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Ring AM, Carlens J, Bush A, Castillo-Corullón S, Fasola S, Gaboli MP, Griese M, Koucky V, La Grutta S, Lombardi E, Proesmans M, Schwerk N, Snijders D, Nielsen KG, Buchvald F. Pulmonary function testing in children's interstitial lung disease. Eur Respir Rev 2020; 29:29/157/200019. [PMID: 32699025 DOI: 10.1183/16000617.0019-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/11/2020] [Indexed: 12/17/2022] Open
Abstract
The use of pulmonary function tests (PFTs) has been widely described in airway diseases like asthma and cystic fibrosis, but for children's interstitial lung disease (chILD), which encompasses a broad spectrum of pathologies, the usefulness of PFTs is still undetermined, despite widespread use in adult interstitial lung disease. A literature review was initiated by the COST/Enter chILD working group aiming to describe published studies, to identify gaps in knowledge and to propose future research goals in regard to spirometry, whole-body plethysmography, infant and pre-school PFTs, measurement of diffusing capacity, multiple breath washout and cardiopulmonary exercise tests in chILD. The search revealed a limited number of papers published in the past three decades, of which the majority were descriptive and did not report pulmonary function as the main outcome.PFTs may be useful in different stages of management of children with suspected or confirmed chILD, but the chILD spectrum is diverse and includes a heterogeneous patient group in all ages. Research studies in well-defined patient cohorts are needed to establish which PFT and outcomes are most relevant for diagnosis, evaluation of disease severity and course, and monitoring individual conditions both for improvement in clinical care and as end-points in future randomised controlled trials.
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Affiliation(s)
- Astrid Madsen Ring
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark.,Joint first authors
| | - Julia Carlens
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Medizinische Hochschule Hannover Zentrum fur Kinderheilkunde und Jugendmedizin, Hannover, Germany.,Joint first authors
| | - Andy Bush
- Paediatrics and Paediatric Respiratory Medicine, Imperial College London, London, UK.,Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Silvia Castillo-Corullón
- Unidad de Neumología infantil y Fibrosis quística, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Salvatore Fasola
- Institute of Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Mirella Piera Gaboli
- Neumologia Infantil y Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario Salamanca, Salamanca, Spain
| | - Matthias Griese
- University Hospital of Munich, Dr. von Hauner Children's Hospital, German Center for Lung Research (DZL), Munich, Germany
| | - Vaclav Koucky
- Dept of Paediatrics, Univerzita Karlova v Praze 2 lekarska fakulta, Prague, Czech Republic
| | - Stefania La Grutta
- Institute of Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Anna Meyer Pediatric University-Hospital, Florence, Italy
| | | | - Nicolaus Schwerk
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Medizinische Hochschule Hannover Zentrum fur Kinderheilkunde und Jugendmedizin, Hannover, Germany
| | | | - Kim Gjerum Nielsen
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark.,Joint last authors
| | - Frederik Buchvald
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark .,Joint last authors
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[Rebreathing method for measuring CO transfer factor in children]. Rev Mal Respir 2019; 36:937-945. [PMID: 31521429 DOI: 10.1016/j.rmr.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/28/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The reference technique to measure the diffusing capacity of the lung for carbon monoxide (DLco) is the single-breath method (sb). For patients unable to perform this method, the rebreathing method (rb) can be used. However, the clinical relevance of DLCOrb has not been evaluated. The aim of this study was to assess the feasibility of the rb method in children seen in a clinical setting and its relationships with sb method. SUBJECTS AND METHOD We prospectively included children referred for 1) a suspected or confirmed interstitial lung disease (ILD group) (DLCOsb and DLCOrb measurements) ; 2) controlled asthma with normal lung function (DLCOrb measurements to derive DLCOrb/KCOrb expected values). DLCOrb was computed from the decrease in CO and Helium concentrations during tidal breathing in a rebreathing bag. RESULTS Data on DLCOrb measurements were available for 53 (91%) children in the ILD group and 48 (91%) control children (mean (range) 11.5 (4.3-18.2) and 9.5 (4-17) years ; respectively). In the ILD group, high or moderate correlations were found between raw DLCOrb and DLCOsb values (rhô=0.82 ; P<0.0001) and between KCOrb and KCOsb (rhô=0.62 ; P<0.0001), respectively. Results expressed as percentage predicted were moderately correlated (rhô=0.55 ; P=0.0003 for DLCO ; rhô=0.51 ; P=0.001 for KCO). CONCLUSION DLCOrb is easy to perform in children and gives values that are highly correlated to DCLOsb. Our preliminary results are in favour of a possible clinical use after further validation.
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Khirani S, Nathan N, Ramirez A, Aloui S, Delacourt C, Clément A, Fauroux B. Work of breathing in children with diffuse parenchymal lung disease. Respir Physiol Neurobiol 2015; 206:45-52. [DOI: 10.1016/j.resp.2014.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/06/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022]
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Abstract
OBJECTIVE To determine whether infants with hyaline membrane disease (HMD) superimposed on immature lung disease (ILD) have more abnormal lung function and respiratory drive during the evolution of chronic neonatal lung disease (CNLD) in extremely low birth weight infants (ELBW; <1000 g). METHODS We measured lung mechanics (respiratory frequency, tidal volume, minute ventilation, lung resistance, lung compliance, lung impedance, and work of breathing per minute) and respiratory drive (airway opening pressure 100 milliseconds after initiation of breath [P(0.1)] and maximal inspiratory pressure generated during airway occlusion) on 3 occasions before term in 24 ELBW infants. RESULTS Ten infants with ILD (mean [95% CI] gestation: 24.3 weeks [23.1,25.4]; birth weight: 675 g [553,798]) were studied at 27, 31, and 35 weeks of postconceptional age and 14 infants with HMD superimposed on ILD (gestation: 25.1 weeks [24.4,25.9]; birth weight: 687 g [601,773]) were studied at 28, 32, and 35 weeks of postconceptional age. There were no statistically significant differences between the groups for respiratory frequency, tidal volume, minute ventilation, lung resistance, lung compliance, lung impedance, work of breathing per minute, P(0.1), and maximal inspiratory pressure generated during airway occlusion. With increasing age, both groups demonstrated increased respiratory drive as measured by P(0.1) without significant changes in respiratory frequency or CO(2). Work of breathing per minute increased in the HMD group with age and was higher in extubated subjects. A similar trend with age was demonstrated in ILD infants. Regardless of whether the initial lung disease was ILD alone or HMD + ILD, ELBW infants developed a mildly reduced lung compliance/kg (.8-1.1 mL/cm.H(2)O/kg) and high lung resistance (75-125 cm.H(2)O/L/second) pattern of CNLD, which changed little after 3 weeks of age. Survival to 6 months was 23/24 (96%). Oxygen dependency was 16/24 (67%) at 35 weeks, yet only 5/23 (22%) survivors required oxygen at discharge from the neonatal unit (43 weeks). CONCLUSIONS The visco-elastic and flow-resistive properties of the lungs in ELBW infants with CNLD remain only mildly abnormal, suggesting a more favorable prognosis for lung function in later years than previously reported.
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Affiliation(s)
- D A Fitzgerald
- Children's Chest Research Centre, New Children's Hospital, Sydney, Australia.
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