Lung Function In Preschool Children Research Articles

Factors Affecting Lung Function in Preschool Children with a History of Transient Tachypnea of the Newborn

Background: Transient tachypnea of the newborn (TTN) is a common cause of self-limiting respiratory distress in neonates. Increasing data suggest that TTN may be a risk factor for developing childhood wheezing attacks or asthma. Objectives: The aim was to evaluate lung functions in preschool children diagnosed with TTN in the neonatal period using an Impulse Oscillometry System (IOS) to assess the presence of respiratory morbidity and its contributing factors. Methods: In this prospective study, preschool children diagnosed with TTN in the neonatal period and healthy age-matched children were defined as the TTN group and control group, respectively. Impulse Oscillometry System values for resistance (R5-R20), reactance (X5-X20), resonant frequency (Z5), and reactance area (AX) were compared between both groups and within the TTN subgroups. Asthma diagnosis was determined following IOS testing using the Modified Asthma Predictive Index/ International Study of Asthma and Allergies in Childhood (ISAAC). Results: A total of 52 preschool children and 101 healthy controls participated in the study. R5 minus R20 was significantly higher, and X10 and X15 values were significantly lower in the TTN group compared to the controls. Additionally, higher R values and AX values were observed in TTN subgroups with a history of late preterm birth, noninvasive respiratory support, and maternal asthma. The rates of variable respiratory symptoms and ≥ 4 wheezing attacks in one year were 20.5% and 18%, respectively. By the end of the study, the rate of newly diagnosed asthma in the TTN group was 30.8%. Moreover, R values and Z5 were significantly higher, and X values were significantly lower in the TTN subgroup exposed to passive smoking (PS) compared to the TTN subgroup not exposed. Conclusions: Our study showed that preschool children diagnosed with TTN in the neonatal period may have peripheral airway obstruction, a known characteristic of asthma. In addition to TTN-related factors, exposure to cigarette smoke appears to negatively impact their lung function. These findings suggest that long-term medical care should be provided for these children.

Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health.

BackgroundThe burden of respiratory disease is high in low-middle income countries (LMIC). Pulmonary function tests are useful as an objective measure of lung health and to track progression. Spirometry is the commonest test, but its use is limited in preschool children. Other lung function methods have been developed but their use in LMIC has not been well described.AimTo review the use of preschool lung function testing in children in LMIC, with particular reference to feasibility and clinical applications.MethodsElectronic databases “PubMed”, “Scopus”,” Web of Science”, and “EBSCO host” were searched for publications in low and middle income countries on preschool lung function testing, including spirometry, fractional exhaled nitric oxide (FeNO), oscillometry, interrupter technique, tidal breathing and multiple breath washout (MBW), from 1 January 2011 to 31 January 2022. Papers in English were included and those including only children ≥6 years were excluded.ResultA total of 61 papers from LMIC in Asia, South America, Africa, Eurasia or the Middle East were included. Of these, 40 included spirometry, 7 FeNO, 15 oscillometry, 2 interrupter technique, and 2 tidal breathing. The papers covered test feasibility (19/61), clinical application (46/61) or epidemiological studies (13/61). Lung function testing was successful in preschool children from LMIC. Spirometry was the most technically demanding and success gradually increased with age.ConclusionPreschool lung function testing is under-represented in LMIC for the burden of respiratory disease. These tests have the potential to strengthen respiratory care in LMIC, however access needs to be improved.

Función pulmonar evolutiva evaluada por oscilometría de impulso en prescolares con asma

Impulse oscillometry (IOS) is useful for measuring lung function in preschool children. Our objective was to describe the alterations and evolutionary profile of IOS in asthmatic children under 6 years of age after one year of follow-up. Patients and Method: 62 preschoolers performed IOS at the beginning of the study and after one year. The proportion of altered IOS and bronchodilator response (BR +) at both times was compared, in addition to sub-analysis according to asthma control and presence of atopy. For the statistical analysis, we used McNemar’s c² and the Student’s t-test with a 5% α error. Results: The initial IOS was altered in 80.6% and in 64.5%% after one year (p = 0.04). 77.4% of the children presented BR+ at the beginning of the study and 83.9% after one year. The uncontrolled asthma group presented a significant improvement in the X5 and D5-20 means, but the controlled asthma group did not. In atopic patients, only uncontrolled asthmatics improved X5, AX, and D5-20. Conclusion: IOS shows alterations in a high percentage of preschoolers with uncontrolled asthma, which decreases significantly at one year, but remains altered and with BR + in most children. Additional studies are required to identify different preschool asthma phenotypes and their evolution with treatment.

Evolutionary lung function evaluated by impulse oscillometry in preschoolers with asthma.

Impulse oscillometry (IOS) is useful for measuring lung function in preschool children. Our objec tive was to describe the alterations and evolutionary profile of IOS in asthmatic children under 6 years of age after one year of follow-up. 62 preschoolers performed IOS at the begin ning of the study and after one year. The proportion of altered IOS and bronchodilator response (BR +) at both times was compared, in addition to sub-analysis according to asthma control and presence of atopy. For the statistical analysis, we used McNemar's %2 and the Student's t-test with a 5% a error. The initial IOS was altered in 80.6% and in 64.5%% after one year (p = 0.04). 77.4% of the children presented BR+ at the beginning of the study and 83.9% after one year. The uncontrolled asthma group presented a significant improvement in the X5 and D5-20 means, but the controlled asthma group did not. In atopic patients, only uncontrolled asthmatics improved X5, AX, and D5-20. IOS shows alterations in a high percentage of preschoolers with uncontrolled asthma, which decreases significantly at one year, but remains altered and with BR + in most children. Ad ditional studies are required to identify different preschool asthma phenotypes and their evolution with treatment.

Lung function determinants and mortality of children and adolescents with cystic fibrosis in South Africa 2007-2016.

Forced expiratory volume in 1 second (FEV1) is an important predictor of outcome in cystic fibrosis (CF). This study aimed to describe the change in lung function, nutritional status, and mortality of children with CF at a single center in Cape Town, South Africa, and identify factors associated with poor lung function and mortality. A retrospective study was conducted of children aged between 5 and 18 years between January 2007 and December 2016. At least two separate best annual FEV1 measurements were required for inclusion in the study. A total of 143 children were followed up from which 107 study participants (median diagnosis age 5.5 months) were included. There was no statistically significant improvement from 2007 to 2016 in population mean FEV1 (2.5 ± 1.70 to -1.9 ± 1.70 [P = .1]) and body mass index (-0.7 ± 1.2 to -0.4 ± 1.2 [P = .3]) Z scores. FEV1 Z score declined by 0.17 per year. No significant correlation between FEV1 and age of diagnosis, sex, ethnicity, genotype, geographical location, pancreatic status, or infections was identified. On multiple stepwise regression analysis, FEV1 at age 6 was found to be the only independent predictor of mortality (adjusted odds ratio [95% CI] 0.5 [0.3-0.8]; P = .005). FEV1 at age 6 was an independent predictor for CF-related mortality. Measurement of lung function in preschool children in SA with CF using more sensitive methods than spirometry is important to identify children at risk of poor outcomes.

Application of the forced oscillation technique in diagnosing and monitoring asthma in preschool children.

The measurement of lung function in preschool children for the diagnosis of asthma is not routinely used. The need to perform forced expiratory manoeuvres requires active cooperation and thus limits the use of spirometry in this age group. The forced oscillation technique (FOT) is a simple and noninvasive method of assessing the mechanical properties of the respiratory system during tidal breathing. It is used in young patients and requires minimal cooperation. It provides an objective assessment of the respiratory system in a group of patients in whom we have not yet had appropriate diagnostic tools. In recent years, due to the availability of new technical solutions, FOT has been increasingly used and has a chance to become a method used routinely in diagnosing and monitoring treatment in preschool children. This article presents the possibility of the clinical application of FOT in diagnosing and monitoring of early childhood asthma.

Feasibility of structured light plethysmography for the evaluation of lung function in preschool children with asthma.

Structured light plethysmography (SLP) is a new noninvasive technology to capture the movement of the thoracic and abdominal wall, and to assess some parameters indicative for lung function. The purpose of the study was to evaluate the feasibility of SLP in children with asthma. A total of 52 patients were enrolled: 25 with asthma exacerbation (group 1), 13 with well-controlled asthma (group 2), and 14 healthy controls (group 3). Every patient underwent SLP evaluation and a lung function test. SLP evaluations showed that the ratio of inspiratory flow at 50% of tidal volume (Vt) to expiratory flow at 50% of Vt, in which Vt is taken to be the exhaled chest wall movement, and flow is taken to be the time derivative of the chest wall movement (IE50) value increased in group 1 compared with groups 2 and 3, with statistical significance (p = 0.018); the data were consistent with the spirometry parameter. A correlation between the IE50 and forced expiratory volume in the first second of expiration was highlighted (r = -0.35, p = 0.019). SLP assessed airway obstruction, and its use in clinical practice could be applied in preschool children in future studies.

Input oscillometry and the forced oscillation technique for assessing lung function in preschool children with asthma

Preschool children with asthma present a challenge in lung function testing, as they cannot readily cooperate with spirometry. The forced oscillation technique (FOT) measures passive pressures and flows delivered by a loudspeaker to a facemask, at frequencies much higher than those occurring physiologically. This in turn allows for rapid collection of data from a spontaneously breathing child in a timespan of seconds. However, at very rapid oscillatory flow rates, the mechanical properties opposing flows into and out of the respiratory system (collectively termed the respiratory system impedance, and comprised of elastic, resistive and inertial components) are very different from at normal breathing frequencies, with elastic properties being less important and inertial properties being more important. An understanding of how the respiratory system behaves at high frequencies is essential to understanding the physiological basis of this technique. This article presents a way to understand these oscillatory mechanics of the respiratory system. It then describes studies of the FOT in normal preschool children and in children with asthma. The technique can also measure the separate contributions of the central and peripheral airways, as well as assess for changes after bronchodilator administration. The FOT holds promise for the objective measurement of lung function in children who are too young to reliably perform spirometry.

Lung function tests to monitor respiratory disease in preschool children.

Pulmonary function tests are routinely used in the diagnosis and follow-up of respiratory diseases. In preschool children assessment and evaluation of lung function has always been challenging but improved techniques that require only minimal collaboration allowed obtaining reliable and useful results even in this group of patients. In this review we will describe the different techniques used in clinical practice to measure lung function in preschool children.(www.actabiomedica.it)

Chest circumference and birth weight are good predictors of lung function in preschool children from an e-waste recycling area.

The purpose of this study was to investigate the associations between birth weight, chest circumference, and lung function in preschool children from e-waste exposure area. A total of 206 preschool children from Guiyu (an e-waste recycling area) and Haojiang and Xiashan (the reference areas) in China were recruited and required to undergo physical examination, blood tests, and lung function tests during the study period. Birth outcome such as birth weight and birth height were obtained by questionnaire. Children living in the e-waste-exposed area have a lower birth weight, chest circumference, height, and lung function when compare to their peers from the reference areas (all p value <0.05). Both Spearman and partial correlation analyses showed that birth weight and chest circumference were positively correlated with lung function levels including forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). After adjustment for the potential confounders in further linear regression analyses, birth weight, and chest circumference were positively associated with lung function levels, respectively. Taken together, birth weight and chest circumference may be good predictors for lung function levels in preschool children.

Evaluation of lung function on impulse oscillometry in preschool children born late preterm.

There is a paucity of data on lung physiology in late-preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term-born children. Children between 3 and 7 years of age who were born late preterm and who were being followed up at the outpatient clinic were included as the late-preterm group. Age-matched healthy term-born children served as controls. A total of 90 late-preterm and 75 healthy children were included in the study. At 5-20 Hz, resistance (R5-R20), reactance (X5-X20), impedans (Z5) and resonant frequency were measured on IOS. Mean IOS R5 and R10 were significantly higher in the late-preterm group than in the control group (P < 0.05). Mean R5, R10 and Z5 were statistically higher in late-preterm children who had been hospitalized for pulmonary infection compared with the control group (P < 0.05). Mean R5, R10, R15, R20 and Z5 were significantly higher, and mean X10 and X15 significantly lower in late-preterm children with passive smoking compared with late-preterm children without passive smoking and controls (P < 0.05). Children born late preterm had signs of peripheral airway obstruction on IOS-based comparison with healthy term-born controls. Besides the inherent disadvantages of premature birth, hospitalization for pulmonary infection and passive smoking also seemed to adversely affect lung function in children born late preterm.

Prenatal Exposure To Endocrine Disruptors And Respiratory Function In A Cohort Of Mexican Preschoolers

Background: Several studies indicate that exposure to endocrine disruptors such as phthalates and bisphenol A may adversely affect the human's health and recent evidence reported associations between exposure to these compounds and effects on respiratory health and metabolic diseases. However, few longitudinal study have been evaluated the exposure during pregnancy and his impact on lung function in preschool children. Objective. To evaluate the effect of prenatal exposure to endocrine disruptors on respiratory function in a cohort of Mexican preschoolers. Methods. We included 152 mother-child pairs, mothers participate in a randomization clinical trial of supplementation with omega 3 fatty acids during pregnancy. The lung function was tested using a forced oscillation technique (Resistance (Rrs6, 8Hz y Rrs8, 8Hz) and reactance (Xrs6, 8Hz y Xrs8, 8Hz) each child at 3, 4 and 5 years of life. For exposure assessment, we performed the determinations of 9 metabolites of phthalates and levels of bisphenol A in maternal urine samples obtained during pregnancy using a high resolution liquid chromatography. An index of phthalate metabolites exposure was realized using principal component analysis. The effect of prenatal exposure to endocrine disruptors on pulmonary function was evaluated using mixed effect models. Results. The average of Rrs6, Rrs8 and Xrs6 and Xrs8 measures were 11.0 and 8 Hz and 5 and 8 Hz respectively; the geometric mean concentrations of bisphenol A was 2.8ug/gr of creatinine. A significant negative effect between BPA and Resistance (Rrs6, Rrs8) and reactance (Xrs8 and higher in Xrs6) was observed (p

Determinants of baseline lung function and bronchodilator response in 4-year-old children.

The prolonged period required for maturation of the respiratory system makes it vulnerable to environmental exposure. This study aimed to investigate the association between early-life factors and lung function in preschool children. Children aged 4 years, who were included in a prospective birth cohort, underwent lung function testing at baseline (n=535) and after bronchodilation (n=498) by forced oscillations. Information on symptoms and exposures was collected through half-yearly questionnaires. Allergen-specific serum IgE was quantified at 1 and 4 years. Multiple linear regression analysis showed that the baseline respiratory resistance and reactance area were larger in the children with previous wheeze, those with early-onset sensitisation to inhalant allergens and those who were smaller. Furthermore, children with previous lower respiratory tract infections exhibited higher baseline resistance values. The baseline resistance was the only independent determinant of the bronchodilator-induced change in resistance, whereas current height and baseline reactance area were independently associated with the change in reactance area. In conclusion, previous lower respiratory tract infections, the timing of previous wheeze, inhalant sensitisation and current height independently influence the baseline lung function of 4-year-old children, whereas baseline lung function is the principal determinant of the bronchodilator response.

Oscilometría de impulso en adultos: una prueba de función pulmonar complementaria

La oscilometría de impulso es una prueba no invasiva que se ha retomado recientemente para determinar la impedancia del sistema respiratorio, principalmente en aquellos pacientes que tengan compromiso de la vía aérea pequeña y cuando no se pueda realizar un esfuerzo adecuado o maniobras convencionales. Puede servir como un método complementario o alternativo a la espirometría en la evaluación del estado del sistema respiratorio. Fue desarrollada desde 1956 pero solo hasta 2007 se incluyó en las guías ATS/ERS para la evaluación de la función pulmonar en preescolares. Consiste en la medición del impedimento natural al flujo de aire, lo cual incluye pérdidas friccionales y cargas elásticas e inerciales. Mide las resistencias centrales (R20) y las resistencias totales (R5), así como el delta de resistencia (ΔR=R5-R20), la reactancia capacitiva distal (X5), la frecuencia de resonancia (Fres) y el área de reactancia (AX). Tiene unos criterios de aceptabilidad que deben cumplirse y se sugiere que la interpretación se realice de manera sistemática. Los valores comparativos para su interpretación se han tomado de diferentes ecuaciones de acuerdo con edad, sexo, raza, altura y peso.Se ha utilizado para evaluar de forma temprana la impedancia del sistema respiratorio en asma y enfermedad pulmonar obstructiva crónica, enfermedades pulmonares intersticiales, cambios pulmonares mecánicos en pacientes con insuficiencia cardíaca congestiva, obstrucción de la vía aérea superior, disfunción de cuerdas vocales, como alternativa para la realización de test de broncoprovocación, como herramienta de evaluación complementaria en el manejo de pacientes con enfermedad pulmonar obstructiva crónica, respuesta a broncodilatadores, cambios en la resistencia de la vía aérea en pacientes con síndrome de apnea/hipopnea obstructiva del sueño, resistencias respiratorias en pacientes con lesión en la médula espinal, entre otras aplicaciones.Sin embargo, se requieren más estudios de calidad apropiada para determinar la utilidad de esta prueba diagnóstica en la práctica clínica.

Exposure to volatile organic compounds and nitrogen oxides and lung function in Mexican Preschoolers

Backgroud: Omega-3 fatty acid such docosahexaenoic acid (DHA) influence immune function and inflammation; however, the influence of prenatal DHA on infant respiratory function is unknown. Objective: To evaluate the impact of air pollutions on lung function in preschool children and evaluate the interaction between supplementation with omega-3 fatty acids and exposure to air pollution in this population. Methods. We realized forced oscillation lung function tests (respiratory resistance (Rrs6, 8 Hz) and reactance (Xrs6, 8 Hz)) using a Cosmed Quark i2m in 631 preschoolers whose mothers participated in a clinical trial of fatty acid supplementation omega-3 during pregnancy. For the exposure assessment to air pollutants we ran land-use regression models using local monitoring information at 60 sites in the state of Morelos. To evaluate the association we ran Gees Generalized Equation Models for binary data adjusting for important variables. Results. Respiratory function did not vary significantly between supplementation groups. An inverse relationship was observed between exposure to toluene and nitrogen oxides on lung function significantly (Rrs6, and Xrs6 8Hz, 8Hz (p &lt;0.05). We observed no significant interaction between treatment group and exposure to air pollutants. Conclusions. Exposure to air pollution affects lung function and growth lung of Mexican preschoolers. Key Words: Forced oscillation test, Preschoolers, lung function, omega-3 supplementation.

P79 Impulse oscillometry for the assessment of lung function deficits associated with preschool wheezing

IntroductionPreschool wheezing affects over 1/3 of children, and is associated with lung function deficits. There is a need for a clinical tool to evaluate lung function in preschool children, which...

Lung function in preschool children with a history of wheezing measured by forced oscillation and plethysmographic specific airway resistance

Wheezing is common in preschool children, but objective evidence for airway obstruction and its reversibility are rarely available in clinical practice. We assessed whether abnormalities of lung function and bronchodilator response can be detected in preschool children using the forced oscillation technique and measurements of specific airway resistance. Fifty-nine children with a history of wheeze and 24 healthy controls aged 3-6 years were recruited. Resistance and reactance at 6 and 8 Hz (Rrs6, Rrs8, Xrs6 and Xrs8, respectively) were measured using the forced oscillation technique and specific airway resistance was measured in a plethysmograph. z-Scores were calculated from published reference data. Tests were repeated 15 min after 400 mcg salbutamol. Bronchodilator response was expressed as the log-transformed ratio of postbronchodilator/prebronchodilator values. Technically acceptable measurements using the forced oscillation technique were obtained in n = 77 (93%) of children and in n = 56 (68%) using plethysmography. There was no significant difference in baseline lung function or bronchodilator response, assessed by either technique, between those with a history of wheeze and healthy controls. Measurement of lung function is feasible in preschool children, but neither of these techniques was able to identify diminished lung function or reversibility to bronchodilator in children with a history of wheeze.

Does ethnicity influence lung function in preschool children?

Effective management of respiratory diseases in young children requires objective outcome measures that do not rely simply on parental reports of symptoms, which are known to be unreliable [1,2]. A...

Spirometric Pulmonary Function Test in Preschool Children

Children aged 3~5 years old represent the challenge in pulmonary function assessment, since evaluating lung function in preschool age group is important for the appropriate treatment for patient with chronic and recurrent cough and wheeze during this period. The joint American Thoracic Society/European Respiratory Society task force has produced recommendations for the spirometric lung function test currently used in the preschool age group. The reliable scientific evidence, documented references and reviews by the experts were used as a support. Reference data of spirometry lung function in preschool children were available in several countries including USA, Norway, Czech, Israel, Canada, and Taiwan. Spirometric pulmonary function tests are feasible in 3~ to 5~year~old children. However, the existing data are not sufficient to make definitive recommendations. Recommendations will need to be revised periodically until sufficient evidence has been collected to make definitive guidelines in various situations.

Haplotype Tagging SNPs in the Beta Adrenergic Receptor (ADRB2) Gene are Associated with Pre and Post-bronchodilator Lung Function in Preschool Children

RATIONALE: Specific airway resistance (sRaw) is a sensitive and reproducible measure of lung function in children - higher sRaw indicating poorer lung function. Albuterol (ADRB2 agonist) is the most common treatment for wheezing illness. We investigated the relationship between five haplotype tagging SNPs in ADRB2 and pre and post albuterol lung function at age 5 years in a population based birth cohort.