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Lung Function Tests (lung + function_test)
Selected AbstractsLung Function Tests in Neonates and Infants with Chronic Lung Disease: Forced Expiratory ManeuversPEDIATRIC PULMONOLOGY, Issue 3 2006Sooky Lum PhD Abstract This fourth paper in a review series on the role of lung function testing in infants and young children with acute neonatal disorders and chronic lung disease of infancy (CLDI) addresses measurements of forced expiration using rapid thoraco-abdominal compression (RTC) techniques and the forced deflation technique. Following orientation of the reader to the subject area, we focus our comments on the areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. All studies on infants and young children with CLDI using forced expiratory or deflation maneuvers demonstrated that forced flows at low lung volume remain persistently low through the first 3 years of life. Measurement of maximal flow at functional residual capacity (V,maxFRC) is the most commonly used method for assessing airway function in infants, but is highly dependent on lung volume and airway tone. Recent studies suggested that the raised volume RTC technique, which assesses lung function over an extended volume range as in older children, may be a more sensitive means of discriminating changes in airway function in infants with respiratory disease. The forced deflation technique allows investigation of pulmonary function during the early development of CLDI in intubated subjects, but its invasive nature precludes its use in the routine setting. For all techniques, there is an urgent need to establish suitable reference data and evaluate within- and between-occasion repeatability, prior to establishing the clinical usefulness of these techniques in assessing baseline airway function and/or response to interventions in subjects with CLDI. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source] Lung Function Tests in Neonates and Infants with Chronic Lung Disease: Global and Regional Ventilation InhomogeneityPEDIATRIC PULMONOLOGY, Issue 2 2006J. Jane Pillow FRACP Abstract This review considers measurement of global and regional ventilation inhomogeneity (VI) in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy (CLDI). We focus primarily on multiple-breath inert gas washout (MBW) and electrical impedance tomography (EIT). The literature is critically reviewed and the relevant methods, equipment, and studies are summarized, including the limitations and strengths of individual techniques, together with the availability and appropriateness of any reference data. There has been a recent resurgence of interest in using MBW to monitor lung function within individuals and between different groups. In the mechanically ventilated, sedated, and paralyzed patient, VI indices can identify serial changes occurring following exogenous surfactant. Similarly, global VI indices appear to be increased in infants with CLDI and to differentiate between infants without lung disease and those with mild, moderate, and severe lung disease following preterm birth. While EIT is a relatively new technique, recent studies suggest that it is feasible in newborn infants, and can quantitatively identify changes in regional lung ventilation following alterations to ventilator settings, positive end expiratory pressure (PEEP), and administration of treatments such as surfactant. As such, EIT represents one of the more exciting prospects for continuous bedside pulmonary monitoring. For both techniques, there is an urgent need to establish guidelines regarding data collection, analysis, and interpretation in infants both with and without CLDI. © 2005 Wiley-Liss, Inc. [source] Lung Function Tests in Neonates and Infants with Chronic Lung Disease of Infancy: Functional Residual CapacityPEDIATRIC PULMONOLOGY, Issue 1 2006Georg Hülskamp MD Abstract This is the second paper in a review series that will summarize available data and discuss the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses the expansive subject of measurements of lung volume using plethysmography and gas dilution/washout techniques. Following orientation of the reader to the subject area, we focus our comments on areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. Measurements of lung volume are important both for assessing growth and development of lungs in health and disease, and for interpreting volume-dependent lung function parameters such as respiratory compliance, resistance, forced expiratory flows, and indices of gas-mixing efficiency. Acute neonatal lung disease is characterized by severely reduced functional residual capacity (FRC), with treatments aimed at securing optimal lung recruitment. While FRC may remain reduced in established chronic lung disease of infancy, more commonly it becomes normalized or even elevated due to hyperinflation, with or without gas-trapping, secondary to airway obstruction. Ideally, accurate and reliable bedside measurements of FRC would be feasible from birth, throughout all phases of postnatal care (including assisted ventilation), and during subsequent long-term follow-up. Although lung volume measurements in extremely preterm infants were described in a research environment, resolution of several issues is required before such investigations can be translated into routine clinical monitoring. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source] Making Sense of Lung Function Tests: A hands-on guideANAESTHESIA, Issue 10 2003S. Harris No abstract is available for this article. [source] Lung function tests in neonates and infants with chronic lung disease: Lung and chest-wall mechanicsPEDIATRIC PULMONOLOGY, Issue 4 2006Monika Gappa MD This is the fifth paper in a review series that summarizes available data and critically discusses the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy (CLDI). This review focuses on respiratory mechanics, including chest-wall and tissue mechanics, obtained in the intensive care setting and in infants during unassisted breathing. Following orientation of the reader to the subject area, we focused comments on areas of enquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically with respect to relevant methods, equipment and study design, limitations and strengths of different techniques, and availability and appropriateness of reference data. Recommendations to guide future investigations in this field are provided. Numerous different methods have been used to assess respiratory mechanics with the aims of describing pulmonary status in preterm infants and assessing the effect of therapeutic interventions such as surfactant treatment, antenatal or postnatal steroids, or bronchodilator treatment. Interpretation of many of these studies is limited because lung volume was not measured simultaneously. In addition, populations are not comparable, and the number of infants studied has generally been small. Nevertheless, results appear to support the pathophysiological concept that immaturity of the lung leads to impaired lung function, which may improve with growth and development, irrespective of the diagnosis of chronic lung disease. To fully understand the impact of immaturity on the developing lung, it is unlikely that a single parameter such as respiratory compliance or resistance will accurately describe underlying changes. Assessment of respiratory mechanics will have to be supplemented by assessment of lung volume and airway function. New methods such as the low-frequency forced oscillation technique, which differentiate the tissue and airway components of respiratory mechanics, are likely to require further development before they can be of clinical significance. Pediatr Pulmonol. © 2006 Wiley-Liss, Inc. [source] Detecting early structural lung damage in cystic fibrosis,,PEDIATRIC PULMONOLOGY, Issue 3 2002Harm A.W.M. Tiddens MD In cystic fibrosis (CF) patients, both severe lung inflammation and severe lung damage occur early and persist throughout life. High-resolution computed tomography (HRCT), a more sensitive method of detecting structural abnormalities than chest X-ray, shows that airways undergo substantial thickening in early CF lung disease. Lung function tests, which are an indirect measure of structural integrity, are insensitive to localized or early damage. Thickening of the peripheral airways causes a reduction in maximal expiratory flow at 25% of forced vital capacity (MEF25) or other measurements of peripheral air flow. Reduced peripheral flows, even in the presence of normal forced expired volume in 1 sec (FEV1) and forced vital capacity (FVC), should be considered an early sign of substantial lung damage and should stimulate aggressive treatment to prevent further deterioration. Pediatr Pulmonol. 2002; 34:228,231. © 2002 Wiley-Liss, Inc. [source] Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 13 2008Sigrid Odencrants MSc Aim. The aim of the study was to describe and compare nutritional status and social and medical characteristics among older patients with chronic obstructive pulmonary disease admitted to an acute care hospital ward for respiratory medicine. Background. Chronic obstructive pulmonary disease is a condition associated with risk of developing malnutrition. A body mass index <20 is predictive of hospitalisation for acute exacerbations of chronic obstructive pulmonary disease. Knowledge about patient characteristics is crucial for the identification of malnourished patients and the development of nursing care for these patients. Design. Quantitative descriptive study. Methods. Thirty-three hospitalised women and 17 men with a mean age of 75·7 years (SD 6·9) were consecutively included. A very severe case of chronic obstructive pulmonary disease was indicated in 28 out of 39 patients who underwent a lung function test. Data were collected with measurement of nutritional status using Mini Nutritional Assessment, anthropometry and lung function. Results. Nearly half of the patients (48%) were identified as malnourished, an equal part as at risk for malnutrition and two patients as well nourished. The mean Mini Nutritional Assessment score of 17·2 (SD 3·99) for all patients was near the Mini Nutritional Assessment cut-off score (i.e. 17) for malnutrition. Patients identified as malnourished had a mean body mass index of 18·9 and those at risk for malnutrition had a mean of 23·4. It was more common for those identified as malnourished to live singly, to not live in own property and to be dependent on daily community service. Seven patients identified as malnourished died during the data collection period. Conclusions. This study provides important knowledge about further risks of impaired nutritional status among older patients with chronic obstructive pulmonary disease. Relevance to clinical practice. This knowledge can provide registered nurses with the necessary knowledge to make them aware of certain patients needing particular kinds of attention. [source] Lung function and exhaled nitric oxide levels in infants developing chronic lung diseasePEDIATRIC PULMONOLOGY, Issue 2 2007Olivia Williams MRCPCH Abstract Chronic lung disease (CLD) is a common outcome of neonatal intensive care. To determine whether the results of serial exhaled nitric oxide (eNO) measurements during the perinatal period differed between infants who did and did not develop CLD. In addition, we wished to assess whether eNO results were more predictive of CLD development than lung function test results or readily available clinical data (gestational age and birthweight). The patients were 24 infants with a median gestational age of 27 (range 25,31) weeks. Measurements of eNO levels, functional residual capacity (FRC), and compliance of the respiratory system (CRS) were attempted on postnatal days 1, 3, 5, 7, 14, and 28 days. The 12 infants who developed CLD were of significantly lower birthweight and gestational age than the rest of the cohort; in addition, they had lower median FRC (P,<,0.02) and CRS (P,<,0.02) results, but not higher eNO levels, in the first week after birth. Construction of receiver operator characteristic (ROC) curves demonstrated that the CRS and FRC results on Day 3 were the best predictors of CLD development; the areas under the ROC curves were 0.94 and 0.91, respectively. Early lung function test results, but not eNO levels, are useful in predicting CLD development, but are not significantly better than birthweight. Pediatr Pulmonol. 2007; 42:107,113. © 2006 Wiley-Liss, Inc. [source] Haplotypes of the interleukin-4 receptor , chain gene associate with susceptibility to and severity of atopic asthmaCLINICAL & EXPERIMENTAL ALLERGY, Issue 10 2004A.-M. Hytönen Summary Background Development of asthma is likely to depend on a complex interaction between environmental and genetic factors. Several groups have suggested the gene of the IL-4 receptor , chain (IL4R) as a candidate gene for the development of asthma, although association with single polymorphisms has shown contradicting results. Objective We chose to analyse IL4R gene haplotypes and assess their possible relevance in susceptibility to asthma and to certain clinical phenotypes. Methods IL4R gene haplotypes were analysed, based on the three markers C-3223T, Q551R and I50V, using the expectation,maximization algorithm, in 170 atopic asthma patients and 350 controls, all adult Swedish Caucasians. Results Our data showed significantly higher levels of soluble IL-4R (sIL-4R) in asthma patients compared with controls (P<0.0001). Furthermore, we showed a significant association between the IL4R haplotype containing the alleles T-3223, V50 and R551 (TVR) of the IL4R gene, and susceptibility to atopic asthma, with a frequency of 6.5% in the patients compared with 1% in the controls (P<0.0005). A subgroup of patients with heterozygous or homozygous state for the T-3223, V50 and R551 alleles, also had lower levels of sIL-4R in their circulation compared with patients with homozygous state in the C-3223, I50 and Q551 alleles (P<0.05) and showed less severe asthma according to lung function test (P<0.05). Analysis of single markers showed the T-3223 IL4R allele to associate with lower serum levels of sIL-4 receptor (P<0.0001) and patients carrying the T allele also had more symptoms of active asthma (wheezing, P<0.01; coughing, P<0.05 and breathing difficulties, P<0.01). Conclusion Our data suggest that asthmatic patients with low levels of sIL-4 receptor may represent a genetically distinct subgroup of atopic asthma. TVR haplotype analyses confirm the importance of IL4R as a candidate gene for susceptibility to asthma. This finding may have implications for the understanding of the pathogenesis of asthma and possibly for the development of more specific therapies. [source] Impaired aortic elastic properties in patients with systemic sarcoidosisEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2008I. Moyssakis Abstract Background, Systemic sarcoidosis (Sar) is a granulomatous disorder involving multiple organs. Widespread vascular involvement and microangiopathy are common in patients with Sar. In addition, subclinical cardiac involvement is increasingly recognized in patients with Sar. However, data on the effect of Sar on the elastic properties of the arteries and myocardial performance are limited. In this study we looked for differences in aortic distensibility (AoD) which is an index of aortic elasticity, and myocardial performance of the ventricles, between patients with Sar and healthy subjects. In addition, we examined potential associations between AoD and clinical, respiratory and echocardiographic findings in patients with Sar. Materials and methods, A total of 83 consecutive patients (26 male/57 female, mean age 51·1 ± 13·3 years) with Sar, without cardiac symptoms, were included. All patients underwent echocardiographic and respiratory evaluation including lung function tests. Additionally, 83 age- and sex-matched healthy subjects served as controls. AoD was determined non-invasively by ultrasonography. Results, AoD was lower in the Sar compared to the control group (2·29 ± 0·26 vs. 2·45 ± 0·20 ·10,6 cm2· dyn,1, P < 0·01), while left ventricular mass (LVM) was higher in the Sar group (221·3 ± 50·2 vs. 195·6 ± 31·3 g, P = 0·007). Furthermore, myocardial performance of both ventricles was impaired in the Sar group. Multivariate linear regression analysis in the total sample population demonstrated a significant and independent inverse relationship between AoD and the presence of Sar (P < 0·001). The same analysis in the Sar patients showed that AoD was associated significantly and independently with the stage of Sar, age, systolic blood pressure, LVM and myocardial performance of both ventricles. No significant relationship was found between AoD and disease duration, pulmonary artery pressure or lung function tests. Conclusions, Presence and severity of Sar are associated with reduced aortic distensibility, irrespective of the disease duration, pulmonary artery pressure and lung function. In addition, patients with Sar have increased LVM and impaired myocardial performance. [source] Comparison between intubation and the laryngeal mask airway in moderately obese adultsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009M. ZOREMBA Background: Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. Methods: We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30° head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t -test analysis. Statistical significance was considered to be P<0.05. Results: Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). Conclusions: In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function. [source] Paediatric bronchiectasis in the twenty-first century: Experience of a tertiary children's hospital in New ZealandJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2003EA Edwards Objective: Despite its decline in developed countries, bronchiectasis appeared to be a common diagnosis in Auckland, New Zealand children. The aims of this study were: to document the number of children in Auckland with bronchiectasis, their severity, clinical characteristics and possible aetiologies; to assess whether there was a relationship between ethnicity and poverty; and to estimate a crude bronchiectasis prevalence rate for New Zealand. Methods: A retrospective review of the case histories of all children attending a tertiary children's hospital in Auckland with bronchiectasis diagnosed by high-resolution chest computed tomography (CT) scan, during the period 1998,2000 was undertaken. Data collected included patient demographics, number of hospitalizations pre- and post-diagnosis, lung function tests, radiology and investigations. The New Zealand deprivation 1996 index was applied to the data to obtain a measure of socio-economic status. Results: Bronchiectasis was found to be common, with an estimated prevalence of approximately one in 6000 in the Auckland paediatric population. It was disproportionately more common in the Pacific Island and Maori children. In Pacific Island children, bronchiectasis not caused by cystic fibrosis was nearly twice as common in the general population than cystic fibrosis. Socio-economic deprivation and low immunization rates may be significant contributing factors. The bronchiectasis seen was extensive. Ninety-three percent had bilateral disease and 64% had involvement of four or more lobes on chest CT scan. A wide range of comorbidities and underlying aetiologies were evident. Conclusions: Paediatric bronchiectasis in Auckland, New Zealand, is common but underresourced. Only the most severe cases are being recognized, providing a significant challenge for paediatric health professionals. [source] Treatment of allergic alveolitis with methylprednisolone pulse therapyPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 1 2003Christiane Chen We report on a 13-year-old-boy who had been admitted to our hospital for dyspnea, hypoxia, and pulmonary infiltrates. The diagnosis of allergic alveolitis was based on history (provocation by exposure), lung function tests, bronchoalveolar lavage, and transbronchial lung biopsy. No specific allergen could be identified. Five courses of methylprednisolone pulse therapy (15 mg/kg on three consecutive days) stabilized the patient with normalization of lung function and blood gas analysis. Between pulses the boy returned to his home on a farm without relapse. It is estimated that the effect of a single pulse lasted for at least 2,4 weeks. We conclude that pulse therapy can be used instead of continuous therapy in this rare disease in childhood. [source] The BAMSE Project: presentation of a prospective longitudinal birth cohort studyPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2002Magnus Wickman The aims of this prospective and longitudinal project are to establish crucial risk factors for asthma and other allergic diseases in childhood, and to study factors of importance for prognosis at already established allergic disease. Socio-economic factors, such as inequality in health, are also to be addressed. The project started in February 1994. To reach sufficient power, 4,000 children had to be included. In November 1996, this number was reached (4,093). Inclusion in the study was made at 3,4 months of age. At that time, and before induction of allergic disease/asthma of the child, a questionnaire focused on exposure, genetics and socio-economic factors was answered. Settled dust was sampled for later analysis of furred animal and mite allergens. When the children were aged both 1 and 2 years, their parents were asked to fill in new questionnaires focusing on respiratory and allergic (skin, gastrointestinal) symptoms, but also key variables of exposure. Cases with asthma are identified and, for every case, two matched controls drawn. During the following winter, the homes of cases and controls were investigated and the temperature, indoor humidity, air change rate and NO2 measured. Two hundred cases (5%) were expected to be identified during the first 2 years of the children's lives. Some 479 homes have now been investigated and 97.7% of the original 4,093 children still remain in the cohort. The 2-year symptom follow-up ended in November 1998. The 4-year follow-up started on 1 September 1998 and was planned to be finished in June 2000. Questionnaires (allergic and respiratory symptoms, key variables of exposure at home and day care) are sent out to all 4,093 families. All children are invited for examination, lung function tests (PEF, flow-volume, MVV and oxygen clearance) and physical performance. Blood is taken from all children (20 ml). Allergy screening is performed and specific IgE examined. Blood cells will be frozen to allow for later DNA extraction. In subsets (children with any allergic and/or respiratory manifestation and controls), markers of inflammation in blood and urine will be examined, as well as eosinophils in nasal smear. Interviews are carried out to assess the severity of asthma, type/periodicity of health care given, asthma medication and parental sick leave when appropriate. As a separate project, financed by the EU, outdoor pollution as risk factors for asthma and allergies are to be studied within the BAMSE cohort. A follow-up of 8,9 years is underway. [source] Using index of ventilation to assess response to treatment for acute pulmonary exacerbation in children with cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 8 2009FRACP, Paul D. Robinson MRCPCH Abstract Background The use of alternative more sensitive measures has become a focus of research in CF. The utility of indexes of ventilation, Lung Clearance Index (LCI) and peak aerobic capacity (peak VO2), were studied as assessment tools in gauging response to intravenous (IV) therapy in acute pulmonary exacerbation, in comparison to the more commonly used index of forced expiratory volume in 1,sec (FEV1). The utility of a previously published clinical score was further explored. Methods Patients aged 8,18 years admitted for IV antibiotic treatment of a pulmonary exacerbation were recruited. Spirometry, plethysmography, multiple breath nitrogen washout, exercise testing, and Cystic Fibrosis Clinical Score (CFCS) were performed on admission and prior to discharge. Results Twenty-eight patients were recruited, with a mean (range) age of 13.7 (8; 17) years, 16 female and 12 male. Mean (range) admission FEV1 was 61.4 (28; 92)% predicted, or z -score ,3.09 (,6.15; ,0.52), FVC 83.0 (38; 120)% predicted, or z -score ,1.71 (,5.66; ,1.17), and Shwachman,Kulczycki 68.9 (50; 90). FEV1 increased by 7.0% (P,<,0.01) from admission to discharge. Mean (range) admission LCI, 10.10 (6.87; 14.83), decreased by 3.8% (P,=,0.03). Mean (range) admission peak VO2 (ml/kg/min), 31.2 (23.4; 45.4), increased on discharge by 6.6% (P,<,0.01). Proposed clinical thresholds, based on the available variability data, highlighted the heterogeneity of response in lung function tests. Mean (range) admission CFCS, 26.5 (19; 39), decreased to 19.9 (13; 31) on discharge, a 25.2% improvement (P,<,0.01). CFCS demonstrated improvement in 27 of 28 patients. Changes in peak VO2 (r,=,,0.50, P,=,0.02) and LCI (r,=,0.48, P,=,0.01) correlated with CFCS change. Conclusions In children with mild-to-moderate CF, whilst statistically significant improvement in both LCI and peak VO2 were seen, heterogeneity of response was evident. The most consistent improvement was seen in CFCS. Correlation of LCI and peak VO2 with change in clinical score (CFCS) was seen. The full clinical significance of these changes in LCI and peak VO2 needs to be evaluated further with additional variability data. The CFCS may be useful in the assessment of response to treatment in CF but requires formal validation. Pediatr Pulmonol. 2009; 44:733,742. © 2009 Wiley-Liss, Inc. [source] Childhood asthma: Exhaled markers of airway inflammation, asthma control score, and lung function testsPEDIATRIC PULMONOLOGY, Issue 2 2004Philippe P.R. Rosias MD Abstract Exhaled markers of airway inflammation become increasingly important in the management of childhood asthma. The aims of the present study are: 1) to compare exhaled markers of inflammation (nitric oxide, carbon monoxide, and acidity of breath condensate) with conventional asthma measures (lung function tests and asthma control score) in childhood asthma; and 2) to investigate the detectability of albumin, CRP, IL-6, IL-8, TNF-alpha, sICAM-1, and sTNF-R75 in the exhaled breath condensate (EBC) of asthmatic children. Thirty-two children with mild to moderate persistent asthma and healthy controls aged 6,12 years were studied. We measured exhaled NO and CO, and subsequently EBC was collected. Inflammatory mediators in EBC were measured using an enzyme-linked immunosorbent assay. Respiratory symptoms and asthma control were assessed using the asthma control questionnaire (ACQ) of Juniper et al. (Eur Respir J 1999;14:902,907). Exhaled NO showed a significant correlation with exhaled CO (r,=,0.59, P,<,0.05) and FEV1 (r,=,,0.59, P,<,0.05), but not with ACQ score (r,=,0.48, P,=,0.06). Exhaled CO was correlated with prebronchodilator FEV1 (r,=,,0.45, P,<,0.05), but not with asthma control (r,=,0.18, P,=,0.35). Acidity of EBC was significantly lower in asthmatic children than in healthy controls (P,<,0.05), but did not correlate with any of the conventional asthma measures. We were not able to demonstrate the presence of CRP, IL-6, IL-8, TNF-alpha, sICAM-1, and sTNF-R75 in EBC. Albumin was found in two EBC samples of asthmatic children. We conclude that exhaled NO had a better correlation with lung function parameters and asthma control than exhaled CO and acidity of EBC, in mild to moderate persistent childhood asthma. However, exhaled NO, CO, and deaerated pH of EBC did not differ between asthmatic children and controls, possibly because of a too homogeneous and well-controlled study population. To further evaluate the clinical utility of exhaled markers in monitoring childhood asthma, more studies are required on a wider range of asthma severity, and preferably with repeated measurements of markers and of asthma control. Pediatr Pulmonol. 2004; 38:107,114. © 2004 Wiley-Liss, Inc. [source] What is the role of tests of lung function in the management of infants with lung disease?PEDIATRIC PULMONOLOGY, Issue 1 2003S. Godfrey MD This review considers whether there is a role for lung function tests in the clinical management of infants with lung disease. The purpose of testing lung function in older subjects, the tests available for infants, and the practical problems of testing lung function in infants are considered. After reviewing all the facts, we suggest that there are four situations in which lung function testing should be recommended for infants, as follows: 1) the infant who presents with unexplained tachypnea, hypoxia, cough, or respiratory distress in whom a definitive diagnosis is not apparent from physical examination and other, less difficult investigations; 2) the infant with severe, continuous, chronic obstructive lung disease who does not respond to an adequate clinical trial of combined corticosteroid and bronchodilator therapy; 3) the infant with known respiratory disease of uncertain severity in whom there is need to justify management decisions; and 4) research and development. A review of 62 recent publications to determine how lung function tests are being used at the present time showed that they are being used overwhelmingly for research. The role of lung function testing in the clinical management of infants has not been established, and research is needed to clarify this situation. We suggest that such studies should explore the role of lung function tests in infants with specific symptoms, signs, or diagnoses, taking into account information from other types of investigation and the cost/benefit/risk ratios. Pediatr Pulmonol. 2003; 36:1,9. © 2003 Wiley-Liss, Inc. [source] Comparison of Indian reference equations for spirometry interpretationRESPIROLOGY, Issue 5 2007Ashutosh N. AGGARWAL Background and objectives: It would be desirable in a large country such as India that a single set of reference equations be used to interpret lung function tests performed across the entire country. This study compared north, west and south reference equations in interpreting spirometry results in north Indian patients. Methods: Spirometric records of 27383 patients aged 16,65 years were assessed. Spirometric values for FVC, FEV1 and FEV1%FVC values derived from north, west and south Indian reference equations were compared. Differences in the lower limit of normal (LLN) were studied across the age and height range of the study group to determine if there was any clinically significant difference in the three derived values. Results: The north and west Indian equations was discordant in 22.1% instances, and the north and south Indian equations in 12.9% instances, with kappa estimates of agreement being 0.626 and 0.781, respectively. Most of the patients with abnormal spirometry using north Indian equations were erroneously interpreted to have normal spirometry using west or south Indian equations. The south Indian equations underpredicted LLN for FVC and FEV1 for most men and women. The west Indian equations underpredicted LLN for FVC and FEV1 in all men, and in younger and short statured women. Conclusions: North, west and south Indian reference equations do not yield equivalent results for spirometry interpretation in north Indian patients. [source] Relationship between impulse oscillometry and spirometric indices in cystic fibrosis childrenACTA PAEDIATRICA, Issue 6 2009Ludovic Moreau Abstract Background: The aim of our retrospective study was to determine the relationship between impulse oscillometry (IOS) data and spirometric tests in cystic fibrosis (CF) children. Methods: Thirty CF children aged 4,19 years have performed lung function tests (LFT). A subset of 15 patients repeated LFT on five separate occasions. IOS parameters were respiratory resistance (Rrs), reactance (Xrs) and impedance at 5 Hz (R5, X5, Zr) and the resonant frequency (Fres). Spirometry indices (SI) included forced expiratory volume in 1 sec (FEV1), forced expiratory flow during the middle half of FVC (FEF25,75) and forced vital capacity (FVC). Results: An inverse relationship was observed between raw values of R5, Zr, Fres and SI respectively, and X5 correlated positively with SI. Although significant, these correlations were poor. Receiver operating characteristic curves (ROC) were constructed to identify cutoff points for IOS parameters to discriminate between children according to predefined FEV1 thresholds (percent predicted), generally used to categorize the level of lung function impairment. No acceptable cutoff points can be found for IOS parameters. Trends analyses in the subgroup of 15 patients showed a significant decline of FEV1 between the first and the fifth evaluation. None of the IOS indices demonstrated a consistent tendency, apart from a slight decrease of Fres. Conclusion: IOS measurements presented an insufficient sensitivity to detect and follow bronchial obstruction in CF patients. [source] | ||||||||||||||||||||||||||||