–20, Ax and X5, based on CAT score (p = 0.009, 0.007 and 0.05, respectively). There was a significant difference in R5–20 and Ax based on the presence of phlegm (p = 0.03 and 0.02, respectively) and the presence of wheeze (p = 0.05 and 0.01, respectively). Oscillometry data did not correlate with spirometry data, but it was associated with CAT scores and correlated with the presence of self-reported symptoms of phlegm and wheeze in this population. Conclusions Oscillometry is associated with respiratory symptom burden and highlights the need for future studies to generate more robust data regarding the use of oscillometry in systematically disadvantaged populations where disease burden is disproportionately higher than the general population. TrialRegistration: ClinicalTrails.gov—NCT03626064, Retrospective registered: August 2018, https://clinicaltrials.gov/ct2/show/NCT03626064
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Affiliation(s)
- Smita Pakhale
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada. .,University of Ottawa, Ottawa, Canada.
| | - Carly Visentin
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,University of Ottawa, Ottawa, Canada
| | - Saania Tariq
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Tina Kaur
- University of Toronto, Toronto, Canada
| | - Kelly Florence
- Community (Peer) Researcher, The Bridge Engagement Centre, Ottawa, Canada
| | - Ted Bignell
- Community (Peer) Researcher, The Bridge Engagement Centre, Ottawa, Canada
| | - Sadia Jama
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada.,University of Ottawa, Ottawa, Canada
| | - Nina Huynh
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Robert Boyd
- Oasis, Sandy Hill Community Health Centre, Ottawa, Canada
| | - Joanne Haddad
- Canadian Mental Health Association, The Ottawa Branch, Ottawa, Canada
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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8
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Association of Dyslipidemia and Respiratory Resistance Assessed by the Forced Oscillation Technique in Asthmatic Children. Lung 2022; 200:73-82. [PMID: 35064334 DOI: 10.1007/s00408-021-00502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to evaluate the associations between dyslipidemia and pulmonary function parameters assessed by spirometry and the forced oscillation technique in asthmatic children. METHODS Asthmatic children (5-18 years old) had fasting serum lipid profiles including low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) concentrations, and C-reactive protein (CRP) measured. Pulmonary function tests were assessed by spirometry and the forced oscillation technique (FOT). RESULTS One hundred forty-one asthmatic children were enrolled with a mean (SD) age of 11.82 (3.38) years. Eighty-eight (62.4%) children were boys, 64 (45.4%) had dyslipidemia, and 20 (14.2%) were obese. Among the children with dyslipidemia, a high LDL-C concentration (65.6%) was the most common form of dyslipidemia, followed by high TC (57.8%), high TG (35.9%), and low HDL-C concentrations (15.6%). Multivariable analysis showed significant associations between HDL-C concentrations and respiratory resistance at 5 Hz (R5) and respiratory resistance at 20 Hz (R20), and TC concentrations were modestly associated with reactance at 5 Hz (X5), the frequency of resonance (Fres), and the area of reactance (ALX). Asthmatic children who had high LDL-C concentrations had a significantly higher expiratory phase R5, whole breath R20, and expiratory phase R20 than those in children with normal LDL-C concentrations. CONCLUSION This study suggests an association of blood cholesterol, especially HDL-C and LDL-C, and respiratory resistance measured by the FOT, irrespective of the obesity status. An intervention for improving LDL-C and HDL-C concentrations may be beneficial on lung function parameters in asthmatic children. CLINICAL TRIAL REGISTRATION TCTR20200305005; date of registration: 03-04-2020 (retrospectively registered).
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9
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Forced Oscillation Technique for Monitoring the Respiratory Status of Children with Cystic Fibrosis: A Systematic Review. CHILDREN-BASEL 2021; 8:children8100857. [PMID: 34682122 PMCID: PMC8534643 DOI: 10.3390/children8100857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
Spirometry is considered the gold standard method for monitoring lung function of patients with cystic fibrosis (CF) but it requires patients’ cooperation and therefore it is not useful for the majority of preschool-aged children. Oscillometry is an alternative modality for lung function monitoring that requires minimal cooperation and can be applied in children as young as 3 years of age. Furthermore, it generates lesser aerosol compared to spirometry, an issue that is of considerable importance in the COVID-19 era. The aim of this review was to present the existing clinical data regarding the application of oscillometry in children and adolescents with CF. The method seems to have acceptable feasibility and repeatability. However, there is conflicting data regarding the correlation of oscillometry values with the clinical symptoms of CF patients either in clinically stable or in exacerbation periods. Furthermore, it is not clear to what extent oscillometry measurements correlate with the spirometry indices. Based on current evidence, spirometry cannot be substituted by oscillometry in the monitoring of the respiratory status of children and adolescents with CF.
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Marinakis G, Paraschos M, Patrani M, Tsoutsouras T, Vassiliou M. Non-interventional monitoring of expiratory flow limitation during experimental mechanical ventilation. ERJ Open Res 2021; 7:00264-2020. [PMID: 33532479 PMCID: PMC7836650 DOI: 10.1183/23120541.00264-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Expiratory flow limitation (EFL) is common among patients in the intensive care unit under mechanical ventilation (MV) and may have significant clinical consequences. In the present study, we examine the possibility of non-interventional detection of EFL during experimental MV. Methods Eight artificially ventilated New Zealand rabbits were included in the experiments. EFL was induced during MV by application of negative expiratory pressure (−5, −8 and −10 hPa) and detected by the negative expiratory pressure technique. Airway pressure (Paw) and gas flow (V′) were digitally recorded and processed off-line for the evaluation of respiratory mechanics. The method is based on the computation and monitoring of instantaneous respiratory resistance Rrs(t). The resistive pressure (Paw,res(t)) is calculated by subtracting from Paw its elastic component and the end-expiratory pressure, as assessed by linear regression. Then, Rrs(t) is computed as the instant ratio Paw,res(t)/V′(t). Results Two completely different patterns of expiratory Rrs(t) separate the cases with EFL from those without EFL. Small and random fluctuations are noticed when EFL is absent, whereas the onset of EFL is accompanied by an abrupt and continuous rise in Rrs(t), towards the end of expiration. Thus, EFL is not only detected but may also be quantified from the volume still to be expired at the time EFL occurs. Conclusion The proposed technique is a simple, accurate and non-interventional tool for EFL monitoring during MV. Respiratory system resistance in expiratory flow limitation during mechanical ventilationhttps://bit.ly/34hU6Bv
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Affiliation(s)
- Giorgos Marinakis
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
| | - Michael Paraschos
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
| | - Maria Patrani
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
| | - Theodoros Tsoutsouras
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
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Postek M, Walicka-Serzysko K, Milczewska J, Sands D. What Is Most Suitable for Children With Cystic Fibrosis-The Relationship Between Spirometry, Oscillometry, and Multiple Breath Nitrogen Washout. Front Pediatr 2021; 9:692949. [PMID: 35096700 PMCID: PMC8795905 DOI: 10.3389/fped.2021.692949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In cystic fibrosis (CF), pathological lung changes begin early in life. The technological progress currently gives many diagnostic possibilities. However, pulmonary function testing in children remains problematic. OBJECTIVES Our study aimed to correlate the results of impulse oscillometry (IOS) with those of multiple breath nitrogen washout (MBNW) in our pediatric CF population. We also compared those parameters between the groups with and without spirometric features of obturation. METHODS We collected 150 pulmonary function test sets, including spirometry, IOS, and MBNW in patients with CF aged 12.08 ± 3.85 years [6-18]. The study group was divided into two subgroups: IA (without obturation) and IB (with obturation). We also compared Sacin, Scond, and oscillometry parameters of 20 patients aged 14-18 years who reached the appropriate tidal volume (VT) during MBNW. RESULTS Statistical analysis showed a negative correlation between lung clearance index (LCI) and spimoetric parameters. Comparison of subgroups IA (n = 102) and IB (n = 48) indicated a statistically significant difference in LCI (p < 0.001) and FEV1z-score (p < 0.001), FEV1% pred (p < 0.001), MEF25z-score (p < 0.001), MEF50 z-score (p < 0.001), MEF75 z-score (p < 0.001), R5% pred (p < 0.05), and R20% pred (p < 0.01). LCI higher than 7.91 was found in 75.33% of the study group, in subgroup IB-91.67%, and IA-67.6%. CONCLUSIONS LCI derived from MBNW may be a better tool than IOS for assessing pulmonary function in patients with CF, particularly those who cannot perform spirometry.
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Affiliation(s)
- Magdalena Postek
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Katarzyna Walicka-Serzysko
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Justyna Milczewska
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
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Martinez ME, Harder OE, Rosas LE, Joseph L, Davis IC, Niewiesk S. Pulmonary function analysis in cotton rats after respiratory syncytial virus infection. PLoS One 2020; 15:e0237404. [PMID: 32776985 PMCID: PMC7416943 DOI: 10.1371/journal.pone.0237404] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/25/2020] [Indexed: 01/31/2023] Open
Abstract
The cotton rat (Sigmodon hispidus) is an excellent small animal model for human respiratory viral infections such as human respiratory syncytial virus (RSV) and human metapneumovirus (HMPV). These respiratory viral infections, as well as other pulmonary inflammatory diseases such as asthma, are associated with lung mechanic disturbances. So far, the pathophysiological effects of viral infection and allergy on cotton rat lungs have not been measured, although this information might be an important tool to determine the efficacy of vaccine and drug candidates. To characterize pulmonary function in the cotton rat, we established forced oscillation technique in uninfected, RSV infected and HDM sensitized cotton rats, and characterized pulmonary inflammation, mucus production, pulmonary edema, and oxygenation. There was a gender difference after RSV infection, with females demonstrating airway hyper-responsiveness while males did not. Female cotton rats 2dpi had a mild increase in pulmonary edema (wet: dry weight ratios). At day 4 post infection, female cotton rats demonstrated mild pulmonary inflammation, no increase in mucus production or reduction in oxygenation. Pulmonary function was not significantly impaired after RSV infection. In contrast, cotton rats sensitized to HDM demonstrated airway hyper-responsiveness with a significant increase in pulmonary inflammation, increase in baseline tissue damping, and a decrease in baseline pulmonary compliance. In summary, we established baseline data for forced oscillation technique and other respiratory measures in the cotton rat and used it to analyze respiratory diseases in cotton rats.
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Affiliation(s)
- Margaret E. Martinez
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Olivia E. Harder
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Lucia E. Rosas
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Lisa Joseph
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Ian C. Davis
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Stefan Niewiesk
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
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Non-invasive forced oscillometry to quantify respiratory mechanics in term neonates. Pediatr Res 2020; 88:293-299. [PMID: 31935746 PMCID: PMC7358118 DOI: 10.1038/s41390-020-0751-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND To determine normative data by forced oscillation technique (FOT) in non-sedated normal term neonates and test the hypothesis that infants with transient tachypnea of the newborn (TTN) have higher resistance (R) and lower reactance (X) on day 1. METHODS Healthy term infants (n = 138) and infants with TTN (n = 17) were evaluated on postnatal days 1 through 3 (NCT03346343). FOT was measured with a mask using a TremoFlo C-100 Airwave System™. R, X, and area under the reactance curve (AX) were measured at prime frequencies 7-41 Hz for 8 s. RESULTS In all, 86% of control infants had adequate measurements (coherence >0.8, CV < 0.25) on day 1. Infants with TTN had higher resistance at 13 Hz (TTN 32.5 cm H2O·s/L [95% CI 25.5-39.4]; controls 23.8 cm H2O·s/L [95% CI 22.2 to 25.3], P = 0.007) and lower reactance from 17 to 37 Hz (TTN -35.1 to -10.5; controls -26.3 to -6.1, P < 0.05). In healthy controls, lung mechanics were unchanged from days 1 to 3. In TTN, lung mechanics normalized on days 2 and 3. CONCLUSIONS FOT is feasible in neonates and distinguishes normal control infants from those with TTN on postnatal day 1. Oscillometry offers a non-invasive, longitudinal technique to assess lung mechanics in newborns.
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Kreetapirom P, Kiewngam P, Jotikasthira W, Kamchaisatian W, Benjaponpitak S, Manuyakorn W. Forced oscillation technique as a predictor for loss of control in asthmatic children. Asia Pac Allergy 2020; 10:e3. [PMID: 32099825 PMCID: PMC7016320 DOI: 10.5415/apallergy.2020.10.e3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023] Open
Abstract
Background A reliable objective tool using as a predictor of asthma control status could assist asthma management. Objective To find the parameters of forced oscillation technique (FOT) as predictors for the future loss of asthma symptom control. Methods Children with well-controlled asthma symptom, aged 6–12 years, were recruited for a 12-week prospective study. FOT and spirometer measures and their bronchodilator response were evaluated at baseline. The level of asthma symptom control was evaluated according to Global Initiative for Asthma. Results Among 68 recruited children, 41 children (60.3%) maintain their asthma control between 2 visits (group C-C), and 27 children (39.7%) lost their asthma control on the follow-up visit (group C-LC). Baseline FOT parameters, including the values of respiratory resistance at 5 Hz (R5), respiratory resistance at 20 Hz (R20), respiratory reactance at 5 Hz, area of reactance, %predicted of R5 and percentage of bronchodilator response (%∆) of R5 and R20 were significantly different between C-C and C-LC groups. In contrast, only %∆ of forced vital capacity, forced expiratory volume in 1 second (FEV1), and FEF25%–75% (forced expiratory flow 25%–75%) were significantly different between groups. Multiple logistic regression analysis revealed that %predicted of R5, %∆R5, %predicted of FEV1 and %∆FEV1 were the predictive factors for predicting the future loss of asthma control. The following cutoff values demonstrated the best sensitivity and specificity for predicting loss of asthma control: %predicted of R5=91.28, %∆R5=21.2, %predicted of FEV1=89.5, and %∆FEV1=7.8. The combination of these parameters predicted the risk of loss of asthma control with area under the curve of 0.924, accuracy of 83.8%. Conclusion Resistance FOT measures have an additive role to spirometric parameter in predicting future loss of asthma control.
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Affiliation(s)
- Piyawut Kreetapirom
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Potjanee Kiewngam
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wanlapa Jotikasthira
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Kamchaisatian
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Benjaponpitak
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wiparat Manuyakorn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Barreto M, Evangelisti M, Montesano M, Martella S, Villa MP. Pulmonary Function Testing in Asthmatic Children. Tests to Assess Outpatients During the Covid-19 Pandemic. Front Pediatr 2020; 8:571112. [PMID: 33313024 PMCID: PMC7707082 DOI: 10.3389/fped.2020.571112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/22/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Mario Barreto
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Melania Evangelisti
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Marilisa Montesano
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Susy Martella
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
| | - Maria Pia Villa
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
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Ferrante G, Cilluffo G, Di Pace MR, Corsello G, Lombardi E, Dellacà RL, Malizia V, La Grutta S. New insights in respiratory impedance in young children after repair of congenital diaphragmatic hernia: a cross-sectional study. Ital J Pediatr 2019; 45:82. [PMID: 31307512 PMCID: PMC6631876 DOI: 10.1186/s13052-019-0670-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/17/2019] [Indexed: 12/02/2022] Open
Abstract
Lung function impairment is common in Congenital Diaphragmatic Hernia (CDH) survivors. The aim of this study was to evaluate, in children who underwent CDH surgical repair, mid and long-term consequences on respiratory impedance, investigating the impact of CDH on both resistance and reactance parameters, as well as bronchodilator response. Forced Oscillation Technique (FOT) parameters were collected from 12 patients (2–11 years). Resistance and reactance values at 8 Hz (Rrs8, Xrs8) and the area under the reactance curve (AX) were measured pre and post-salbutamol. Quantitative variables were compared using Mann-Whitney U test. Differences of categorical variables were evaluated using Fisher exact test. Statistically significant differences between measured and predicted values for Rrs8 (p = 0.04), Xrs8 (p = 0.02) and AX (p = 0.01) were found. When stratifying for age, significant difference between measured and predicted values was observed only in children < 5 years (n = 6) (Rrs8 p = 0.03, Xrs8 p = 0.001, AX p = 0.007). With respect to children 5 years (n = 6), the younger ones showed higher z-scores in Rrs8 (p = 0.015), Xrs8 (p = 0.002) and AX (p = 0.002) values. Since the z-score difference was greater than 0.5, it was considered a difference clinically relevant. No differences in bronchodilator response were recorded. In children with CDH an impairment of respiratory impedance measured by FOT is observed only in children aged less than 5 years.
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Affiliation(s)
- Giuliana Ferrante
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, via del Vespro 129, 90127, Palermo, Italy.
| | - Giovanna Cilluffo
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Maria Rita Di Pace
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, via del Vespro 129, 90127, Palermo, Italy
| | - Giovanni Corsello
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, via del Vespro 129, 90127, Palermo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University-Hospital, Viale G. Pieraccini 24, 50139, Florence, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy
| | - Velia Malizia
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Stefania La Grutta
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
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Ducharme FM, Jroundi I, Jean G, Lavoie Boutin G, Lawson C, Vinet B. Interdevice agreement in respiratory resistance values by oscillometry in asthmatic children. ERJ Open Res 2019; 5:00138-2018. [PMID: 30895187 PMCID: PMC6421362 DOI: 10.1183/23120541.00138-2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND With several commercially available devices measuring respiratory impedance by oscillometry, the agreement between values obtained on different instruments or frequencies remains unclear. Our aim was to examine the agreement between resistance and reactance parameters on two oscillometry instruments using different waveforms. METHODS We conducted a prospective cross-sectional study in asthmatic children aged 3-17 years. Reproducible oscillometry measurements were obtained in random order, by blinded operators, at three modes: 5-10-15-20-25 Hz (5-25 Hz) multifrequency mode on the MasterScreen impulse oscillometry system, and both 5-25 Hz multifrequency mode and 7 Hz monofrequency on the tremoFlo C-100 airwave sinusoidal system. Resistance, reactance and within-breath parameters were examined using the intraclass correlation coefficient (ICC), paired t-test, linear regression and Bland-Altman method. RESULTS Of 50 participants, 44 and 38 completed between-device and within-frequency measurements, respectively. Between-device measurements at 5-25 Hz showed high (ICC 0.88-0.91) and good (ICC 0.69-0.87) agreement in resistance and reactance, respectively, but with an absolute within-patient difference (≥0.05 kPa·L-1·s-1) and proportional bias (≥30% per kPa·L-1·s-1) in all parameters and oscillatory frequencies, apart from resistance at 5 Hz. A significant proportional bias was documented in most within-breath parameters at 5 versus 7 Hz on tremoFlo. CONCLUSION Observed differences in resistance and reactance suggest the need for instrument- and frequency-specific paediatric normative values.
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Affiliation(s)
- Francine M. Ducharme
- Dept of Pediatrics, University of Montreal, Montreal, QC, Canada
- Dept of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
- Clinical Research on Childhood Asthma Research Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
| | - Imane Jroundi
- Clinical Research on Childhood Asthma Research Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
- Unit of Training and Research in Public Health, School of Medicine and Pharmacy of Rabat, University of Mohamed V, Rabat, Morocco
| | - Guillaume Jean
- Clinical Research on Childhood Asthma Research Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
| | - Guillaume Lavoie Boutin
- Clinical Research on Childhood Asthma Research Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
| | - Christiane Lawson
- Clinical Research on Childhood Asthma Research Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
| | - Benjamin Vinet
- Clinical Research on Childhood Asthma Research Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
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Question 3: Can we diagnose asthma in children under the age of 5 years? Paediatr Respir Rev 2019; 29:25-30. [PMID: 30528365 PMCID: PMC6444340 DOI: 10.1016/j.prrv.2018.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 12/27/2022]
Abstract
The diagnosis of asthma in children under five years has been controversial due to changing concepts of what true asthma is in this age group. Previous diagnostic algorithms that used clinical indices to predict the persistence of asthma symptoms or phenotypes based on asthma triggers do not predict which children will benefit from asthma medication. A pragmatic approach to asthma diagnosis in this age group is based on identifying signs and symptoms of reversible airflow obstruction and documenting their response to asthma medication. Hopefully, this approach will provide clearer guidance to clinicians and improve asthma morbidity in these young children.
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Mulholland A, Ainsworth A, Pillarisetti N. Tools in Asthma Evaluation and Management: When and How to Use Them? Indian J Pediatr 2018; 85:651-657. [PMID: 29139062 DOI: 10.1007/s12098-017-2462-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/24/2017] [Indexed: 01/08/2023]
Abstract
The goals of asthma management are accurate diagnosis, prompt initiation of treatment and monitoring of disease progression to limit potential morbidity and mortality. While the diagnosis and management is largely based on history taking and clinical examination, there are an increasing number of tools available that could be used to aid diagnosis, define phenotypes, monitor progress and assess response to treatment. Tools such as the Asthma Predictive Index could help in making predictions about the possibility of asthma in childhood based on certain clinical parameters in pre-schoolers. Lung function measurements such as peak expiratory flow, spirometry, bronchodilator responsiveness, and bronchial provocation tests help establish airway obstruction and variability over time. Tools such as asthma questionnaires, lung function measurements and markers of airway inflammation could be used in combination with clinical assessments to assess ongoing asthma control. Recent advances in digital technology, which open up new frontiers in asthma management, need to be evaluated and embraced if proven to be of value. This review summarises the role of currently available tools in asthma diagnosis and management. While many of the tools are readily available in resource rich settings, it becomes more challenging when working in resource poor settings. A rational approach to the use of these tools is recommended.
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Affiliation(s)
- Anna Mulholland
- Pediatric Respiratory Medicine, Starship Children's Hospital, Park Road, Grafton, Auckland, 1023, New Zealand
| | - Alana Ainsworth
- Pediatric Respiratory Medicine, Starship Children's Hospital, Park Road, Grafton, Auckland, 1023, New Zealand
| | - Naveen Pillarisetti
- Pediatric Respiratory Medicine, Starship Children's Hospital, Park Road, Grafton, Auckland, 1023, New Zealand. .,Department of Pediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Licari A, Brambilla I, Marseglia A, De Filippo M, Paganelli V, Marseglia GL. Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population. Front Pediatr 2018; 6:170. [PMID: 29971223 PMCID: PMC6018103 DOI: 10.3389/fped.2018.00170] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/24/2018] [Indexed: 01/14/2023] Open
Abstract
Evaluating the degree of disease control is pivotal when assessing a patient with asthma. Asthma control is defined as the degree to which manifestations of the disease are reduced or removed by therapy. Two domains of asthma control are identified in the guidelines: symptom control and future risk of poor asthma outcomes, including asthma attacks, accelerated decline in lung function, or treatment-related side effects. Over the past decade, the definition and the tools of asthma control have been substantially implemented so that the majority of children with asthma have their disease well controlled with standard therapies. However, a small subset of asthmatic children still requires maximal therapy to achieve or maintain symptom control and experience considerable morbidity. Childhood uncontrolled asthma is a heterogeneous group and represents a clinical and therapeutic challenge requiring a multidisciplinary systematic assessment. The identification of the factors that may contribute to the gain or loss of control in asthma is essential in differentiating children with difficult-to-treat asthma from those with severe asthma that is resistant to traditional therapies. The aim of this review is to focus on current concept of asthma control, describing monitoring tools currently used to assess asthma control in clinical practice and research, and evaluating comorbidities and modifiable and non-modifiable factors associated with uncontrolled asthma in children, with particular reference to severe asthma.
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Affiliation(s)
| | | | | | | | | | - Gian L. Marseglia
- Department of Pediatric, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Fretzayas A, Moustaki M, Loukou I, Douros K. Differentiating vocal cord dysfunction from asthma. J Asthma Allergy 2017; 10:277-283. [PMID: 29066919 PMCID: PMC5644529 DOI: 10.2147/jaa.s146007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Vocal cord dysfunction (VCD)-associated symptoms are not rare in pediatric patients. Dyspnea, wheezing, stridor, chest pain or tightness and throat discomfort are the most commonly encountered symptoms. They may occur either at rest or more commonly during exercise in patients with VCD, as well as in asthmatic subjects. The phase of respiration (inspiration rather than expiration), the location of the wheezing origin, the rapid resolution of symptoms, and the timing occurring in relation to exercise, when VCD is exercise induced, raise the suspicion of VCD in patients who may have been characterized as merely asthmatics and, most importantly, had not responded to the appropriate treatment. The gold standard method for the diagnosis of VCD is fiberoptic laryngoscopy, which may also identify concomitant laryngeal abnormalities other than VCD. However, as VCD is an intermittent phenomenon, the procedure should be performed while the patient is symptomatic. For this reason, challenges that induce VCD symptoms should be performed, such as exercise tests. Recently, for the evaluation of patients with exercise-induced VCD, continuous laryngoscopy during exercise (such as treadmill, bicycle ergometer, swimming) was used. A definite diagnosis of VCD is of importance, especially for those patients who have been erroneously characterized as asthmatics, without adequate response to treatment. In these cases, another therapeutic approach is necessary, which will depend on whether they suffer solely from VCD or from both conditions.
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Affiliation(s)
- Andrew Fretzayas
- Third Department of Pediatrics, Athens University Medical School, "Attikon" University Hospital, Haidari, Greece.,Athens Medical Center, Department of Pediatrics, Marousi, Greece
| | - Maria Moustaki
- Department of Cystic Fibrosis, "Aghia Sofia", Children's Hospital, Athens, Greece
| | - Ioanna Loukou
- Department of Cystic Fibrosis, "Aghia Sofia", Children's Hospital, Athens, Greece
| | - Konstantinos Douros
- Respiratory Unit, Third Department of Pediatrics, Athens University Medical School, "Attikon" University Hospital, Haidari, Greece
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