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Lai SH, Liao SL, Tsai MH, Hua MC, Chiu CY, Yeh KW, Yao TC, Huang JL. Low cord-serum 25-hydroxyvitamin D levels are associated with poor lung function performance and increased respiratory infection in infancy. PLoS One 2017; 12:e0173268. [PMID: 28267792 PMCID: PMC5340372 DOI: 10.1371/journal.pone.0173268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background Perinatal vitamin D deficiency is associated with a higher risk of wheezing in childhood. However, the relationship between vitamin D levels and lung function in infancy has not been investigated. The aim of this study was to investigate the impact of perinatal vitamin D levels on respiratory function and disease outcome in infancy. Materials and methods Full-term infants without any chronic diseases or major anomalies were enrolled in the Prediction of Allergies in Taiwanese Children cohort study. Maternal and cord blood were collected for determining the 25(OH)D level. Questionnaires were recorded at birth and 6 months of age. Infant lung function, including tidal breathing analysis, respiratory mechanics, and forced tidal expiration, was tested at 6 months of age. Results A total of 122 mother—infant pairs were enrolled in this study, and 71 infants underwent lung function testing at 6 months of age. 25(OH)D levels in maternal and cord serum were highly correlated (r2 = 0.457, p < 0.0001). Infants with lower cord serum 25(OH)D levels (< 13.7 ng/ml) had higher resistance of respiratory system (p < 0.01) and a higher risk of a respiratory tract infection before the age of 6 months (p < 0.01). Conclusion Although a high correlation was found between maternal and cord vitamin D levels, the effect on respiratory outcome was different. Our study is the first to show that low cord 25(OH)D levels significantly relationship with poorer lung function performance and higher likelihood of a respiratory tract infection before 6 months of age.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- * E-mail: (TCY); (JLH)
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- * E-mail: (TCY); (JLH)
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Lanza FC, Wandalsen GF, Dos Santos AM, Solé D. Bronchodilator response in wheezing infants assessed by the raised volume rapid thoracic compression technique. Respir Med 2016; 119:29-34. [PMID: 27692144 DOI: 10.1016/j.rmed.2016.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/16/2016] [Accepted: 08/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bronchodilator response (BDR) analyzed by the raised volume rapid thoracic compression (RVRTC) in wheezing infants is not yet well described, although bronchodilators (BD) are routine in the treatment of this population. OBJECTIVE To evaluate BDR by RVRTC technique in infants with recurrent wheezing and compare to control group. METHOD Cross sectional study, 45 infants, age 56 weeks (38-67 weeks). Two groups: wheezing group (WG: history of recurrent wheezing) and control group (CG). RVRTC was evaluated, FVC, FEV0.5, FEF50, FEF75, FEF85, FEF25-75 were measured. Salbutamol was delivered to infants and RVRTC evaluated again. BDR was determined by the increase greater than two standard deviation from the mean change in the CG. RESULTS In WG (n = 32) lung function was worse than in CG (n = 13): FEV0.5: 0.0(-0.9-0.9z score) vs 0.8(0.2-1.4z score); FEF50: 0.2(-0.3-1.1z score) vs 0.9(0.5-1.4z score); and FEF25-75: 0.2(-0.5-1.1z score) vs 1.1(0.6-1.6z score), respectively, p < 0.05. Both groups had similar increase after BD. In WG 11 patients (34%) were responder and these had worse lung function compared to nonresponder (n = 21) (p < 0.05). The increase in lung function after BD in responder was higher than in nonresponder: FEV0.5: 6.5(2.1-7.1%) vs -0.5(-2.5-0.7%), FEF50: 5.1(2.7-11.7%) vs 0.4(-1.1-2.8%), FEF75: 20.7(4.7-23.6%) vs -1.3(-6.4-3.9%), FEF25-75: 9.9(3.8-16.4%) vs 0.0(-1.5-1.0%), respectively, p < 0.05. CONCLUSION 34% WG showed BDR measured by the RVRTC. The best variables to detect BDR were FEF75, FEF25-75 and FEV0.5. Patients with worse lung function showed better response to BD.
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Affiliation(s)
- Fernanda Cordoba Lanza
- Discipline of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of Sao Paulo - UNIFESP, Sao Paulo, SP, Otonis St 725, 04025-002, Brazil.
| | - Gustavo Falbo Wandalsen
- Discipline of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of Sao Paulo - UNIFESP, Sao Paulo, SP, Otonis St 725, 04025-002, Brazil.
| | - Amelia Miyashiro Dos Santos
- Neonatal Division of Medicine - Department of Pediatrics - Federal University of Sao Paulo - UNIFESP, Sao Paulo, SP, Marselhesa St 630, 04020-060, Brazil.
| | - Dirceu Solé
- Discipline of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of Sao Paulo - UNIFESP, Sao Paulo, SP, Otonis St 725, 04025-002, Brazil.
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Shavit S, Cohen S, Goldman A, Ben-Dov L, Avital A, Springer C, Hevroni A. Bronchodilator responsiveness in wheezy infants predicts continued early childhood respiratory morbidity. J Asthma 2016; 53:707-13. [PMID: 27042758 DOI: 10.3109/02770903.2016.1154071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Spirometry including bronchodilator responsiveness is considered routine in the workup of asthma in older children. However, in wheezy infants the existence of bronchodilator responsiveness and its prognostic significance remain unclear. METHODS Infants (< 2 years) with chronic or recurrent wheezing or coughing were evaluated by infant pulmonary function testing (PFT). Maximal expiratory flow at the point of functional residual capacity (V̇maxFRC) was measured before and 20 minutes after salbutamol administration. Only infants with an obstructive profile (V̇maxFRC < 80% predicted) were included. The infants were divided into two groups with regard to whether or not a response to salbutamol was observed on PFT. A response was defined as a mean V̇maxFRC after salbutamol administration exceeding the upper confidence interval limit of individual pre-bronchodilator V̇maxFRC measurements. Follow-up data was gathered after a mean of 2 years. MEASUREMENTS AND MAIN RESULTS Sixty infants were included in the study of which 32 (53%) demonstrated responsiveness to bronchodilators. The infants in the responsive group had a significantly higher frequency of physician visits for wheezing than the non-responders (3.0 mean visits/yr vs. 1.5 respectively, P = 0.03), and had a higher likelihood of having received asthma medication in the last year of the follow-up period (84% vs. 50% respectively, RR: 1.68[1.10-2.56]). At the end of the follow-up period, more parents in the responsive group reported continued respiratory disease (71% vs. 22%, RR:3.21[1.30-7.95]). CONCLUSIONS Bronchodilator responsiveness can be demonstrated by infant PFT in infants with recurrent wheezing and can predict increased respiratory morbidity until 3 years of age.
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Affiliation(s)
- Solomon Shavit
- a Department of Pediatrics - Mount Scopus, Hadassah University Hospital , Jerusalem , Israel
| | - Shlomo Cohen
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Aliza Goldman
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Lior Ben-Dov
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Avraham Avital
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Chaim Springer
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
| | - Avigdor Hevroni
- b Institute of Pulmonology , Hadassah University Hospital , Jerusalem , Israel
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Vogt B, Falkenberg C, Weiler N, Frerichs I. Pulmonary function testing in children and infants. Physiol Meas 2014; 35:R59-90. [PMID: 24557323 DOI: 10.1088/0967-3334/35/3/r59] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pulmonary function testing is performed in children and infants with the aim of documenting lung development with age and making diagnoses of lung diseases. In children and infants with an established lung disease, pulmonary function is tested to assess the disease progression and the efficacy of therapy. It is difficult to carry out the measurements in this age group without disturbances, so obtaining results of good quality and reproducibility is challenging. Young children are often uncooperative during the examinations. This is partly related to their young age but also due to the long testing duration and the unpopular equipment. We address a variety of examination techniques for lung function assessment in children and infants in this review. We describe the measuring principles, examination procedures, clinical findings and their interpretation, as well as advantages and limitations of these methods. The comparability between devices and centres as well as the availability of reference values are still considered a challenge in many of these techniques. In recent years, new technologies have emerged allowing the assessment of lung function not only on the global level but also on the regional level. This opens new possibilities for detecting regional lung function heterogeneity that might lead to a better understanding of respiratory pathophysiology in children.
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Affiliation(s)
- B Vogt
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Sarria EE, Mattiello R, Yao W, Chakr V, Tiller CJ, Kisling J, Tabbey R, Yu Z, Kaplan MH, Tepper RS. Atopy, cytokine production, and airway reactivity as predictors of pre-school asthma and airway responsiveness. Pediatr Pulmonol 2014; 49:132-9. [PMID: 23401409 PMCID: PMC3998641 DOI: 10.1002/ppul.22784] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 12/13/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Childhood asthma is often characterized by recurrent wheezing, airway hyper-reactivity, atopy, and altered immune characteristics; however, our understanding of the development of these relationships from early in life remains unclear. The aim of our study was to evaluate whether atopy, cytokine production by peripheral blood mononuclear cells (PBMCs), and airway responsiveness, assessed in infants and toddlers, are associated with asthma and airway responsiveness at 4-years of age. METHODS Infants with eczema (N = 116), enrolled prior to wheezing, were assessed at entry (mean age of 10.7 months), at 1-year follow-up (N = 112), and at 4-years of age (N = 94). Total serum IgE, specific IgE to allergens, and cytokines produced by stimulated PBMCs, were assessed at entry and 1-year follow-up. Spirometry was obtained at all 3-visits, while airway reactivity to methacholine was assessed at entry and 1-year follow-up, and bronchodilator (BD) responsiveness, as well as current asthma was assessed at 4-years of age. RESULTS We found that pre-school children with asthma had lower spirometry and a greater BD-response. Serum IgE, particularly to egg and/or milk, and altered cytokine production by PBMCs at entry to the study were associated with asthma, lower spirometry, and greater airway responsiveness at 4-years of age. In addition, we found that airway responsiveness, as well as spirometry, tracked from infancy to 4-years of age. CONCLUSIONS While spirometry and airway responsiveness track longitudinally from early in life, atopy and cytokine production by PBMCs are associated not only with an increased risk of pre-school asthma, but also lower spirometry and increased airway responsiveness.
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Affiliation(s)
- Edgar E Sarria
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana; Centro Infant-Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Ghalibafsabbaghi B, Raj D, Lodha R, Kabra SK. Assessment of bronchodilator response in preschool children by pulmonary function tests. Indian Pediatr 2013; 50:957-60. [PMID: 23798631 DOI: 10.1007/s13312-013-0259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/30/2013] [Indexed: 11/28/2022]
Abstract
We performed pulmonary function test to document bronchodilator response by using tidal breathing flow volume loop (TBFVL), rapid thoracic compression (RTC), and raised volume rapid thoracic compression (RVRTC) techniques. Thirty-nine children (mean age 45.2 months) were evaluated. The parameters that showed significant improvement after bronchodilator administration included TEF10/ PTEF ratio in TBFVL, and FEF25-75%, FEV1 and PEF in RVRTC. None of the parameters measured in RTC showed significant improvement. We conclude FEV1, PEF and FEF 25-75% in RVRTC have greater sensitivity for detection of airways changes.
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Affiliation(s)
- Babak Ghalibafsabbaghi
- Division of Pulmonology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India. Correspondence to: Dr S K Kabra, Professor, Division of Pulmonology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Scarlett EE, Walker S, Rovitelli A, Ren CL. Tidal Breathing Responses to Albuterol and Normal Saline in Infants with Viral Bronchiolitis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012. [DOI: 10.1089/ped.2012.0141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Seth Walker
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Amy Rovitelli
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Clement L. Ren
- Department of Pediatrics, University of Rochester, Rochester, New York
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Morris MG. Nasal versus oronasal raised volume forced expirations in infants--a real physiologic challenge. Pediatr Pulmonol 2012; 47:780-94. [PMID: 22328241 PMCID: PMC3395775 DOI: 10.1002/ppul.22509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/29/2011] [Indexed: 11/12/2022]
Abstract
Raised volume rapid thoracoabdominal compression (RTC) generates forced expiration (FE) in infants typically from an airway opening pressure of 30 cm H(2)O (V(30)). We hypothesized that the higher nasal than pulmonary airway resistance limits forced expiratory flows (FEF(%)) during (nasal) FE(n), which an opened mouth, (oronasal) FE(o), would resolve. Measurements were performed during a brief post-hyperventilation apnea on 12 healthy infants aged 6.9-104 weeks. In two infants, forced expiratory (FEFV) flow volume (FV) curves were generated using a facemask that covered the nose and a closed mouth, then again with a larger mask with the mouth opened. In other infants (n = 10), the mouth closed spontaneously during FE. Oronasal passive expiration from V(30) generated either the inspiratory capacity (IC) or by activating RTC before end-expiration, the slow vital capacity ((j) SVC). Peak flow (PF), FEF(25), FEF(50), FEF(25-75), FEV(0.4), and FEV(0.5) were lower via FE(n) than FE(o) (P < 0.05), but the ratio of expired volume at PF and forced vital capacity (FVC) as percent was higher (P < 0.05). FEF(75), FEF(85), FEF(90), FVC as well as the applied jacket pressures were not different (P > 0.05). FEFV curves generated via FE(o) exhibited higher PF than FV curves of IC (P < 0.05); PF of those produced via FE(n) were not different from FV curves of IC (P > 0.05) but lower than those of (j) SVC (P < 0.05). In conclusion, the higher nasal than pulmonary airways resistance unequivocally affects the FEFV curves by consistently reducing PF and decreases mid-expiratory flows. A monitored slightly opened mouth and a gentle anterior jaw thrust are physiologically integral for raised volume RTC in order to maximize the oral and minimize nasal airways contribution to FE so that flow limitation would be in the pulmonary not nasal airways.
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Affiliation(s)
- Mohy G Morris
- Department of Pediatrics, Pulmonary Medicine Section, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202-3591, USA.
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Carroll CL, Sala K, Zucker AR, Schramm CM. Pulmonary mechanics following albuterol therapy in mechanically ventilated infants with bronchiolitis. J Asthma 2012; 49:688-96. [PMID: 22741817 DOI: 10.3109/02770903.2012.685541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS Bronchiolitis is a common cause of critical illness in infants. Inhaled β(2)-agonist bronchodilators are frequently used as part of treatment, despite unproven effectiveness. The purpose of this study was to describe the physiologic response to these medications in infants intubated and mechanically ventilated for bronchiolitis. MATERIALS AND METHODS We conducted a prospective trial of albuterol treatment in infants intubated and mechanically ventilated for bronchiolitis. Before and for 30 minutes following inhaled albuterol treatment, sequential assessments of pulmonary mechanics were determined using the interrupter technique on repeated consecutive breaths. RESULTS Fifty-four infants were enrolled. The median age was 44 days (25-75%; interquartile range (IQR) 29-74 days), mean hospital length of stay (LOS) was 18.3 ± 13.3 days, mean ICU LOS was 11.3 ± 6.4 days, and mean duration of mechanical ventilation was 8.5 ± 3.5 days. Fifty percent (n = 27) of the infants were male, 81% (n = 44) had public insurance, 80% (n = 41) were Caucasian, and 39% (n = 21) were Hispanic. Fourteen of the 54 (26%) had reduction in respiratory system resistance (Rrs) that was more than 30% below baseline, and were defined as responders to albuterol. Response to albuterol was not associated with demographic factors or hospitalization outcomes such as LOS or duration of mechanical ventilation. However, increased Rrs, prematurity, and non-Hispanic ethnicity were associated with increased LOS. CONCLUSIONS In this population of mechanically ventilated infants with bronchiolitis, relatively few had a reduction in pulmonary resistance in response to inhaled albuterol therapy. This response was not associated with improvements in outcomes.
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Affiliation(s)
- Christopher L Carroll
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
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Debley J, Stanojevic S, Filbrun AG, Subbarao P. Bronchodilator responsiveness in wheezy infants and toddlers is not associated with asthma risk factors. Pediatr Pulmonol 2012; 47:421-8. [PMID: 22006677 PMCID: PMC3325342 DOI: 10.1002/ppul.21567] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/17/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND There are limited data assessing bronchodilator responsiveness (BDR) in infants and toddlers with recurrent wheezing, and factors associated with a positive response. OBJECTIVES In a multicenter study of children ≤ 36 months old, we assessed the prevalence of and factors associated with BDR among infants/toddlers with recurrent episodes of wheezing. METHODS Forced expiratory flows and volumes using the raised-volume rapid thoracic compression method were measured in 76 infants/toddlers [mean (SD) age 16.8 (7.6) months] with recurrent wheezing before and after administration of albuterol. Prior history of hospitalization or emergency department treatment for wheezing, use of inhaled or systemic corticosteroids, physician treatment of eczema, environmental tobacco smoke exposure, and family history of asthma or allergic rhinitis were ascertained. RESULTS Using the published upper limit of normal for post bronchodilator change (FEV(0.5) ≥ 13% and/or FEF(25-75) ≥ 24%) in healthy infants, 24% (n = 18) of children in our study exhibited BDR. The BDR response was not associated with any clinical factor other than body size. Dichotomizing subjects into responders (defined by published limits of normal) or by quartile to identify children with the greatest change from baseline (4th quartile vs. other) did not identify any other factor associated with BDR. CONCLUSIONS Approximately one quarter of infants/toddlers with recurrent wheezing exhibited BDR at their clinical baseline. However, BDR in wheezy infants/toddlers was not associated with established clinical asthma risk factors.
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Affiliation(s)
- Jason Debley
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
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Bronchiolitis. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7173523 DOI: 10.1016/b978-1-4377-2702-9.00033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vilozni D, Bentur L, Godfrey S, Barker M, Bar-Yishay E. Maximal Flow at Functional Residual Capacity in Healthy Children From Birth to 7 Years, and Beyond. Chest 2011; 139:1439-1444. [DOI: 10.1378/chest.10-0625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Clinical Applications of Pediatric Pulmonary Function Testing: Lung Function in Recurrent Wheezing and Asthma. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2011; 24:69-76. [DOI: 10.1089/ped.2010.0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pérez-Yarza EG, Sardón Prado O, Korta Murua J. [Recurrent wheezing in three year-olds: facts and opportunities]. An Pediatr (Barc) 2009; 69:369-82. [PMID: 18928707 DOI: 10.1157/13126564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The 3 year-old group of children has an increased incidence and prevalence of recurrent wheezing episodes. There are different subgroups, who give different inflammatory responses to different triggering agents, and subgroups that differ in aetiopathology and immunopathology. Current diagnostic methods (exhaled nitric oxide in multiple breaths, nitric oxide in exhaled air condensate, induced sputum, broncho-alveolar lavage and endo-bronchial biopsy), enable the inflammatory pattern to be identified and to give the most effective and safe treatment. The various therapeutic options for treatment are reviewed, such as inhaled glucocorticoids when the inflammatory phenotype is eosinophilic, and leukotriene receptor antagonists, when the inflammatory phenotype is predominantly neutrophilic. In accordance with the current recommendations, for the diagnosis as well as for the therapy initiated in children of this age, they must be regularly reviewed, so that if the benefit is not clear, the treatment must be stopped and an alternative diagnosis and treatment considered. The start of treatment should be determined depending on the intensity and frequency of the symptoms, with the aim of decreasing morbidity and increasing the quality of life of the patient.
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Affiliation(s)
- E G Pérez-Yarza
- Unidad de Neumología, Servicio de Pediatría, Hospital Donostia, San Sebastián, España.
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16
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Akute virale Infektionen des unteren Respirationstraktes. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mallol J, Aguirre V. Avances en el estudio de la función pulmonar en lactantes: maniobras de espiración forzada con volumen pulmonar aumentado. Arch Bronconeumol 2007. [DOI: 10.1157/13100543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mallol J, Aguirre V. [Advances in the study of infant lung function: forced expiratory maneuvers from an increased lung volume]. Arch Bronconeumol 2007; 43:233-8. [PMID: 17397588 DOI: 10.1016/s1579-2129(07)60056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Forced expiratory maneuvers from an increased lung volume in infants date from 1989 and consist of raising the inspiratory volume by applying a specific inflation pressure until a level close to the total lung capacity is reached. The chest and abdomen are then compressed by means of an inflatable jacket in order to obtain a forced expiratory flow-volume curve similar to that obtained for an adult. Forced expiration from an increased lung volume in infants is useful, just as the maneuver is in older patients, for studying airway function, diagnosing obstructive diseases early, and assessing response to treatment. The objective of this review is to provide information on the physiological bases and technical aspects of a lung function test that has proven highly useful for the study of the airways of healthy infants as well as those with respiratory diseases.
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Affiliation(s)
- Javier Mallol
- Departamento de Medicina Respiratoria Infantil, Facultad de Ciencias Médicas, Hospital CRS El Pino, Universidad de Santiago de Chile, Santiago, Chile.
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Subbarao P, Ratjen F. Beta2-agonists for asthma: the pediatric perspective. Clin Rev Allergy Immunol 2007; 31:209-18. [PMID: 17085794 DOI: 10.1385/criai:31:2:209] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/11/2022]
Abstract
Inhaled beta-agonists are commonly prescribed for the treatment of wheezing disorders in infants and children. Despite this, there are concerns that these medications have potentially detrimental effects on lung health and symptoms. We will review the ontogeny of beta-agonist receptor and smooth muscle development from fetal life through infancy and childhood as well as the evidence supporting the clinical utility of beta-agonists in wheezing infants and asthmatic children. Finally, the potential detrimental effects of long- and short-acting beta-agonists in infants and children are discussed.
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Affiliation(s)
- Padmaja Subbarao
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Götz M, Eber E, Frischer T, Horak E, Kurz H, Riedler J, Schmitzberger R, Zach M. [Recurring obstructive bronchitis and asthmatic bronchitis in preschool aged children]. Wien Klin Wochenschr 2006; 118:302-6. [PMID: 16810490 DOI: 10.1007/s00508-006-0589-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Manfred Götz
- Abteilung für Kinder- und Jugendheilkunde mit Lungen- und Infektionskrankheiten, Wilhelminenspital der Stadt Wien, Wien, Austria.
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Loland L, Buchvald FF, Halkjaer LB, Anhøj J, Hall GL, Persson T, Krause TG, Bisgaard H. Sensitivity of bronchial responsiveness measurements in young infants. Chest 2006; 129:669-75. [PMID: 16537866 DOI: 10.1378/chest.129.3.669] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES There is limited evidence on the preferred methods for evaluating lung function in infancy. The objective of this study was to compare sensitivity and repeatability of indexes of lung function in young infants during induced airway obstruction. METHODS The study population consisted of 402 infants (median age, 6 weeks). Forced flow-volume measurements were obtained by the raised volume rapid thoracoabdominal compression technique and were compared with indexes of tidal breathing, measurements of transcutaneous oxygen (Ptco(2)), and auscultation during methacholine challenge testing. RESULTS Ptco(2) was the most sensitive parameter to detect increasing airway obstruction during methacholine challenge, followed by forced expiratory volume at 0.5 s (FEV(0.5)). Both were superior to other indexes of forced spirometry as well as tidal breathing indexes and auscultation. Coefficients of variations for Ptco(2) and FEV(0.5) were 4% and 7%, respectively. CONCLUSIONS Ptco(2) and FEV(0.5) are the most sensitive parameters for measurement of bronchial responsiveness in young infants. Measurements of baseline lung function should preferably be made using FEV(0.5.) Measurements of bronchial responsiveness are best assessed using Ptco(2), which may be performed in nonsedated infants and improve feasibility of future studies on lung function in infancy.
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Affiliation(s)
- Lotte Loland
- Danish Pediatric Asthma Center, Department of Pediatrics, Copenhagen University Hospital, Gentofte, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark
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23
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Affiliation(s)
- Howard B Panitch
- Department of Pediatrics, University of Pennsylvania School of Medicine, and the Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Friedrich L, Stein RT, Pitrez PMC, Corso AL, Jones MH. Reduced lung function in healthy preterm infants in the first months of life. Am J Respir Crit Care Med 2005; 173:442-7. [PMID: 16322648 DOI: 10.1164/rccm.200503-444oc] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Preterm delivery has been associated with a higher incidence of respiratory morbidity even in infants that do not have significant respiratory disease during the neonatal period. Reduced flows have been reported in children and adolescents born prematurely. OBJECTIVE The aim of this study was to assess lung function in healthy preterm infants in the first months of life. METHODS Preterm infants with less than 48 h of supplemental oxygen were recruited. Lung function was assessed by the raised-volume rapid thoracic compression in the first months of life. The control group consisted of full-term infants without a history of respiratory diseases. MEASUREMENTS AND MAIN RESULTS Sixty-two preterm (29 male) and 27 full-term (10 male) infants were tested. Adjusting for length, age, and sex, we found a mean significant reduction of 92 ml/s (22%) in FEF(50), 73 ml/s (21%) in FEF(25-75), and 19 ml (28%) in FEV(0.5) in the preterm group. These differences in expiratory flows remained significant using another model that adjusts for lung volume (p < 0.01 for FEF(50), FEF(25-75), and FEV(0.5), and p < 0.05 for FEF(75)). In the preterm group, after adjusting for length, male sex, lower gestational age, and increased weight were significantly and independently associated with reduced flows. CONCLUSIONS Our findings confirm that prematurity is independently associated with reduced lung function and that this is detectable in the first months of life. Male sex, lower gestational age, and weight are important predictors for reduced expiratory flows in this group.
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Affiliation(s)
- Luciana Friedrich
- Department of Pediatrics, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Modl M, Eber E, Malle-Scheid D, Weinhandl E, Zach MS. Does bronchodilator responsiveness in infants with bronchiolitis depend on age? J Pediatr 2005; 147:617-21. [PMID: 16291351 DOI: 10.1016/j.jpeds.2005.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 05/05/2005] [Accepted: 06/02/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the relation between age and bronchodilator responsiveness in infants with bronchiolitis. STUDY DESIGN In 41 infants (age, 2 to 18 months) with bronchiolitis, lung function was measured with the raised volume rapid thoracoabdominal compression technique before and after salbutamol inhalation. Lung function was quantified in terms of timed volumes (FEV(0.5), FEV(0.75), and FEV(1.0)). A significant change was defined as a postbronchodilator value that differed from baseline by more than twice the within-subject coefficient of variation. RESULTS For the group, postbronchodilator values did not differ significantly from baseline (DeltaFEV(0.5), 3.8% +/- 9.3%; DeltaFEV(0.75), 3.5% +/- 9.5%; and DeltaFEV(1.0), 4.0 +/- 9.8%). Eleven subjects showed significantly increased timed volumes; 3 presented with a decreased lung function; the remaining patients failed to show a significant change. The mean age of subjects with improved lung function did not differ significantly from the mean age of those with no or paradoxical responses (9.7 +/- 4.7 vs 8.1 +/- 4.1 months); there was no correlation of age with the size of the bronchodilator response. CONCLUSIONS The results of the current study indicate that bronchodilator responsiveness in infants with bronchiolitis is not age-dependent.
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Affiliation(s)
- Manfred Modl
- Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Austria
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Hofhuis W, van der Wiel EC, Nieuwhof EM, Hop WCJ, Affourtit MJ, Smit FJ, Vaessen-Verberne AAPH, Versteegh FGA, de Jongste JC, Merkus PJFM. Efficacy of fluticasone propionate on lung function and symptoms in wheezy infants. Am J Respir Crit Care Med 2004; 171:328-33. [PMID: 15531753 DOI: 10.1164/rccm.200402-227oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role of inhaled corticosteroids in the treatment of recurrent or persistent wheeze in infancy remains unclear. We evaluated the effect of 3 months of treatment with inhaled fluticasone propionate, 200 microg daily (FP200), on lung function and symptom scores in wheezy infants. Moreover, we evaluated whether infants with atopy and/or eczema respond better to FP200 as compared with non-atopic infants. Forced expiratory flow (Vmax(FRC)) was measured at baseline and after treatment. Sixty-five infants were randomized to receive FP200 or placebo, and 62 infants (mean age, 11.3 months) completed the study. Mean Vmax(FRC), expressed as a Z score, was significantly below normal at baseline and after treatment in both groups. The change from baseline of Vmax(FRC) was not different between the two treatment arms. After 6 weeks of treatment, and not after 13 weeks, the FP200 group had a significantly higher percentage of symptom-free days and a significant reduction in mean daily cough score compared with placebo. Separate analysis of treatment effect in infants with atopy or eczema showed no effect modification. We conclude that in wheezy infants, after 3 months of treatment with fluticasone, there was no improvement in lung function and no reduction in respiratory symptoms compared with placebo.
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Affiliation(s)
- Ward Hofhuis
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus University MC/Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Abstract
BACKGROUND Studies into the effects of salbutamol in the treatment of wheeze in infancy have been conflicting, possibly due to differences in outcome variables. We aimed to assess the response to salbutamol using indices derived from passive and forced expiration. METHODS We recruited 39 infants who had a history of wheezing (mean age 43 weeks) and measured maximum flow at functional residual capacity (V'(max FRC)) by rapid thoracoabdominal compression (RTC), and forced expired volume at 0.4s (FEV0.4) using the raised-volume RTC technique (RV-RTC). We calculated passive compliance (C(rs)), resistance (R(rs)) and time constant (tau) from relaxed expirations that followed the augmented inspirations delivered during RV-RTC. Measurements were repeated after aerosol salbutamol (800 mcg). RESULTS Data were obtained in 32 infants for V'(max FRC), 22 for FEV0.4 and 19 for passive mechanics. There were no mean changes in any index of forced expiration after salbutamol. Some individuals showed significant changes (improvement or worsening) in one or other index. Overall, there was a small increase in C(rs) after salbutamol but no change in R(rs) or tau. CONCLUSIONS We found no consistent pattern of response in either index of forced expiration. Validated clinical scores or alternative physiological techniques may be preferable to respiratory mechanics in assessing bronchodilator response.
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Affiliation(s)
- Caroline S Beardsmore
- Department of Child Health, Institute for Lung Health, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, P.O. Box 65, Leicester LE2 7LX, UK.
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Lum S, Hulskamp G, Hoo AF, Ljungberg H, Stocks J. Effect of raised lung volume technique on subsequent measures of V'maxFRC in infants. Pediatr Pulmonol 2004; 38:146-54. [PMID: 15211699 DOI: 10.1002/ppul.20039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Partial and "full" forced expiratory maneuvers are both used to assess airway function in infants. Despite the increasing use of the raised volume technique, there is little information regarding the influence of lung inflations as are necessary for the raised volume technique on other measurements of lung function in infants. The aim of this study was to assess whether application of the raised volume technique influences subsequent tidal measurements of maximal expired flow at functional residual capacity (V'maxFRC). Paired measurements of V'maxFRC were obtained in 29 healthy infants (aged 6-65 weeks) before and after raised volume maneuvers, wherein a lung inflation pressure of 3 kPa was used. When compared with measurements prior to raising lung volume, there was a highly significant (P < 0.001) decrease in V'maxFRC by 40 ml.sec(-1) when measurements were repeated (95% CI, -59, -20 ml.sec(-1)), equivalent to a reduction of 20% or -0.6 SD scores in flows. There was no significant change in selected tidal breathing parameters, 95% CI of differences between the two sets of measurements being -1.5, 1.2 bpm for respiratory rate; -0.5, 0.2 ml.kg(-1) for weight corrected tidal volume, and -0.04, 0.01 for tidal breathing ratio (tPTEF:tE). In conclusion, although the mechanism remains unclear, raised volume maneuvers may influence subsequent measures of lung function in infants. Further research is needed to clarify the potential mechanisms. In the meantime, the potential impact of the order of lung function tests within any given study protocol should be considered carefully.
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Affiliation(s)
- S Lum
- Portex Anesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, London, United Kingdom.
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Lødrup Carlsen KC, Pettersen M, Carlsen KH. Is bronchodilator response in 2-yr-old children associated with asthma risk factors? Pediatr Allergy Immunol 2004; 15:323-30. [PMID: 15305941 DOI: 10.1111/j.1399-3038.2004.00147.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Factors that might influence lung function bronchodilator response by 2 yr of age is largely unknown, thus we aimed to assess this in the 'Environment and Childhood asthma' (ECA) study in Oslo. A clinical investigation at mean age 26 months was attended by 516 (84%) children included in a nested case-control study [children with recurrent bronchial obstruction (rBO)] (n = 265) and controls without a history of lower respiratory disease (n = 251). Tidal lung function measures before and after inhaled nebulized salbutamol (bronchodilator response) (when clinically without BO) were obtained in 46%. Clinical characteristics and personal and family history of allergic/respiratory diseases (asthma risk factors) were ascertained by structured interview and clinical examination. Allergic sensitization was assessed by skin prick test/specific IgE antibody analyses to common allergens. Mean (95% CI) per cent change in time to reach peak flow/total expiratory time (t(PTEF)/t(E)) from before to after salbutamol was significantly larger in children with rBO [17.3 (9.4-25.3) than controls (-2.2 (-7.7 to 3.0)]. The bronchodilator response increased significantly (p = 0.001) with increasing number of asthma risk factors, but was not significantly associated with allergic sensitization, parental 'atopy', or maternal smoking alone. Children treated with inhaled corticosteroids had greater bronchodilator response than those treated with bronchodilators alone. Bronchodilator response in asymptomatic 2-yr-old children was most closely associated with the presence of rBO, but increasing number of asthma risk factors and treatment with inhaled corticosteroids were associated with increased bronchodilator response.
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Affiliation(s)
- Karin C Lødrup Carlsen
- Department of Paediatrics, Division of Women and Child, Ullevål University Hospital HF, Oslo, Norway.
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Abstract
Pulmonary function tests in infants have been used for many years, but they have been largely relegated to specialized centers and research purposes. More recently, development of commercial equipment and newer techniques has allowed for more broad use and application of these tests. This review describes different techniques that have been used to study infants and toddlers, and their clinical applications.
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Affiliation(s)
- Daniel J Weiner
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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Jones MH, Howard J, Davis S, Kisling J, Tepper RS. Sensitivity of spirometric measurements to detect airway obstruction in infants. Am J Respir Crit Care Med 2003; 167:1283-6. [PMID: 12615631 DOI: 10.1164/rccm.200204-339oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We evaluated the ability of forced expiratory flow volume curves from raised lung volumes to assess airway function among infants with differing severities of respiratory symptoms. Group 1 (n = 33) had previous respiratory symptoms but were currently asymptomatic; group 2 (n = 36) was symptomatic at the time of evaluation. As a control group, we used our previously published sample of 155 healthy infants. Flow volume curves were quantified by FVC, FEF50, FEF75, FEF25-75, FEV0.5, and FEV0.5/FVC, which were expressed as Z scores. All variables except FVC had Z scores that were significantly less than zero and distinguished groups 1 and 2 with progressively lower Z scores. The mean Z scores of the flow variables (FEF50%, FEF75%, and FEF25-75%) were more negative than the Z scores for the timed expired volumes (FEV0.5 or FEV0.5/FVC) for both groups. In general, measures of flow identified a greater number of infants with abnormal lung function than measures of timed volume; FEF50 had the highest performance in detecting abnormal lung function. In summary, forced expiratory maneuvers obtained by the raised volume rapid compression technique can discriminate among groups of infants with differing severity of respiratory symptoms, and measures of forced expiratory flows were better than timed expiratory volume in detecting abnormal airway function.
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Affiliation(s)
- Marcus H Jones
- Department of Pediatric Pulmonary and Critical Care, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, 702 Barnhill Drive, Room 4270, Indianapolis, Indiana 46202-5225, USA
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Hofhuis W, van der Wiel EC, Tiddens HAWM, Brinkhorst G, Holland WPJ, de Jongste JC, Merkus PJFM. Bronchodilation in infants with malacia or recurrent wheeze. Arch Dis Child 2003; 88:246-9. [PMID: 12598393 PMCID: PMC1719464 DOI: 10.1136/adc.88.3.246] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Controversy remains regarding the effectiveness of bronchodilators in wheezy infants. AIMS To assess the effect of inhaled beta(2) agonists on lung function in infants with malacia or recurrent wheeze, and to determine whether a negative effect of beta(2) agonists on forced expiratory flow (V'(maxFRC)) is more pronounced in infants with airway malacia, compared to infants with wheeze. METHODS We retrospectively analysed lung function data of 27 infants: eight with malacia, 19 with recurrent wheeze. Mean (SD) age was 51 (18) weeks. Mean V'(maxFRC) (in Z score) was assessed before and after inhalation of beta(2) agonists. RESULTS Baseline V'(maxFRC) was below reference values for both groups. Following inhalation of beta(2) agonists the mean (95% CI) change in mean V'(maxFRC) in Z scores was -0.10 (-0.26 to 0.05) and -0.33 (-0.55 to -0.11) for the malacia and wheeze group, respectively. CONCLUSIONS In infants with wheeze, inhaled beta(2) agonists caused a significant reduction in mean V'(maxFRC). Infants with malacia were not more likely to worsen after beta(2) agonists than were infants with recurrent wheeze.
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Affiliation(s)
- W Hofhuis
- Department of Paediatrics, Division of Respiratory Medicine, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands.
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Panitch HB. Respiratory syncytial virus bronchiolitis: supportive care and therapies designed to overcome airway obstruction. Pediatr Infect Dis J 2003; 22:S83-7; discussion S87-8. [PMID: 12671457 DOI: 10.1097/01.inf.0000053890.66801.97] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment of respiratory syncytial virus bronchiolitis rests primarily on supportive care with oxygen and fluid management. Other therapies commonly used include bronchodilators, corticosteroids and ribavirin, when considered appropriate. Small studies have also suggested that exogenous surfactant, helium/oxygen mixtures (heliox) and combination therapies may offer clinical benefit as well. Management of bronchiolitis can be facilitated by (1) recognizing the risks and benefits of various therapies, (2) understanding the markers of disease severity and (3) gaining familiarity with the time course of viral replication compared with presentation of symptoms. Although oxygen administration and judicious fluid replacement are the only interventions proved to be of reliable benefit to infants with bronchiolitis, newer studies support a role for adjunctive therapies aimed at relieving airway obstruction, especially when administered very early in the course of the illness or given to infants with more severe disease.
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Affiliation(s)
- Howard B Panitch
- Division of Pulmonary Medicine, Fifth Floor Wood Building, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
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Tobin MJ. Compliance (COMmunicate PLease wIth Less Abbreviations, Noun Clusters, and Exclusiveness). Am J Respir Crit Care Med 2002; 166:1534-6. [PMID: 12471069 DOI: 10.1164/rccm.2211001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hofhuis W, Huysman MWA, van der Wiel EC, Holland WPJ, Hop WCJ, Brinkhorst G, de Jongste JC, Merkus PJFM. Worsening of V'maxFRC in infants with chronic lung disease in the first year of life: a more favorable outcome after high-frequency oscillation ventilation. Am J Respir Crit Care Med 2002; 166:1539-43. [PMID: 12471071 DOI: 10.1164/rccm.2202046] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Little is known about the development of maximal flow at functional residual capacity, a measure of airway patency, in infants with chronic lung disease (CLD). In a follow-up study, we evaluated V'maxFRC in very low birth weight infants with CLD, treated with high-frequency oscillation ventilation (HFOV) or conventional mechanical ventilation. In 36 infants with CLD, V'maxFRC was evaluated at 6 and/or 12 months corrected age, and the relationship between perinatal factors and lung function was studied. Mean (SD) birth weight and gestational age were 837 (152) g and 26.8 (1.7) weeks, respectively. At 6 and 12 months, mean V'maxFRC was significantly below normal. Between 6 and 12 months, there was a mean (95% confidence interval) reduction in V'maxFRC (Z score) of 0.5 (0.2-0.7) (p < 0.001). At 12 months, the mean V'maxFRC (Z score) was higher for children initially treated with HFOV (n = 15), as compared with children treated with conventional mechanical ventilation (n = 16): mean (95% confidence interval) difference was 0.6 (0.2-1.0) (p = 0.008). We conclude that very low birth weight infants with CLD have decreased V'maxFRC that worsen during the first year of life. Initial treatment with HFOV was associated with a more favorable outcome of V'maxFRC at 12 months corrected age.
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Affiliation(s)
- Ward Hofhuis
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
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Ranganathan SC, Bush A, Dezateux C, Carr SB, Hoo AF, Lum S, Madge S, Price J, Stroobant J, Wade A, Wallis C, Wyatt H, Stocks J. Relative ability of full and partial forced expiratory maneuvers to identify diminished airway function in infants with cystic fibrosis. Am J Respir Crit Care Med 2002; 166:1350-7. [PMID: 12421744 DOI: 10.1164/rccm.2202041] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The tidal and raised volume rapid thoracoabdominal compression techniques are increasingly used to detect diminished airway function in infancy. The aim of this study was to assess the relative ability of parameters measured by these techniques to identify diminished airway function in infants newly diagnosed with cystic fibrosis (CF) with and without clinical evidence of prior lower respiratory illness. A cross-sectional, prospective study design was used in which maximal flow at functional residual capacity (VmaxFRC) from the tidal technique and FVC, FEV0.5, FEF75, and FEF25-75 from the raised volume technique were measured in 47 infants with CF and 187 healthy infants of similar body size, sex distribution, ethnic group, and exposure to maternal smoking. Multiple linear regression was used to assess group differences and to calculate SD scores for each parameter for the infants with CF. Airway function was also compared with clinical assessments of respiratory status made by pediatric pulmonologists. FEV0.5 was significantly diminished in 13 infants with CF, of whom 4 had been identified by clinicians as having normal respiratory status. Only one infant with CF had a VmaxFRC below the estimated normal range. Airway function is diminished in infants with CF irrespective of prior lower respiratory illness and in those whose respiratory status is considered normal by pediatric pulmonologists. In infants with CF, the raised volume technique identified diminished airway function more frequently than the tidal technique.
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Affiliation(s)
- Sarath C Ranganathan
- Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, London, United Kingdom.
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Lum S, Hoo AF, Stocks J. Influence of jacket tightness and pressure on raised lung volume forced expiratory maneuvers in infants. Pediatr Pulmonol 2002; 34:361-8. [PMID: 12357480 DOI: 10.1002/ppul.10170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While the use of the raised volume rapid thoraco-abdominal compression (RVRTC) technique has been shown to provide new insights into airway and pulmonary pathophysiology in infants, and appears to resemble the spirometric techniques used in older subjects, there is as yet no consensus regarding measurement procedures, which are known to vary considerably between laboratories (Gappa [1999] Pediatr Pulmonol 28:391-393). The aims of this study were to assess the effects of tightness of jacket fit, the efficiency with which pressure is transmitted from the jacket to the intrathoracic airways, and the effect of jacket pressure on parameters derived from the RVRTC technique. Paired forced expiratory maneuvers were performed in 20 infants with the jacket snugly or loosely wrapped around the infant's torso, and in a further 21 infants using "optimal" or a higher jacket pressure (P(j)) (1-2 kPa above "optimal" P(j)). When either a loosened jacket or a higher than "optimal" P(j) was used, forced expired flow at low lung volumes (FEF(75)) was significantly reduced by, on average, 8% and 7%, respectively. There were, however, minimal changes in forced vital capacity (FVC) or forced expired volume in 0.4 sec (FEV(0.4)). The observed changes may have been due to the increased pressure transmitted to the intrathoracic structures under these experimental conditions, and emphasize the need to assess optimal jacket pressure within each infant when using the RVRTC technique. In addition, when using a loosened jacket or a higher than "optimal" P(j), chest wall and upper airway reflexes such as glottic closure, peripheral airway closure, and negative flow dependence were more evident.
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Affiliation(s)
- Sooky Lum
- Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital NHS Trust, London, United Kingdom.
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40
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Ranganathan SC, Hoo AF, Lum SY, Goetz I, Castle RA, Stocks J. Exploring the relationship between forced maximal flow at functional residual capacity and parameters of forced expiration from raised lung volume in healthy infants. Pediatr Pulmonol 2002; 33:419-28. [PMID: 12001274 DOI: 10.1002/ppul.10086] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The raised volume rapid thoraco-abdominal compression technique (RVRTC) is being increasingly used to assess airway function in infants, but as yet no consensus exists regarding the equipment, methods, or analysis of recorded data. The aim of this study was to explore the relationship between maximal flow at functional residual capacity (V'(maxFRC)) and parameters derived from raised lung volumes, and to address analytical aspects of the latter technique in an attempt to assist with future standardization initiatives. Forced vital capacity (FVC) from lung volume raised to 3 kPa, timed forced expiratory volumes (FEV(t)), and forced expiratory flow parameters at different percentages of expired FVC (FEF(%)) were measured in 98 healthy infants (1-69 weeks of age). V'(maxFRC) using the tidal rapid thoraco-abdominal compression (RTC) technique was also measured. The within-subject relationships and within-subject variability of the various parameters were assessed. Duration of forced expiration was < 0.5 sec in 5 infants, meaning that FEV(0.3) and FEV(0.4) were the only timed volume parameters that could be calculated in all infants during the first months of life, and even when it could be calculated, FEV(0.5) approached FVC in many of these infants. It is recommended that FEV(0.4) be routinely reported in infants less than 3 months of age. Contrary to previous reports, within subject variability of V'(maxFRC) was less than that of FEF(75) (mean CV = 6.3% and 8.9%, respectively).A more standardized protocol when analyzing data from the RVRTC would facilitate comparisons of results between centers in the future.
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Affiliation(s)
- S C Ranganathan
- Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, London, UK.
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41
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Barry P. Aerosols in bronchiolitis. JOURNAL OF AEROSOL MEDICINE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR AEROSOLS IN MEDICINE 2002; 15:109-16. [PMID: 12184860 DOI: 10.1089/089426802320282220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Bronchiolitis is a common illness of the lower respiratory tract affecting infants that has considerable short and long-term morbidity and occasional mortality. It is the commonest cause of hospitalization for respiratory infection in early childhood, and the seasonal nature of the illness places considerable strain on health care resources during the bronchiolitis season. The youngest infants and those with preexisting cardiorespiratory disease are particularly at risk of severe illness. The treatment of infants with bronchiolitis is largely supportive. There are no therapies that have been proven to reduce the length of the hospitalization or intensive care stay. This paper will review the clinical course of bronchiolitis and discuss the aerosolized therapies that have been proposed for its treatment.
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Affiliation(s)
- Peter Barry
- Department of Child Health, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65, Leicester LE2 7LX, United Kingdom.
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42
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Tobin MJ. Pediatrics, surfactant, and cystic fibrosis in AJRCCM 2000. Am J Respir Crit Care Med 2001; 164:1581-94. [PMID: 11719294 DOI: 10.1164/ajrccm.164.9.2108125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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43
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Abstract
Bronchiolitis is a common cause of wheezing among infants. Respiratory syncytial virus (RSV) is the most common infectious agent to cause bronchiolitis, and RSV infection accounts for more than 125,000 hospitalizations per year in the United States. Beyond supportive measures, the care of infants with bronchiolitis remains controversial. Practitioners continue to treat infants with a variety of pharmacologic agents, despite limited evidence of their efficacy. Investigators continue to search for the safest and most cost-effective methods to treat infants with bronchiolitis, not only to overcome obstructive symptoms during the acute illness, but also to prevent recurrent symptoms of airway obstruction that occur in some children for years after their initial episode of bronchiolitis. Improved understanding of the pathogenesis of RSV infection and of virus-host interactions may one day lead to the development of agents that alter the initial inflammatory response and strategies that help prevent recurrent episodes of wheezing and the development of asthma after acute bronchiolitis.
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Affiliation(s)
- H B Panitch
- University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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44
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45
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Grimfeld A. [Bronchodilator treatments during acute bronchiolitis in infants]. Arch Pediatr 2001; 8 Suppl 1:81S-82S. [PMID: 11232448 DOI: 10.1016/s0929-693x(01)80161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Grimfeld
- Centre de diagnostic et traitement de l'asthme de l'enfant, hôpital d'enfants Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75571 Paris, France
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