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Bayat S. [Respiratory oscillometry: Theoretical foundations and clinical applications]. Rev Mal Respir 2024; 41:593-604. [PMID: 39174416 DOI: 10.1016/j.rmr.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024]
Abstract
Oscillometry measures the mechanical properties of the respiratory system. As they are carried out during spontaneous breathing, oscillometry measurements do not require forced breathing maneuvers or the patient's active cooperation. The technique is complementary to conventional pulmonary function testing methods for the investigation of respiratory function, diagnosis and monitoring of respiratory diseases, and assessment of response to treatment. The present review aims to describe the theoretical foundations and practical methodology of oscillometry. It describes the gaps in scientific evidence regarding its clinical utility, and provides examples of current research and clinical applications.
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Affiliation(s)
- S Bayat
- Unité d'explorations fonctionnelles cardiorespiratoires, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France; STROBE, Inserm UA07, université Grenoble Alpes, Grenoble, France.
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2
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Chaya S, Vanker A, Brittain K, MacGinty R, Jacobs C, Hantos Z, Zar HJ, Gray DM. The impact of antenatal and postnatal indoor air pollution or tobacco smoke exposure on lung function at 3 years in an African birth cohort. Respirology 2023; 28:1154-1165. [PMID: 37587874 PMCID: PMC10947154 DOI: 10.1111/resp.14576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Indoor air pollution (IAP) and tobacco smoke exposure (ETS) are global health concerns contributing to the burden of childhood respiratory disease. Studies assessing the effects of IAP and ETS in preschool children are limited. We assessed the impact of antenatal and postnatal IAP and ETS exposure on lung function in a South African birth cohort, the Drakenstein Child Health Study. METHODS Antenatally enrolled mother-child pairs were followed from birth. Lung function measurements (oscillometry, multiple breath washout and tidal breathing) were performed at 6 weeks and 3 years. Quantitative antenatal and postnatal IAP (particulate matter [PM10 ], volatile organic compounds [VOC]) and ETS exposures were measured. Linear regression models explored the effects of antenatal and postnatal exposures on lung function at 3 years. RESULTS Five hundred eighty-four children had successful lung function testing, mean (SD) age of 37.3 (0.7) months. Exposure to antenatal PM10 was associated with a decreased lung clearance index (p < 0.01) and postnatally an increase in the difference between resistance at end expiration (ReE) and inspiration (p = 0.05) and decrease in tidal volume (p = 0.06). Exposure to antenatal VOC was associated with an increase in functional residual capacity (p = 0.04) and a decrease in time of expiration over total breath time (tE /tTOT ) (p = 0.03) and postnatally an increase in respiratory rate (p = 0.05). High ETS exposure postnatally was associated with an increase in ReE (p = 0.03). CONCLUSION Antenatal and postnatal IAP and ETS exposures were associated with impairment in lung function at 3 years. Strengthened efforts to reduce IAP and ETS exposure are needed.
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Affiliation(s)
- S. Chaya
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - A. Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - K. Brittain
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - R. MacGinty
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - C. Jacobs
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Z. Hantos
- Department of Anaesthesiology and Intensive TherapySemmelweis UniversityBudapestHungary
| | - H. J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - D. M. Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
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Radics BL, Gyurkovits Z, Makan G, Gingl Z, Czövek D, Hantos Z. Respiratory Oscillometry in Newborn Infants: Conventional and Intra-Breath Approaches. Front Pediatr 2022; 10:867883. [PMID: 35444964 PMCID: PMC9013809 DOI: 10.3389/fped.2022.867883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oscillometry has been employed widely as a non-invasive and standardized measurement of respiratory function in children and adults; however, limited information is available on infants. AIMS To establish the within-session variability of respiratory impedance (Zrs), to characterize the degree and profile of intra-breath changes in Zrs and to assess their impact on conventional oscillometry in newborns. METHODS 109 healthy newborns were enrolled in the study conducted in the first 5 postpartum days during natural sleep. A custom-made wave-tube oscillometry setup was used, with an 8-48 Hz pseudorandom and a 16 Hz sinusoidal signal used for spectral and intra-breath oscillometry, respectively. A resistance-compliance-inertance (R-C-L) model was fitted to average Zrs spectra obtained from successive 30-s recordings. Intra-breath measures, such as resistance (Rrs) and reactance (Xrs) at the end-expiratory, end-inspiratory and maximum-flow points were estimated from three 90-s recordings. All natural and artifact-free breaths were included in the analysis. RESULTS Within-session changes in the mean R, C and L values, respectively, were large (mean coefficients of variation: 10.3, 20.3, and 26.6%); the fluctuations of the intra-breath measures were of similar degree (20-24%). Intra-breath analysis also revealed large swings in Rrs and Xrs within the breathing cycle: the peak-to-peak changes amounted to 93% (range: 32-218%) and 41% (9-212%), respectively, of the zero-flow Zrs magnitude. DISCUSSION Intra-breath tracking of Zrs provides new insight into the determinants of the dynamics of respiratory system, and highlights the biasing effects of mechanical non-linearities on the average Zrs data obtained from the conventional spectral oscillometry.
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Affiliation(s)
- Bence L Radics
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zita Gyurkovits
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Gergely Makan
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Dorottya Czövek
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Zoltán Hantos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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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: 14] [Impact Index Per Article: 3.5] [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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King GG, Bates J, Berger KI, Calverley P, de Melo PL, Dellacà RL, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, Kaminsky DA, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oppenheimer BW, Simpson SJ, Thamrin C, van den Berge M, Oostveen E. Technical standards for respiratory oscillometry. Eur Respir J 2020; 55:13993003.00753-2019. [PMID: 31772002 DOI: 10.1183/13993003.00753-2019] [Citation(s) in RCA: 285] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
Oscillometry (also known as the forced oscillation technique) measures the mechanical properties of the respiratory system (upper and intrathoracic airways, lung tissue and chest wall) during quiet tidal breathing, by the application of an oscillating pressure signal (input or forcing signal), most commonly at the mouth. With increased clinical and research use, it is critical that all technical details of the hardware design, signal processing and analyses, and testing protocols are transparent and clearly reported to allow standardisation, comparison and replication of clinical and research studies. Because of this need, an update of the 2003 European Respiratory Society (ERS) technical standards document was produced by an ERS task force of experts who are active in clinical oscillometry research.The aim of the task force was to provide technical recommendations regarding oscillometry measurement including hardware, software, testing protocols and quality control.The main changes in this update, compared with the 2003 ERS task force document are 1) new quality control procedures which reflect use of "within-breath" analysis, and methods of handling artefacts; 2) recommendation to disclose signal processing, quality control, artefact handling and breathing protocols (e.g. number and duration of acquisitions) in reports and publications to allow comparability and replication between devices and laboratories; 3) a summary review of new data to support threshold values for bronchodilator and bronchial challenge tests; and 4) updated list of predicted impedance values in adults and children.
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Affiliation(s)
- Gregory G King
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Jason Bates
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Kenneth I Berger
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Pedro L de Melo
- Institute of Biology and Faculty of Engineering, Department of Physiology, Biomedical Instrumentation Laboratory, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB, Politecnico di Milano University, Milano, Italy
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Iulia Ioan
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Charles G Irvin
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - David W Kaczka
- Depts of Anesthesia, Biomedical Engineering and Radiology, University of Iowa, Iowa City, IA, USA
| | - David A Kaminsky
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Hajime Kurosawa
- Dept of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Pediatric University Hospital, Florence, Italy
| | - Geoffrey N Maksym
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - François Marchal
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Beno W Oppenheimer
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Shannon J Simpson
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Cindy Thamrin
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Shao J, Zosky GR, Hall GL, Wheeler AJ, Dharmage S, Melody S, Dalton M, Foong RE, O'Sullivan T, Williamson GJ, Chappell K, Abramson MJ, Johnston FH. Early life exposure to coal mine fire smoke emissions and altered lung function in young children. Respirology 2019; 25:198-205. [DOI: 10.1111/resp.13617] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/16/2019] [Accepted: 05/14/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Jingyi Shao
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
| | - Graeme R. Zosky
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
- School of Medicine, Faculty of HealthUniversity of Tasmania Hobart TAS Australia
| | - Graham L. Hall
- Children's Lung HealthTelethon Kids Institute Perth WA Australia
- School of Physiotherapy and Exercise ScienceCurtin University Perth WA Australia
| | - Amanda J. Wheeler
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
- Behaviour, Environment and Cognition Research ProgramMary MacKillop Institute for Health Research, Australian Catholic University Melbourne VIC Australia
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global HealthUniversity of Melbourne Melbourne VIC Australia
| | - Shannon Melody
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
| | - Marita Dalton
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
| | - Rachel E. Foong
- Children's Lung HealthTelethon Kids Institute Perth WA Australia
- School of Physiotherapy and Exercise ScienceCurtin University Perth WA Australia
| | - Tierney O'Sullivan
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
| | | | - Katherine Chappell
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
| | - Michael J. Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash University Melbourne VIC Australia
| | - Fay H. Johnston
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart TAS Australia
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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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Gray DM, Czovek D, McMillan L, Turkovic L, Stadler JAM, Vanker A, Radics BL, Gingl Z, Hall GL, Sly PD, Zar HJ, Hantos Z. Intra-breath measures of respiratory mechanics in healthy African infants detect risk of respiratory illness in early life. Eur Respir J 2019; 53:13993003.00998-2018. [PMID: 30464010 PMCID: PMC7931666 DOI: 10.1183/13993003.00998-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/01/2018] [Indexed: 12/02/2022]
Abstract
Lower respiratory tract illness (LRTI) is a leading cause of mortality and morbidity in children. Sensitive and noninvasive infant lung function techniques are needed to measure risk for and impact of LRTI on lung health. The objective of this study was to investigate whether lung function derived from the intra-breath forced oscillation technique (FOT) was able to identify healthy infants at risk of LRTI in the first year of life. Lung function was measured with the novel intra-breath FOT, in 6-week-old infants in a South African birth cohort (Drakenstein Child Health Study). LRTI during the first year was confirmed by study staff. The association between baseline lung function and LRTI was assessed with logistic regression and odds ratios determined using optimal cut-off values. Of the 627 healthy infants with successful lung function testing, 161 (24%) had 238 LRTI episodes subsequently during the first year. Volume dependence of respiratory resistance (ΔR) and reactance (ΔX) was associated with LRTI. The predictive value was stronger if LRTI was recurrent (n=50 (31%): OR 2.5, ΔX), required hospitalisation (n=38 (16%): OR 5.4, ΔR) or was associated with wheeze (n=87 (37%): OR 3.9, ΔX). Intra-breath FOT can identify healthy infants at risk of developing LRTI, wheezing or severe illness in the first year of life. Novel measurements of respiratory mechanics are feasible in infants in a community setting and able to detect changes in lung function in healthy infants associated with increased risk of subsequent LRTI in infancyhttp://ow.ly/IUKk30mCfi3
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Affiliation(s)
- Diane M Gray
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.,These two authors are joint first authors
| | - Dorottya Czovek
- Child Health Research Centre, University of Queensland, Brisbane, Australia.,1st Dept of Paediatrics, Semmelweis University, Budapest, Hungary.,These two authors are joint first authors
| | - Lauren McMillan
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | | | - Jacob A M Stadler
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anessa Vanker
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Bence L Radics
- Dept of Pulmonology, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Dept of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Centre for Child Health, University of Western Australia, Perth, Australia
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Heather J Zar
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.,These two authors are joint senior authors
| | - Zoltán Hantos
- Dept of Pulmonology, University of Szeged, Szeged, Hungary.,Dept of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.,These two authors are joint senior authors
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Sly PD, Hantos Z. The International Collaboration to Improve Respiratory Health in Children (INCIRCLE) ERS Clinical Research Collaboration. Eur Respir J 2018; 52:52/6/1801867. [DOI: 10.1183/13993003.01867-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022]
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10
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Kattan M, Bacharier LB, O'Connor GT, Cohen R, Sorkness RL, Morgan W, Gergen PJ, Jaffee KF, Visness CM, Wood RA, Bloomberg GR, Doyle S, Burton R, Gern JE. Spirometry and Impulse Oscillometry in Preschool Children: Acceptability and Relationship to Maternal Smoking in Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:1596-1603.e6. [PMID: 29449165 PMCID: PMC6089669 DOI: 10.1016/j.jaip.2017.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comparisons of the technical acceptability of spirometry and impulse oscillometry (IOS) and clinical correlations of the measurements have not been well studied in young children. There are no large studies focused on African American and Hispanic children. OBJECTIVES We sought to (1) compare the acceptability of spirometry and IOS in 3- to 5-year-old children and (2) examine the relationship of maternal smoking during pregnancy to later lung function. METHODS Spirometry and IOS were attempted at 4 sites from the Urban Environmental and Childhood Asthma Study birth cohort at ages 3, 4, and 5 years (472, 471, and 479 children, respectively). We measured forced expiratory flow in 0.5 s (forced expiratory volume in 0.5 seconds [FEV0.5]) with spirometry and area of reactance (AX), resistance and reactance at 5 Hz (R5 and X5, respectively) using IOS. RESULTS Children were more likely to achieve acceptable maneuvers with spirometry than with IOS at age 3 (60% vs 46%, P < .001) and 5 years (89% vs 84%, P = .02). Performance was consistent among the 4 study sites. In children without recurrent wheeze, there were strong trends for higher FEV0.5 and lower R5 and AX over time. Maternal smoking during pregnancy was associated with higher AX at ages 4 and 5 years (P < .01 for both years). There was no significant difference in FEV0.5 between children with and without in utero exposure to smoking. CONCLUSION There is a higher rate of acceptable maneuvers with spirometry compared with IOS, but IOS may be a better indicator of peripheral airway function in preschool children.
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Affiliation(s)
- Meyer Kattan
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo
| | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Robyn Cohen
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Ronald L Sorkness
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Wayne Morgan
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Ariz
| | - Peter J Gergen
- Division of Allergy, Immunology, and Transplantation, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | | | - Robert A Wood
- Department of Pediatric Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Gordon R Bloomberg
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo
| | - Susan Doyle
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ryan Burton
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - James E Gern
- Pharmacy Practice Division, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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11
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Bush A. A scandal in South Africa: And not just there! Pediatr Pulmonol 2018; 53:698-700. [PMID: 29673131 DOI: 10.1002/ppul.24010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Andrew Bush
- Imperial College, London, UK.,National Heart and Lung Institute, London, UK.,Royal Brompton Harefield NHS Foundation Trust, London, UK
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12
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Vanker A, Barnett W, Workman L, Nduru PM, Sly PD, Gie RP, Zar HJ. Early-life exposure to indoor air pollution or tobacco smoke and lower respiratory tract illness and wheezing in African infants: a longitudinal birth cohort study. Lancet Planet Health 2017; 1:e328-e336. [PMID: 29167839 PMCID: PMC5681433 DOI: 10.1016/s2542-5196(17)30134-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Indoor air pollution (IAP) and environmental tobacco smoke (ETS) are associated with lower respiratory tract illness (LRTI) or wheezing in children. However, the effect of the timing of these exposures, specifically antenatal versus postnatal, and of alternate fuel sources such as the increasingly used volatile organic compounds have not been well studied. We longitudinally investigated the effect of antenatal or postnatal IAP and ETS on LRTI or wheezing prevalence and severity in African infants. METHODS Mother and infant pairs enrolled over a 3-year period in a birth cohort study in two centres in Paarl, South Africa, were followed for the first year of life for LRTI or wheezing illness. We measured exposure to IAP (particulate matter, nitrogen dioxide, sulphur dioxide, carbon monoxide, and volatile organic compounds benzene and toluene) using devices placed in homes, antenatally and postnatally. We measured ETS longitudinally by maternal self-report and by urine cotinine measures. Study staff trained in recognition of LRTI or wheeze documented all episodes, which were categorised according to WHO case definition criteria. We used multivariate logistic and Poisson regressions to explore associations. FINDINGS Between March 1, 2012, and March 31, 2015, we enrolled 1137 mothers with 1143 livebirths. Of 1065 infants who attended at least one study visit, 524 episodes of LRTI occurred after discharge with a wheezing prevalence of 0·23 (95% CI 0·21-0·26) episodes per child year. Exposures associated with LRTI were antenatal maternal smoking (incidence rate ratio 1·62, 95% CI 1·14-2·30; p=0·004) or particulate matter (1·43, 1·06-1·95; p=0·008). Subanalyses of LRTI requiring hospitalisation (n=137) and supplemental oxygen (n=69) found antenatal toluene significantly increased the risk of LRTI-associated hospitalisation (odds ratio 5·13, 95% CI 1·43-18·36; p=0·012) and need for supplemental oxygen (13·21, 1·96-89·16; p=0·008). Wheezing illness was associated with both antenatal (incidence rate ratio 2·09, 95% CI 1·54-2·84; p<0·0001) and postnatal (1·27, 95% CI 1·03-1·56; p=0·024) maternal smoking. Antenatally, wheezing was associated with maternal passive smoke exposure (1·70, 1·25-2·31; p=0·001) and, postnatally, with any household member smoking (1·55, 1·17 -2·06; p=0·002). INTERPRETATION Antenatal exposures were the predominant risk factors associated with LRTI or wheezing illness. Toluene was a novel exposure associated with severe LRTI. Urgent and effective interventions focusing on antenatal environmental factors are required, including smoking cessation programmes targeting women of childbearing age pre-conception and pregnant women. FUNDING Bill & Melinda Gates Foundation, Discovery Foundation, South African Thoracic Society AstraZeneca Respiratory Fellowship, Medical Research Council South Africa, National Research Foundation South Africa, and CIDRI Clinical Fellowship.
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Affiliation(s)
- Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, South Africa; MRC Unit on Child & Adolescent Health, University of Cape Town, Rondebosch, South Africa.
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, South Africa; MRC Unit on Child & Adolescent Health, University of Cape Town, Rondebosch, South Africa
| | - Lesley Workman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, South Africa; MRC Unit on Child & Adolescent Health, University of Cape Town, Rondebosch, South Africa
| | - Polite M Nduru
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, South Africa; MRC Unit on Child & Adolescent Health, University of Cape Town, Rondebosch, South Africa
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Robert P Gie
- Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, South Africa; MRC Unit on Child & Adolescent Health, University of Cape Town, Rondebosch, South Africa
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Karron RA, Zar HJ. Determining the outcomes of interventions to prevent respiratory syncytial virus disease in children: what to measure? THE LANCET RESPIRATORY MEDICINE 2017; 6:65-74. [PMID: 28865676 DOI: 10.1016/s2213-2600(17)30303-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 02/02/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of viral acute lower respiratory tract illness (LRTI) in young children, and a major cause of hospital admissions and health-care utilisation globally. Substantial efforts have been made to develop RSV vaccines and vaccine-like monoclonal antibodies to prevent acute RSV LRTI. Prevention of acute disease could improve long-term lung health, with potential effects on wheezing, asthma, and chronic lung disease. This Personal View describes assessments that should be initiated during clinical trials and continued after licensure to fully evaluate the effect of RSV preventive interventions. These assessments include recording the incidence of RSV-specific LRTI and all-cause LRTI through two RSV seasons, and assessment of the prevalence and severity of recurrent wheezing or asthma in children aged up to 6 years. Standardised assessments in diverse settings are needed to fully determine the effect of interventions for the prevention of RSV disease.
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Affiliation(s)
- Ruth A Karron
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heather J Zar
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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14
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Vanker A, Gie R, Zar H. The association between environmental tobacco smoke exposure and childhood respiratory disease: a review. Expert Rev Respir Med 2017; 11:661-673. [PMID: 28580865 PMCID: PMC6176766 DOI: 10.1080/17476348.2017.1338949] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/02/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Childhood respiratory illness is a major cause of morbidity and mortality particularly in low and middle-income countries. Environmental tobacco smoke (ETS) exposure is a recognised risk factor for both acute and chronic respiratory illness. Areas covered: The aim of this paper was to review the epidemiology of ETS exposure and impact on respiratory health in children. We conducted a search of 3 electronic databases of publications on ETS and childhood respiratory illness from 1990-2015. Key findings were that up to 70% of children are exposed to ETS globally, but under-reporting may mask the true prevalence. Maternal smoking and ETS exposure influence infant lung development and are associated with childhood upper and lower respiratory tract infection, wheezing or asthma. Further, exposure to ETS is associated with more severe respiratory disease. ETS exposure reduces lung function early in life, establishing an increased lifelong risk of poor lung health. Expert commentary: Urgent and effective strategies are needed to decrease ETS exposure in young children to improve child and long-term lung health in adults especially in low and middle income countries where ETS exposure is increasing.
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Affiliation(s)
- A. Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - R.P. Gie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H.J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
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15
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Gray D, Willemse L, Visagie A, Czövek D, Nduru P, Vanker A, Stein DJ, Koen N, Sly PD, Hantos Z, Hall GL, Zar HJ. Determinants of early-life lung function in African infants. Thorax 2017; 72:445-450. [PMID: 27856821 PMCID: PMC5520243 DOI: 10.1136/thoraxjnl-2015-207401] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/13/2016] [Accepted: 10/17/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Low lung function in early life is associated with later respiratory illness. There is limited data on lung function in African infants despite a high prevalence of respiratory disease. AIM To assess the determinants of early lung function in African infants. METHOD Infants enrolled in a South African birth cohort, the Drakenstein child health study, had lung function measured at 6-10 weeks of age. Measurements, made with the infant breathing via a facemask during natural sleep, included tidal breathing, sulfur hexafluoride multiple breath washout and the forced oscillation technique. Information on antenatal and early postnatal exposures was collected using questionnaires and urine cotinine. Household benzene exposure was measured antenatally. RESULTS Successful tests were obtained in 645/675 (95%) infants, median (IQR) age of 51 (46-58) days. Infant size, age and male gender were associated with larger tidal volume. Infants whose mothers smoked had lower tidal volumes (-1.6 mL (95% CI -3.0 to -0.1), p=0.04) and higher lung clearance index (0.1 turnovers (95% CI 0.01 to 0.3), p=0.03) compared with infants unexposed to tobacco smoke. Infants exposed to alcohol in utero or household benzene had lower time to peak tidal expiratory flow over total expiratory time ratios, 10% (95% CI -15.4% to -3.7%), p=0.002) and 3.0% (95% CI -5.2% to -0.7%, p=0.01) lower respectively compared with unexposed infants. HIV-exposed infants had higher tidal volumes (1.7 mL (95% CI 0.06 to 3.3) p=0.04) compared with infants whose mothers were HIV negative. CONCLUSION We identified several factors including infant size, sex, maternal smoking, maternal alcohol, maternal HIV and household benzene associated with altered early lung function, many of which are factors amenable to public health interventions. Long-term study of lung function and respiratory disease in these children is a priority to develop strategies to strengthen child health.
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Affiliation(s)
- Diane Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Lauren Willemse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Ane Visagie
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dorottya Czövek
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Polite Nduru
- Division of Epidemiology and Biostatistics, Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorder, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorder, University of Cape Town, Cape Town, South Africa
| | - Peter D Sly
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Zoltán Hantos
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Graham L Hall
- Telethon Kids Institute, Australia Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Investigating the relationship between environmental factors and respiratory health outcomes in school children using the forced oscillation technique. Int J Hyg Environ Health 2017; 220:494-502. [DOI: 10.1016/j.ijheh.2017.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 11/21/2022]
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17
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Gray DM, Turkovic L, Willemse L, Visagie A, Vanker A, Stein DJ, Sly PD, Hall GL, Zar HJ. Lung Function in African Infants in the Drakenstein Child Health Study. Impact of Lower Respiratory Tract Illness. Am J Respir Crit Care Med 2017; 195:212-220. [PMID: 27509359 PMCID: PMC5394784 DOI: 10.1164/rccm.201601-0188oc] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Lower respiratory tract illness is a major cause of childhood morbidity and mortality. It is unknown whether infants are predisposed to illness because of impaired lung function or whether respiratory illness reduces lung function. OBJECTIVES To investigate the impact of early life exposures, including lower respiratory tract illness, on lung function during infancy. METHODS Infants enrolled in the Drakenstein child health study had lung function at 6 weeks and 1 year. Testing during quiet natural sleep included tidal breathing, exhaled nitric oxide, and multiple breath washout measures. Risk factors for impaired lung health were collected longitudinally. Lower respiratory tract illness surveillance was performed and any episode investigated. MEASUREMENTS AND MAIN RESULTS Lung function was tested in 648 children at 1 year. One hundred and fifty (29%) infants had a lower respiratory tract illness during the first year of life. Lower respiratory tract illness was independently associated with increased respiratory rate (4%; 95% confidence interval [CI], 1.01-1.08; P = 0.02). Repeat episodes further increased respiratory rate (3%; 95% CI, 1.01-1.05; P = 0.004), decreased tidal volume (-1.7 ml; 95% CI, -3.3 to -0.2; P = 0.03), and increased the lung clearance index (0.13 turnovers; 95% CI, 0.04-0.22; P = 0.006) compared with infants without illness. Tobacco smoke exposure, lung function at 6 weeks, infant growth, and prematurity were other independent predictors of lung function at 1 year. CONCLUSIONS Early life lower respiratory tract illness impairs lung function at 1 year, independent of baseline lung function. Preventing early life lower respiratory tract illness is important to optimize lung function and promote respiratory health in childhood.
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Affiliation(s)
- Diane M. Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Lidija Turkovic
- Telethon Kids Institute and Centre for Child Health, University of Western Australia, Perth, Australia
| | - Lauren Willemse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Ane Visagie
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Peter D. Sly
- Children’s Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland and Queensland Children's Medical Research Institute, Brisbane, Australia; and
| | - Graham L. Hall
- Telethon Kids Institute and Centre for Child Health, University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
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High Success Rate of Lung Function Testing in Healthy, Unsedated 1- and 2-Year-Old South African Children. Ann Am Thorac Soc 2016; 13:2099-2101. [DOI: 10.1513/annalsats.201605-404le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jo HE, Corte TJ, Wort SJ, Eves ND, Piper A, Wainwright C. Year in review 2015: Interstitial lung disease, pulmonary vascular disease, pulmonary function, sleep and ventilation, cystic fibrosis and paediatric lung disease. Respirology 2016; 21:556-66. [DOI: 10.1111/resp.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Helen E. Jo
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
| | - Tamera J. Corte
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
| | - Stephen J. Wort
- Department of Pulmonary Hypertension; Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London; London UK
| | - Neil D. Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development; University of British Columbia; Kelowna British Columbia Canada
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Woolcock Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - Claire Wainwright
- Lady Cilento Children's Hospital, School of Medicine; University of Queensland; Brisbane Queensland Australia
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Gray D, Willemse L, Visagie A, Smith E, Czövek D, Sly PD, Hantos Z, Hall GL, Zar HJ. Lung function and exhaled nitric oxide in healthy unsedated African infants. Respirology 2015; 20:1108-14. [PMID: 26134556 PMCID: PMC4623783 DOI: 10.1111/resp.12579] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/24/2015] [Accepted: 03/31/2015] [Indexed: 12/30/2022]
Abstract
Background and objective Population-appropriate lung function reference data are essential to accurately identify respiratory disease and measure response to interventions. There are currently no reference data in African infants. The aim was to describe normal lung function in healthy African infants. Methods Lung function was performed on healthy South African infants enrolled in a birth cohort study, the Drakenstein child health study. Infants were excluded if they were born preterm or had a history of neonatal respiratory distress or prior respiratory tract infection. Measurements, made during natural sleep, included the forced oscillation technique, tidal breathing, exhaled nitric oxide and multiple breath washout measures. Results Three hundred sixty-three infants were tested. Acceptable and repeatable measurements were obtained in 356 (98%) and 352 (97%) infants for tidal breathing analysis and exhaled nitric oxide outcomes, 345 (95%) infants for multiple breath washout and 293 of the 333 (88%) infants for the forced oscillation technique. Age, sex and weight-for-age z score were significantly associated with lung function measures. Conclusions This study provides reference data for unsedated infant lung function in African infants and highlights the importance of using population-specific data.
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Affiliation(s)
- Diane Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
| | - Lauren Willemse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
| | - Ane Visagie
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
| | - Emilee Smith
- Division of Epidemiology and Biostatistics, School of Public Health and Family, University of Cape Town, Cape Town, South Africa
| | - Dorottya Czövek
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.,Queensland Children's Medical Research Institute, University of Queensland, Perth, Western Australia, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, University of Queensland, Perth, Western Australia, Australia
| | - Zoltán Hantos
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.,Queensland Children's Medical Research Institute, University of Queensland, Perth, Western Australia, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
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