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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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Oropharyngeal obstruction and respiratory system compliance are linked to ventilatory control parameters in pediatric obstructive sleep apnea syndrome. Sci Rep 2022; 12:17340. [PMID: 36243786 PMCID: PMC9569362 DOI: 10.1038/s41598-022-22236-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/11/2022] [Indexed: 01/10/2023] Open
Abstract
Instable ventilatory control is an endotypic trait of obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the relationships between the anatomical compromise of the upper (oro- and naso-pharynx) and lower airways and ventilatory control (measured by chemical loop gain) in otherwise healthy children suffering from moderate to severe OSAS (apnea hypopnea index ≥ 5/hour). The children underwent ear, nose and throat examination, measurement of impedance of the respiratory system that allowed characterizing peripheral lung mechanics using the extended Resistance-Inertance-Compliance model. Physiologically constrained analytical model based on tidal breathing analysis allowed for the computation of steady-state plant gain, steady-state controller gain (CG0) and steady-state loop gain (LG0). Medium-frequency components of the feedback control system were then deduced. Fifty children (median age 11.2 years) were enrolled. Oropharyngeal obstruction was associated with decreased CG0 (0.6 [0.2; 1.0] vs 1.5 [0.5; 6.6] L.s- 1.mmHg- 1, p = 0.038) and LG0 (0.4 [0.2; 1.1] vs 1.2 [0.4; 9.3], p = 0.027), while nasal obstruction did not modify ventilatory control parameters. In a multivariate analysis Medium-Frequency PG was negatively related to minute ventilation and respiratory system compliance. Both upper (tonsil hypertrophy) and lower (compliance of respiratory system) airways are linked to ventilatory control in children with moderate to severe OSAS.
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Hopp R, Lee J, Bohan H. An a Priori Approach to Small Airway Dysfunction in Pediatric Asthmatics. CHILDREN 2022; 9:children9101454. [PMID: 36291390 PMCID: PMC9600101 DOI: 10.3390/children9101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
Abstract
Small airway dysfunction remains a stepchild in the pediatric asthma care pathway. In brief, elements of the pulmonary function test (PFT) concerning smaller airway data remain less utilized. To further the value of the standard PFT we underwent a prospective Proof of Concept (POC) project, utilizing the outpatient performance of PFT tests in children 6–18 years during a 15-month period. The goal of the study was to determine if a priori the PFT represented a small airway disease pattern or not. Only the pulmonary function was used to make that distinction. Children 6–18 years with asthma who completed a PFT had their PFT as being characterized with or without a small airway dysfunction (SAD) designation, coded in the electronic medical record as an a priori decision using the code J98.4 (other disorders of lung) as a marker for electronic medical records retrieval. Subsequently, the results were analyzed between a group of 136 children designated (a priori) as having no small airway dysfunction in comparison to 91 children a priori designated as having small airway dysfunction. The a priori designation groups were post hoc compared for large and smaller airway function differences. Both large and smaller airway dysfunction were highly significantly different between the 2 groups, based solely on the initial division of the total group based on the decision the PFT represented a small airway pattern. We concluded the baseline pulmonary function test used in the evaluation of pediatric asthma has readily identifiable information regarding the presence of small airway dysfunction, and we characterized what was unique on the PFT based on that SAD classification
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Affiliation(s)
- Russell Hopp
- Department of Pediatrics, University of Nebraska Medical Center, 42nd and Emile St., Omaha, NE 68198, USA
- Children’s Hospital and Medical Center, 8200 Dodge St., Omaha, NE 68114, USA
- Correspondence:
| | - Junghyae Lee
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Heather Bohan
- Children’s Hospital and Medical Center, 8200 Dodge St., Omaha, NE 68114, USA
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Wu J, Zhang H, Shi Y, Wang J, Han Y, Zhang Q, Wang N, Liu S, Zhang Y, Zi H, Wang F, Liu A, Song Y, Jia C, Feng Y, Liu Q, Wan L, Ji M, Long Z, Huang J, Liu L, Sun Y, Tang S, Dong X, Zhou X, Jiang W, Shen L, Jiang H. Reference values of impulse oscillometry (IOS) for healthy Chinese children aged 4-17 years. Respir Res 2022; 23:182. [PMID: 35831898 PMCID: PMC9281015 DOI: 10.1186/s12931-022-02080-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To establish the predicted value of pulmonary function determined by impulse oscillometry (IOS) in children (4-17 years old) in China. METHODS A total of 6270 healthy children aged 4-17 years in China were included. The Master Screen IOS pulmonary function device (Jaeger Co, Germany) was used to detect the respiratory impedance (Zrs), resonant frequency (Fres), respiratory system resistance (Rrs) and respiratory system reactance (Xrs) at various oscillation frequencies, and the indices above were analysed. Stepwise multivariate regression was used to establish the regression equation of related parameters of IOS in different sexes, ages, height, and weight. RESULTS The differences in the main IOS parameters between different age stages were statistically significant regardless of sex (P < 0.05). The stepwise multivariate regression analysis showed that IOS parameters were related to height, age, and weight, and most IOS parameters were most closely related to height (the absolute value of the regression coefficient was the largest). With increasing age and height, the values of Z5, R5, R20, R5-R20, and Fres decreased, while the value of X5 increased. Through height, age, and weight, we obtained the normal predicted values equation of children's IOS parameters. Compared with the other reference equations, our reference equation is more suitable for Chinese children. CONCLUSIONS The study revealed the reference values of IOS parameters in healthy Chinese children. In the evaluation of results for lung function measurements, this predicted value equation is more consistent with the characteristics of Chinese children than other reference equations. CLINICAL TRIAL ChiCTR: 1800019029.
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Affiliation(s)
- Jinhong Wu
- grid.16821.3c0000 0004 0368 8293Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Hao Zhang
- Department of Internal Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Yongsheng Shi
- Department of Pediatric Respiratory, Maternity and Child-Care Hospital of Gansu Province, Lanzhou, 730050 China
| | - Jinrong Wang
- Department of Pediatric Respiratory, Affiliated Provincial Hospital of Shandong First Medical University, Jinan, 250021 China
| | - Yuling Han
- grid.27255.370000 0004 1761 1174Department of Respiratory, Qilu Children’s Hospital of Shandong University, Jinan, 250022 China
| | - Qiaoling Zhang
- Department of Pediatric Respiratory, Maternal and Child Health Hospital in Inner Mongolia Autonomous Region, Hohhot, 010020 China
| | - Ning Wang
- grid.452902.8Asthma Centre of Xi’an Children’s Hospital, Xi’an, 710003 China
| | - Sha Liu
- grid.488412.3Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
| | - Yuehua Zhang
- Pediatrics Infection Disease Ward, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, 570208 China
| | - Huifen Zi
- grid.489937.80000 0004 1757 8474Department of Pediatrics, Baotou Central Hospital, Baotou, 014040 China
| | - Fei Wang
- Department of Pediatric Respiratory, Guiyang Maternal and Child Health Hospital (Guiyang Children’s Hospital), Guiyang, 550003 China
| | - Aihong Liu
- Department of Respiratory Medicine, Children’s Hospital of Shanxi, Taiyuan, 030013 China
| | - Yuxin Song
- Department of Allergy, Harbin Children’s Hospital, Harbin, 150010 China
| | - ChunMei Jia
- Department of Pediatric Respiratory, The Fourth Hospital of Baotou (Baotou Children’s Hospital), Baotou, 014030 China
| | - Yong Feng
- grid.412467.20000 0004 1806 3501Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Quanhua Liu
- grid.412987.10000 0004 0630 1330Department of Pulmonology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China
| | - liya Wan
- grid.417022.20000 0004 1772 3918Respiratory department of Tianjin Children’s Hospital, Tianjin, 300074 China
| | - Minghong Ji
- grid.59053.3a0000000121679639Department of Pediatric, The First Affiliated Hospital of USTC Anhui Provincial Hospital, Hefei, 230001 China
| | - Zhen Long
- grid.33199.310000 0004 0368 7223Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
| | - Jianfeng Huang
- grid.411333.70000 0004 0407 2968Department of Pulmonology, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Li Liu
- grid.430605.40000 0004 1758 4110Department of Pediatric Respiratory, The First Hospital of Jilin University, Changchun, 130021 China
| | - Yun Sun
- General Pediatric, Yinchuan Women and Children Healthcare Hospital, Yinchuan, 750001 China
| | - Suping Tang
- grid.256112.30000 0004 1797 9307Department of Asthma and Tracheitis, Fuzhou Children’s Hospital, Fujian Medical University, Fuzhou, 350000 China
| | - Xiaoyan Dong
- grid.16821.3c0000 0004 0368 8293Department of Pulmonology, Shanghai Children’s Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200040 China
| | - Xiaojian Zhou
- grid.16821.3c0000 0004 0368 8293Department of Pediatrics, Shanghai First People’s Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200080 China
| | - Wenhui Jiang
- grid.413428.80000 0004 1757 8466Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou, 510623 China
| | - Li Shen
- grid.412524.40000 0004 0632 3994Department of Respiratory, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200025 China
| | - Haohua Jiang
- grid.412524.40000 0004 0632 3994Department of Respiratory, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200025 China
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