Lung Function Testing In Children Research Articles

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.

Clinical features and lung function in HIV-infected children with chronic lung disease

Background. Although chronic lung disease (CLD) is commonly seen in children with advanced HIV disease, it is poorly studied. Objectives. To report on the clinical manifestations and lung function tests in children with advanced HIV disease at a tertiary care centre, and determine clinical predictors of poor lung function. Methods. We undertook a cross-sectional study of children with advanced HIV disease in whom CLD was suspected. We undertook clinical evaluation and lung function tests, accompanied by a retrospective chart review. Results. In 56 children identified, the median age was 5 (interquartile range (IQR) 2 - 8) years with equal gender ratio. The majority (93%) had been previously treated for tuberculosis and/or pneumonia (71%). The most common CLD identified was lymphocytic interstitial pneumonitis (54%). The median nadir CD4 percentage was 13% (IQR 8.5 - 16%) and the median highest reported viral load was log5.8 (IQR log5.0 - log6.5). The median duration of antiretroviral therapy was 9.8 (IQR 1.1 - 19.5) months. Lung function tests were performed in 27 (48%) children. The median forced expiratory volume in 1 second (FEV 1 ) was 60% (IQR 45.3 - 86.3%) predicted. Previous hospitalisation, respiratory rate, digital clubbing, chest hyperinflation and hyperpigmented skin lesions were associated with a decreased FEV 1 in a univariate relationship. In a multiple linear regression analysis, hyperinflation, increased respiratory rate and hyperpigmented skin lesions were associated with poor lung function (percentage FEV 1 ). Conclusion. We identified useful clinical signs predictive of poor lung function in HIV-infected children with CLD, especially in resource-limited settings.

Paediatric spirometry guideline of the South African Thoracic Society: Part 1

Spirometry forms an important component in the diagnosis and management of pulmonary diseases in children. In the paediatric setting, there are different challenges in terms of performance and interpretation of good quality and reliable tests. An awareness of the physiological and developmental aspects that exist in children is necessary to improve the quality and reliability of spirometry. We reviewed the recommendations on the technical aspects of performing spirometry in children, from the available guidelines and clinical trials. The focus was on the indications, methods and the interpretation of lung function tests in children <12 years of age. Reliable lung function testing can be performed in children, but an awareness of the limitations, the use of incentives and a dedicated lung function technologist are necessary.

Épreuves fonctionnelles respiratoires de l’enfant de 3 à 5 ans : quel matériel, quelles mesures ?

Lung function testing in children 3 to 5years of age is possible using equipment and techniques suitable for this age group. The use of different techniques will depend on the child's ability as well as on the technician's skill to use specific techniques. This review will detail the techniques that are easily available for routine lung function assessment in private practice or in hospital laboratory.

Capnovolumetry: a new tool for lung function testing in children with asthma

In capnovolumetry, the expiratory CO2 concentration of exhaled air is plotted against the volume and thereby allows to determine functional dead space volumes. This method might offer additional information in lung function testing in children and adolescents with bronchial asthma. We aimed at determining whether a bronchospasmolysis (BSL) effect in the lower airways could also be detected by capnovolumetry as reflected by changes in the functional threshold dead space volumes (VDT). In 47 patients (aged 4-16 years) with a mild persistent bronchial asthma, VDT were determined before and after bronchodilation prior to starting therapy with inhaled steroids and after 6 months of treatment. Additionally, spirometry and body plethysmography were performed in all patients. There were significantly higher VDT values after BSL before and after 6 months of therapy (P<0.0001). VDT values before BSL were tendatively higher after 6 months of therapy compared with baseline values (P=0.07). VDT values correlated with parameters derived from conventional pulmonary function testing, i.e. vital capacity, forced expiratory volume in 1 s (FEV1), and maximum expiratory flow (MEF50). As VDT values particularly reflect the volumes of the lower bronchi this method may provide supplementary information to conventional lung function tests which are based on breathing mechanics. This seems to be especially helpful in situations where body plethysmography is not available or cooperation in forced expiration manoeuvres is insufficient.

Effects of a Program of Hospital-Supervised Chest Physical therapy on Lung Function Tests in Children with Chronic Respiratory Disease: 1-Year Follow-up

To investigate whether a hospital-supervised program of chest physical therapy improves lung function in children with chronic pulmonary diseases, twenty-four children (4 with Kartagener?s syndrome, 12 with common variable immunodeficiency, and 8 with primary ciliary dyskinesia) average age 11.2 +/- 3.2 years, were randomly assigned to a one-month hospital-supervised program of chest physical therapy (13 patients) or to a control group (11 patients) that continued unsupervised chest physical therapy at home. Lung function was assessed before the program, and one and 12 months after. At the one-month assessment, thoracic gas volume was significantly lower in the supervised group than in the controls. At the one-year assessment, forced expiratory volume in one second was significantly higher in the supervised group than in controls. A supervised program of chest physical therapy significantly improved lung function in children with chronic pulmonary diseases.

Effets bronchomoteurs de l'inspiration profonde. Mécanismes et intérêt en pédiatrie

There is significant alteration of airway calibre after deep inhalation (DI). An increase of airway calibre has been evidenced in children in case of mild asthmatic obstruction and after a positive response to methacholine or exercise challenge. Such an increase is blunted in the presence of a moderate to severe asthmatic airway obstruction and no bronchodilatory effect of DI has been found in infants. Bronchial hyperreactivity and airway inflammation strongly influence post-DI alterations of bronchomotor tone. Airways and lung parenchyma are interdependent but both exhibit imperfect elasticity. Hysterisis characterizes imperfect elasticity of pressure–volume relationship. The mechanical theory of relative hysteresis between airway and lung parenchyma is the main mechanism implicated in the induced changes of airway calibre. DI may influence results of lung function testing in children. The technique may be of interest to increase sensibility of routine lung function testing in children.

Applied physiology: lung function testing in children

Recent developments in the techniques available to measure lung function in children have greatly improved our understanding of lung development in both health and disease. In everyday clinical practice, lung function tests can provide objective information about the severity and progression of disease and the response to treatment. Although spirometry remains the most useful and widely used test, newer techniques such as specific airways resistance (sRaw) and Rint (resistance measured by the interrupter technique) now allow children who are too young to co-operate with spirometry, to be tested. This is of great importance as it is increasingly recognized that many chronic respiratory illnesses in older children and adults have their origins in early life. In this paper we describe the basic physiology of some standard tests and some of the newer tests which are increasing our understanding of lung disease.

Seqüelas respiratórias de doenças virais: do diagnóstico ao tratamento

Objetivos: o objetivo do presente texto é apresentar uma revisão acerca das principais questões clínicas que envolvem o pediatra frente ao diagnóstico, manejo e prognóstico da situação. Fontes de dados: foram utilizadas informações de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline. Síntese dos dados: para fins diagnósticos, a investigação radiológica evidencia hiperinsuflação pulmonar, espessamento dos feixes broncovasculares e, menos freqüentemente, bronquiectasias, atelectasias e hiperlucência pulmonar. A tomografia computadorizada permite visualizar alterações estruturais e funcionais, como aprisionamento de ar, bronquiectasias e padrão mosaico. Estudos funcionais pulmonares, em crianças e lactentes, revelam invariavelmente redução acentuada dos fluxos expiratórios. Biópsia pulmonar não é obrigatória para confirmação de bronquiolite obliterante (BO). O diagnóstico pode ser feito pela combinação de história de bronquiolite, doença pulmonar obstrutiva crônica e alterações tomográficas características. O tratamento feito pela maioria dos centros inclui corticóides orais e inalatórios e broncodilatadores por períodos prolongados, e o manejo das exacerbações freqüentemente requer antibióticos e fisioterapia. Conclusões: a maioria dos pacientes tem uma evolução favorável, com lenta melhora da função pulmonar e da necessidade de oxigênio suplementar. Alguns pacientes evoluem com piora progressiva da hipoxemia e retenção de CO2, levando à hipertensão pulmonar e cor pulmonale. A maioria dos pacientes portadores de BO pós-infecciosa apresenta quadros leves e moderados, fazendo com que o prognóstico, em geral, seja bom, com baixa mortalidade.

Respiratory sequelae of viral diseases: from diagnosis to treatment

The objective of the present article is to present a review of the main clinical issues faced by pediatricians while defining the diagnosis, management and prognosis of postinfectious bronchiolitis obliterans. Data from national and international scientific journals selected from the Lilacs and Medline databases. With the purpose of establishing the diagnosis, a radiological investigation shows high levels of pulmonary insufflation, thickened bronchovascular bundles and, less often, bronchiectasis, atelectasis and pulmonary hyperlucency. The CT exam allows the visualization of structural and functional findings, such as air trapping, bronchiectasis and mosaic pattern. Lung function tests in children and infants always reveal significant reduction of expiratory flows. Pulmonary biopsy is not mandatory in order to confirm bronchiolitis obliterans. Diagnosis can be established through the combination of history of bronchiolitis, chronic obstructive pulmonary disease and typical tomographic findings. The treatment used by most services includes oral and inhaled corticosteroids and bronchodilators for long periods. The management of exacerbated conditions often requires antibiotics and physical therapy. Most patients present a favorable outcome with slow improvement of the pulmonary function and reduced necessity for supplementary oxygen. Some patients present progressive worsening of hypoxemia and CO2 retention, which leads to pulmonary hypertension and cor pulmonale. Postinfectious bronchiolitis obliterans is mild and moderate in most patients, with consequent good prognosis and low mortality.

Ethical issues in lung function testing in children

Most lung function tests are non-invasive and they are widely performed in children and adults for clinical reasons. The prevalence of respiratory disorders is such that there is a considerable amount of research in the area. For both clinical and research applications, professionals involved in lung function testing in children need to be aware of ethical issues pertaining to such testing. In general, these are not specific to lung function testing but are common to other non-invasive procedures. These include the need to recognize the autonomy of the child (appropriate for age and maturity) and the importance of providing information in ways that a child can understand. The issues surrounding consent, confidentiality, and risk-benefit assessment are particularly important in vulnerable groups such as children. Parents, too, have a clear influence on healthcare issues surrounding children and hitherto have not always been appropriately involved. Healthcare professionals have a duty to children and their families to safeguard their psychological, social and emotional well-being, as well as their physical health.

A practical approach to the interpretation of lung function testing in children.

Lung function testing is an increasingly important tool in the diagnosis and monitoring of lung disease in children. However, not all paediatricians will have had training in lung function testing. Here, a structured approach to the interpretation of lung function results is developed. This should help the clinician understand the results from their lung function laboratory.

S18.2. Value of more comprehensive lung function tests in children

S18.2. Value of more comprehensive lung function tests in children

Determinants of reproducibility of lung function tests in children aged 7 to 10 years

Determinants of reproducibility of lung function tests in children aged 7 to 10 years

Pulmonary function abnormalities in young adults with thalassemia major

Abstract Thalassemia seems to be the most common genetic disorder. The pathophysiologic mechanisms for lung impairment is not clear. Lung function tests in children showed small airway obstruction and restrictive lung changes. Forty-two patients, 22 females and 20 males, aged from 17 to 36 years old, with homozygous β -thalassemia were examined in a lung function laboratory. All patients received chelation therapy and none of them had history of respiratory disease. Lung function tests included spirometry, static lung volumes measured by a closed circuit helium rebreathing technique and diffusion capacity measured by the method of single breath diffusion of carbon monoxide. All patients, before these tests, had haematologic examinations (Hb, serum ferritin), electrocardiogram and echocardiogram. Only five out of 42 patients had completely normal pulmonary function. Four had only diffusion impairment, 18 restrictive and 15 combined (restrictive and obstructive) pattern of lung disease. Vital capacity (in 27 patients), total lung capacity (in 21 patients) and forced expiratory volume in the first second (in 30 patients) were abnormally reduced. The ratio of residual volume (RV) to total lung capacity (TLC) was increased in 19 patients. Patients with only diffusion impairment had statistically significant more increased serum ferritin value (4415 ng/ml) than other patterns of lung function. Patients with combined or restrictive pattern of lung function, had heart failure and osteoporosis more often than other patients. Heart failure and the aberrant growth process that limits the volume of peripheral airspace are perhaps the possible mechanisms for the restrictive lung disease, small airways obstruction and hyperinflation.

Pulmonary Function Testing in Children

This article concentrates on those factors that are particularly important for performing and interpreting lung function tests in children. Specifically, technical considerations such as equipment, personnel, test performance, and bronchoprovocation procedures are discussed. Changes in lung function with growth and appropriate use of race-specific reference standards are emphasized, and references for standard and experimental pulmonary function tests are provided. Several examples illustrating the utility of pulmonary function testing in clinical situations in children with lung disease are provided as well.

Regional lung function in children: the accuracy of nitrogen-13 inhalation and infusion studies.

The assumptions made in 13N lung function tests in children with pulmonary or cardiac disorders have been examined. The index of lung function employed was the height/area (H/A) of the lung curves obtained following either bolus inhalation or infusion of 13N. Three aspects were considered: (1) the accuracy of H/A values with count rates obtained in typical patients; (2) the effect on perfusion H/A values of prolonged arrival of isotope in the lungs; and (3) the effect on perfusion H/A values of recirculation of isotope through the lungs due to a right-to-left intracardiac shunt. It was found that, for inhalation studies, the index H/A was sufficiently accurate to distinguish localised from generalised disease. For perfusion studies, prolonged arrival of isotope in the lungs caused a reduction in measured H/A values of up to 15%. In the presence of a right-to-left shunt recirculation of isotope could prevent the detection of a small, poorly-ventilated lung component. It is concluded that the use of 13N for measurement of ventilation/perfusion balance is not a sensitive method for monitoring the progress of generalised pulmonary disease.

A pocket computer program for normal values of selected lung function tests in children and young adults

Assessment of selected pulmonary functions can supply objective data useful for the overall management of respiratory problems in children. Determination of peak expiratory flow, FEV 1, FVC, and MMEF are readily available in most hospitals, and in the offices of an increasing number of general practitioners and paediatricians. Modern equipments output patient's performance as a percentage of the average expected but confidence limits are lacking and the programmed norms for children are inadequate. This article describes the use of a pocket computer for a quick display of the above parameters based on recently published prediction formulae.

Standardization of lung function testing in children: Proceedings and recommendations of the GAP conference Committee, cystic fibrosis foundation

Standardization of lung function testing in children: Proceedings and recommendations of the GAP conference Committee, cystic fibrosis foundation

Relationship between Ig-E Levels and Lung Function Tests in Children with Asthma

Background: Asthma is the most common chronic disorder in childhood. A high level of Ig E is associated with asthma. Objectives: The present study was carried out to observe the relation of serum IgE level with lung function parameters in asthma children and apparently healthy normal children. Methods: This study was carried out in the out patient department of paediatrics, Dhaka Medical College, Dhaka between January 2010 and June 2010. Total sixty children with age range from six to fifteen years of both sexes were included in this study. Thirty children suffering from asthma and thirty apparently healthy children with no systemic disorder were taken as study population. Serum Ig-E levels were measured in all subjects using a standard Immulite assay by ELISA method. Subjects were classified as having high IgE if their total IgE level was greater than or equal to 100 IU /ml .Subjects were classified as having low IgE if their total IgE level was less than 100 IU /ml. Spirometry was conducted on all patients by using Spirolab a new generation spirometer according to American Thoracic Society standards. Data were analyzed by unpaired t test and Chi-squares test. Results: The mean percentage of predicted values of FEV1, FVC, FEV1/FVC% were significantly lower in high Ig E (&gt;100 IU/ml) level group in comparison with low Ig E(&lt;100 IU/ml) group. Conclusion: Therefore the result of the present study reveals that higher IgE is related with lower lung function and also there were more chance in symptoms based asthma in our study populations. DOI: 10.3329/jdmc.v19i1.6242 J Dhaka Med Coll. 2010; 19(1) : 3-6.