DOCSLIB.ORG

Lung Function in Recurrent Wheezing and Asthma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Lung Function in Recurrent Wheezing and Asthma PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY Volume 24, Number 2, 2011 ª Mary Ann Liebert, Inc. DOI: 10.1089/ped.2010.0060 Clinical Applications of Pediatric Pulmonary Function Testing: Lung Function in Recurrent Wheezing and Asthma Jason Debley, M.D., M.P.H.,1 Amy G. Filbrun, M.D., M.S.,2 and Padmaja Subbarao, M.D., M.Sc. (Epid), FRCP(C)3 Pulmonary function testing remains the gold standard for the diagnosis and management of wheezing disorders in older children and adults. Although wheezing disorders are among the most common clinical problems in pediatrics, most young children and toddlers cannot perform most of the currently clinically available pulmo- nary function tests. In this article, we review the different types of pulmonary function tests available and discuss the applicability and utility in the different age groups with specific reference to suitability in the diagnosis and management of wheezing disorders. Introduction In this review, we will attempt to concisely review the literature of currently available pulmonary function tech- sthma is a chronic reversible obstructive airway dis- niques in children to assist in the diagnosis and management ease. In school-age children objective measurement of of asthma and recurrent wheezing. A lung function is essential to the diagnosis and evaluation of asthma, as medical history and physical examination are not reliable means of assessment.1 Although clinicians are gen- Spirometry 2 erally able to identify airflow obstruction clinically, they are Childhood unable to assess the degree or reversibility of the airflow obstruction.3 In a recent study, up to a third of children with Spirometry is the gold standard for the diagnosis and moderate-to-severe asthma were reclassified to a more se- management of asthma. It is the most commonly used method vere asthma category when spirometry was assessed in ad- to assess lung function. Recent NIH guidelines7 recommend 4 dition to symptom frequency. In contrast, another study the use of spirometry, specifically FEV1 and FEV1/FVC found that most children with mild-to-moderate asthma by [forced vital capacity (spirometry)] ratio for the diagnosis and symptom classification were found to have normal lung management of children older than 5 years. This is in part due function by FEV1 [forced expiratory volume in one second to the fact that pulmonary function has been found to be more (spirometry)].5 These seemingly contradictory findings em- sensitive than clinical examination2,3 or symptoms for the phasize the importance of including pulmonary function detection of obstructive pathology.4 The greatest value in di- testing (PFT) in a comprehensive assessment of asthma. agnosing asthma with the use of spirometry is the docu- Recurrent wheezing affects 20%–30% of infants and tod- mentation of reversibility with short acting bronchial agonist. dlers, yet resolves in at least half of these children by school The degree of reversibility has been correlated with the degree age. Eighty percent of school-age children with persistent of airway inflammation8 and postbronchodilator measures asthma were symptomatic by age 6 years, with more than can be used to follow lung growth and remodeling.9 Further, half symptomatic by age 3 years.6 However, differentiating those children with the greatest reversibility with a short transient wheezing from persistent asthma in the early years acting bronchial agonist are most at risk for remodeling and is problematic since the 2 syndromes have only been de- loss of lung function over time.10 scribed epidemiologically. Therefore, practical methodolo- Other factors making spirometry a useful test in the as- gies to objectively assess lung function in infants and sessment of asthma and bronchodilator response (BDR) in- toddlers for the purposes of accurately diagnosing asthma clude portability of the measurement device, ease of use for are highly desirable. the operator, and repeatability of the maneuver. Spirometry 1Seattle Children’s Hospital, University of Washington, Seattle, Washington. 2C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan. 3Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 69 70 DEBLEY, FILBRUN, AND SUBBARAO is the least variable of the pulmonary function maneuvers dividual asthmatic children had evidence of airflow ob- currently commercially offered in most clinical laboratories. struction by FEV1 or FEF25–75 [forced expiratory flow at 25% The coefficient of variation for FEV1 ranges from 2.7% to 5%, to 75% of expiration (spirometry)], suggesting that preschool whereas the variability of other measures such as specific spirometry may provide clinically useful information for a airway resistance (sRaw), respiratory resistance during in- substantial subset of individual patients in this age group. terruption (interrupter resistance) (Rint), and respiratory impedance (forced oscillation technique) (Xrs) are at least Infants double to triple.11,12 This low coefficient of variation would Although infants and toddlers are not capable of inde- suggest that FEV1 would be the most sensitive test to detect BDR; however, most studies have not assessed the between- pendently performing spirometric maneuvers, the raised- occasion repeatability in disease states.13 Only 1 study in volume rapid thoracoabdominal compression (RVRTC) adults studied this phenomenon and suggested that the technique can be used to measure forced expiratory flows and volumes in children £ 3 years of age under sedation with variability of FEV1 was significantly higher in disease states, thus suggesting that other measures may be more sensitive chloral hydrate. During the RVRTC maneuver an infant’s to BDR assessment.13 This conclusion requires further study. lungs are inflated to near total lung capacity (TLC) followed by a forced expiration.21–23 The RVRTC technique allows gener- Other limitations of FEV1 relate to the physiology under- lying its measurement. Asthma is primarily a disease of the ation of flow–volume curves that are similar to adult-type small airways14 and studies in well-controlled asthmatics flow–volume curves. RVRTC-forced expiratory flows and volumes have been used to assess infants with bronchiolitis have shown continued obstruction and airway inflammation 24,25 in the small airways despite normal measures of the large and recurrent wheezing, and bronchodilator responsive- ness in healthy infants.26 Reference values from healthy infants airways. The FEV1 may remain preserved despite significant 27 small airway obstruction, and hence the need for more sen- are published, and 2 devices to perform infant PFT (iPFT) sitive measures of small airway obstruction. This is an active using the RVRTC method are commercially available. area of research and may in the near future lead to the de- However, there are several important barriers to using the velopment of novel strategies to monitor disease progression. RVRTC technique to obtain lung function measurements for clinical use. Little data exist regarding the within- and At the current time, FEV1 remains the most studied lung function measure in asthma and remains the most re- between-occasion repeatability of RVRTC measurements. commended physiological assessment for the diagnosis and Performing RVRTC measurements is complex and time con- management of wheezing disorders in childhood. suming, requires sedation of the patient, and must be per- formed using expensive equipment operated by highly trained personnel. For these reasons, the ability to obtain high- Preschool children quality RVRTC measurements is limited to a small number of Children as young as 3 years of age are capable of per- laboratories around the world. Published normative data forming spirometry under ideal laboratory conditions when were derived from a relatively small sample size (n = 155), trained by technicians skilled in performing spirometry in limiting its generalizability to populations around the world with different ethnicities as well as social and environmental this age group. In 2007 the American Thoracic Society (ATS) 27 and European Respiratory Society (ERS) published a state- backgrounds. Further, longitudinal studies assessing the ment that included technical recommendations for the per- predictive value of RVRTC lung function values for per- formance of spirometry in preschool children to facilitate sistent asthma among infants with recurrent wheezing is comparison of data between centers.11 Several studies de- lacking. Although published data describing forced ex- piratory volumes and flows following administration of al- scribing spirometric data in healthy preschool-age children 26 have been published over the past decade,15–18 and recently buterol in healthy children exist, a consensus does not yet Stanojevic et al. published robust reference equations for reached on the definition of a clinical BDR during RVRTC children ages 3 through 7 years based on an analysis of maneuvers. Although infant lung function testing using the preschool lung function data from 3,777 children collated RVRTC technique is a powerful research tool, the technical from 15 centers in 11 countries.19 issues summarized above may limit its use as a routine clin- An important limitation to clinical use of preschool spi- ical tool in assessing infants and toddlers with wheezing rometry is the lack of repeatability data, thus limiting inter- disorders. pretations of change in lung function following a clinical intervention, such as response to bronchodilators or corti-
Load more

Recommended publications
  • Maximum Expiratory Flow Rates in Induced Bronchoconstriction in Man
    Maximum expiratory flow rates in induced bronchoconstriction in man A. Bouhuys, … , B. M. Kim, A. Zapletal J Clin Invest. 1969;48(6):1159-1168. https://doi.org/10.1172/JCI106073. Research Article We evaluated changes of maximum expiratory flow-volume (MEFV) curves and of partial expiratory flow-volume (PEFV) curves caused by bronchoconstrictor drugs and dust, and compared these to the reverse changes induced by a bronchodilator drug in previously bronchoconstricted subjects. Measurements of maximum flow at constant lung inflation (i.e. liters thoracic gas volume) showed larger changes, both after constriction and after dilation, than measurements of peak expiratory flow rate, 1 sec forced expiratory volume and the slope of the effort-independent portion of MEFV curves. Changes of flow rates on PEFV curves (made after inspiration to mid-vital capacity) were usually larger than those of flow rates on MEFV curves (made after inspiration to total lung capacity). The decreased maximum flow rates after constrictor agents are not caused by changes in lung static recoil force and are attributed to narrowing of small airways, i.e., airways which are uncompressed during forced expirations. Changes of maximum expiratory flow rates at constant lung inflation (e.g. 60% of the control total lung capacity) provide an objective and sensitive measurement of changes in airway caliber which remains valid if total lung capacity is altered during treatment. Find the latest version: https://jci.me/106073/pdf Maximum Expiratory Flow Rates in Induced Bronchoconstriction in Man A. Bouiuys, V. R. HuNTr, B. M. Kim, and A. ZAPLETAL From the John B. Pierce Foundation Laboratory and the Yale University School of Medicine, New Haven, Connecticut 06510 A B S T R A C T We evaluated changes of maximum ex- rates are best studied as a function of lung volume.
    [Show full text]
  • Pulmonary Adaptations the Respiratory System
    Dr. Robergs Fall, 2010 Pulmonary Adaptations The Respiratory System Pulmonary Physiology 1 Dr. Robergs Fall, 2010 This is a cast of the airways that conduct air to the lungs. Why is this morphology potentially detrimental to air conductance into and from the lungs? Note; The respiratory zone has the greatest surface area and a dense capillary network. Pulmonary Physiology 2 Dr. Robergs Fall, 2010 Note the density of the alveoli and Note the dense capillary their thin walls. network that surrounds alveoli. Surfactant A phospholipoprotein molecule, secreted by specialized cells of the lung, that lines the surface of alveoli and respiratory bronchioles. Surfactant lowers the surface tension of the alveoli membranes, preventing the collapse of alveoli during exhalation and increasing compliance during inspiration. Respiration The process of gas exchange, which for the human body involves oxygen (O2) and carbon dioxide (CO2). Internal respiration - at the cellular level External respiration - at the lung Pulmonary Physiology 3 Dr. Robergs Fall, 2010 The distribution of surfactant is aided by holes that connect alveoli called Pores of Kohn. Ventilation The movement of air into and from the lung by the process of bulk flow. Ventilation (VE) (L/min) = frequency (br/min) x tidal volume (L) For rest conditions, VE (L/min) = 12 (br/min) x 0.5 (L) = 6 L/min For exercise at VO2max, VE (L/min) = 60 (br/min) x 3.0 (L) = 180 L/min Compliance - the property of being able to increase size or volume with only small changes in pressure. Pulmonary Physiology 4 Dr. Robergs Fall, 2010 Ventilation During Rest Inspiration is controlled by a repetitive discharge of action potentials from the inspiratory center.
    [Show full text]
  • Residual Volume and Total Lung Capacity to Assess Reversibility in Obstructive Lung Disease
    Residual Volume and Total Lung Capacity to Assess Reversibility in Obstructive Lung Disease Conor T McCartney MD, Melissa N Weis MD, Gregg L Ruppel MEd RRT RPFT FAARC, and Ravi P Nayak MD BACKGROUND: Reversibility of obstructive lung disease is traditionally defined by changes in FEV1 or FVC in response to bronchodilators. These may not fully reflect changes due to a reduction in hyperinflation or air-trapping, which have important clinical implications. To date, only a handful of studies have examined bronchodilators’ effect on lung volumes. The authors sought to better characterize the response of residual volume and total lung capacity to bronchodilators. METHODS: Responsiveness of residual volume and total lung capacity to bronchodilators was assessed with a retrospective analysis of pulmonary function tests of 965 subjects with obstructive lung disease as defined by the lower limit of normal based on National Health and Nutritional Examination Survey III prediction equations. RESULTS: A statistically significant number of subjects demonstrated response to bronchodilators in their residual volume independent of re- sponse defined by FEV1 or FVC, the American Thoracic Society and European Respiratory Society criteria. Reduced residual volume weakly correlated with response to FEV1 and to FVC. No statistically significant correlation was found between total lung capacity and either FEV1 or FVC. CONCLUSIONS: A significant number of subjects classified as being nonresponsive based on spirometry have reversible residual volumes. Subjects whose residual volumes improve in response to bronchodilators represent an important subgroup of those with obstructive lung disease. The identification of this subgroup better characterizes the heterogeneity of obstructive lung disease. The clinical importance of these findings is unclear but warrants further study.
    [Show full text]
  • The Large Lungs of Elite Swimmers: an Increased Alveolar Number?
    Eur Respir J 1993, 6, 237-247 The large lungs of elite swimmers: an increased alveolar number? J. Armour*, P.M. Donnelly**, P.T.P. Bye* The large lungs of elite swimmers: an increased alveolar number? J. Armour, P.M. * Institute of Respiratory Medicine, Donnelly, P.T.P. Bye. Royal Prince Alfred Hospital, ABSTRACT: In order to obtain further insight into the mechanisms relating Camperdown, NSW, Australia. to the large lung volumes of swimmers, tests of mechanical lung function, in­ ** University of Sydney, Sydney, NSW, cluding lung distensibility (K) and elastic recoil, pulmonary diffusion capacity, Australia. and respiratory mouth pressures, together with anthropometric data (height, Correspondence: P.M. Donnelly weight, body surface area, chest width, depth and surface area), were com­ Institute of Respiratory Medicine pared in eight elite male swimmers, eight elite male long distance athletes and Royal Prince Alfred Hospital eight control subjects. The differences in training profiles of each group were Camperdown NSW 2050 also examined. Australia There was no significant difference in height between the subjects, but the swimmers were younger than both the runners and controls, and both the Keywords: Alveolar distensibility swimmers and controls were heavier than the runners. Of all the training chest enlargement diffusion coefficient variables, only the mean total distance in kilometres covered per week was sig­ growth hormone nificantly greater in the runners. Whether based on: (a) adolescent predicted lung growth values; or (b) adult male predicted values, swimmers had significantly increased respiratory mouth pressures total lung capacity ((a) 145±22%, (mean±so) (b) 128±15%); vital capacity ((a) swimmers' lungs 146±24%, (b) 124±15%); and inspiratory capacity ((a) 155±33%, (b) 138±29%), but this was not found in the other two groups.
    [Show full text]
  • Interrelationship Between Lung Volume, Expiratory Flow, and Lung Transfer Factor in Fibrosing Alveolitis
    Thorax: first published as 10.1136/thx.36.11.858 on 1 November 1981. Downloaded from thorax 1981 ;36:858-862 Interrelationship between lung volume, expiratory flow, and lung transfer factor in fibrosing alveolitis JN PANDE From the Respiratory Laboratory, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India ABSTRACT Fifty patients with fibrosing alveolitis studied on 104 occasions exhibited significant direct correlations between vital capacity (VC), maximum mid-expiratory flow rate (MMFR), and transfer factor for carbon monoxide (TLCO). Forced expired volume in the first second (FEV,)/VC ratio bore a weak negative correlation with VC. Peak expiratory flow, MMFR, and maximum flow rates at 50 % and 25 % of VC were often reduced in patients with severe grades of pulmonary dys- function. It appears that as the severity of the fibrotic process increases, the lung volumes shrink and the transfer factor for CO decreases. The total lung capacity decreases predominantly on account of reduction in VC. With a decrease in lung volume the MMFR also falls. Decrease in flow rates at low lung volumes is greater as compared to the fall in peak flow. The expiratory flow rates how- ever were normal or even increased when related to absolute lung volume. Some patients exhibit disproportionate expiratory slowing as evidenced by a decrease in MMFR which is out of propor- tion to the reduction in VC. These patients also have a reduced FEV1,/VC ratio. These changes are probably the consequence of associated peripheral airway narrowing. copyright. Increased elastic recoil of the lung limiting maximal 33 women. Their age ranged from 16-68 years (mean inflation is considered to be the main abnormality of ± SE 42-1 ± 1-7 years).
    [Show full text]
  • PFT Interpretation
    PFT Interpretation Presented by: Shazhad Manawar, MD Medical Director Respiratory Care & Pulmonary Rehab McLaren Bay Region Introduction History or symptoms suggestive of lung disease. Risk factors for lung disease are present. Pulmonary Function Tests Spirometry Spirometry before and after bronchodilator Lung volumes Diffusing capacity for carbon monoxide Maximal respiratory pressures Flow volume loops Spirometry Volume of air exhaled at specific time points during forceful and complete exhalation. Total exhaled volume, know as the FVC (forced vital capacity). Volume exhaled in the first second, know as the forced expiratory volume in one second (FEV1) Spirometry - continued Ratio (FEV1/FVC) are the most important variables Minimal risk Key diagnostic test Asthma Chronic Obstructive Pulmonary Disease (COPD) Chronic cough Spirometry - continued Monitor a broad spectrum of respiratory diseases. Asthma COPD Interstitial Lung Disease Neuromuscular diseases affecting respiratory muscles Spirometry - continued Slow vital capacity (SVC) Useful measurement when FVC is reduced and airway obstruction is present Post-bronchodilator Determine the degree of reversibility Administration of albuterol Technique is important Increase in the FEV1 of more than 12% or greater than 0.2 L suggests acute bronchodilator responsiveness. Subjective improvements Post-bronchodilator - continued Thus, the lack of an acute bronchodilator response on spirometry should not preclude a one to eight week therapeutic trial of bronchodilators
    [Show full text]
  • Physiologic Changes in the Elderly Michael C
    Theme 1: Physiologic Changes in the Elderly Michael C. Lewis, MD Associate Professor of Clinical Anesthesiology This unit forms the second part of a series of teaching modules on Anesthesia for the Elderly. It will guide you step-by-step through some salient physiologic differences between the aged and the younger adult population. It is our hope that on completing this component you will appreciate why understanding physiologic differences between these age groups guides us in our anesthetic management. Introduction This section describes significant physiologic changes between the aged and younger populations as defined in longitudinal studies of healthy people. It will be seen that aging results in significant anatomic and functional changes in all the major organ systems. Aging is marked by a decreased ability to maintain homeostasis. However, within the elderly population there is significant heterogeneity of this decline. This unit introduces facts in a systemic fashion, and then asks you some questions testing your mastery of the information. Each section is self-contained and leads to the next. One should not progress until one has fully understood the material in the previous section. Goals After completing this unit the resident should be able to: Understand the main structural and functional changes associated with normal aging Understand how these changes will impact the practice of anesthesiology 1 Cardiovascular System (CVS) “In no uncertain terms, you are as old as your arteries.” — M. F. Roizen, RealAge It is controversial whether significant CVS changes occur with aging. Some authors claim there is no age-related decline in cardiovascular function at rest.
    [Show full text]
  • Pulmonary Ventilation
    CHAPTER 2 Pulmonary Ventilation © IT Stock/Polka Dot/ inkstock Chapter Objectives By studying this chapter, you should be able to do Name two things that cause pleural pressure the following: to decrease. 8. Describe the mechanics of ventilation with 1. Identify the basic structures of the conducting respect to the changes in pulmonary pressures. and respiratory zones of the ventilation system. 9. Identify the muscles involved in inspiration and 2. Explain the role of minute ventilation and its expiration at rest. relationship to the function of the heart in the 10. Describe the partial pressures of oxygen and production of energy at the tissues. carbon dioxide in the alveoli, lung capillaries, 3. Identify the diff erent ways in which carbon tissue capillaries, and tissues. dioxide is transported from the tissues to the 11. Describe how carbon dioxide is transported in lungs. the blood. 4. Explain the respiratory advantage of breathing 12. Explain the significance of the oxygen– depth versus rate during a treadmill exercise. hemoglobin dissociation curve. 5. Describe the composition of ambient air and 13. Discuss the eff ects of decreasing pH, increasing alveolar air and the pressure changes in the pleu- temperature, and increasing 2,3-diphosphoglyc- ral and pulmonary spaces. erate on the HbO dissociation curve. 6. Diagram the three ways in which carbon dioxide 2 14. Distinguish between and explain external res- is transported in the venous blood to the lungs. piration and internal respiration. 7. Defi ne pleural pressure. What happens to alve- olar volume when pleural pressure decreases? Chapter Outline Pulmonary Structure and Function Pulmonary Volumes and Capacities Anatomy of Ventilation Lung Volumes and Capacities Lungs Pulmonary Ventilation Mechanics of Ventilation Minute Ventilation Inspiration Alveolar Ventilation Expiration Pressure Changes Copyright ©2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company Content not final.
    [Show full text]
  • ATS/NHLBI Consensus Document 12 Nov 03 1
    ATS/NHLBI Consensus Document 12 Nov 03 1 CONSENSUS STATEMENT ON MEASUREMENTS OF LUNG VOLUMES IN HUMANS JL Clausen and JS Wanger for the Workshop participants. Developed from workshops sponsored by the American Thoracic Society and the National Heart, Lung, and Blood Institute (conference grant #R13 HL48384-01). Workshop participants included: Eduardo Bancalari, M.D., University of Miami; Miami Florida Robert A. Brown, M.D., Massachusetts General Hospital, Boston, Massachusetts Jack L. Clausen, M.D. University of California, San Diego (Co-Chairman) Allan L. Coates, M.D., Hospital for Sick Children, Toronto, Canada (Co-Chairman) Robert O. Crapo, M.D. LDS Hospital, Salt Lake City, Utah Paul Enright, M.D. U of Arizona, Tucson, Arizona Claude Gaultier, M.D., PhD, Hôpital Robert Debré, Paris, France John Hankinson, Ph.D. NIOSH, Morgantown, WV Robert L. Johnson, Jr. M.D. U of Texas, Dallas Texas David Leith, M.D., Kansas State University, Manhattan Kansas Christopher J.L. Newth, M.D. Children's Hospital, Los Angeles, California Rene Peslin, M.D.Inserm, Vandoeuvre Les Nancy France Philip H. Quanjer, M.D. Leiden University, Leiden, The Netherlands (Co-chairman) Daniel Rodenstein, M.D. Cliniques St. Luc, Brussels, Belgium Janet Stocks, Ph.D. Institute of Child Health, London England Jean Claude Yernault, M.D. Hospital Erasme, Brussels, Belgium ATS staff: Graham M. Nelan, New York, NY NHLBI staff: James P. Kiley, Ph.D., Bethesda, Maryland ATS/NHLBI Consensus Document 12 Nov 03 2 MEASUREMENTS OF LUNG VOLUMES IN HUMANS TABLE of CONTENTS: 1. Introduction 2. Terminology 3. Effects of nutrition, growth hormone, training, and altitude on lung volumes 3.1 Effects of nutrition 3.2 Effects of growth hormone 3.3 Effects of training 3.4 Effects of altitude 4.
    [Show full text]
  • Factors Determining Maximum Inspiratory Flow and Maximum Expiratory Flow of the Lung
    Thorax: first published as 10.1136/thx.23.1.33 on 1 January 1968. Downloaded from Thorax (1968), 23, 33. Factors determining maximum inspiratory flow and maximum expiratory flow of the lung J. JORDANOGLOU AND N. B. PRIDE From the M.R.C. Clinical Pulmonary Physiology Research Unit, King's College Hospital Medical School, Denmark Hill, London, S.E.5 The factors determining maximum expiratory flow and maximum inspiratory flow of the lung are reviewed with particular reference to a model which compares the lung on forced expiration to a Starling resistor. The theoretical significance of the slope of the expiratory maximum flow- volume curve is discussed. A method of comparing maximum expiratory flow with maximum inspiratory flow at similar lung volumes is suggested; this may be applied either to a maximum flow-volume curve or to a forced expiratory and inspiratory spirogram. During the last 15 to 20 years a number of tests FACTORS DETERMINING MAXIMUM FLOW AT A GIVEN based on the forced vital capacity manceuvre LUNG VOLUME have come into widespread use for the assessment of the ventilatory function of the lungs. Origin- ISO-VOLUME PRESSURE-FLOW CURVES These ally the forced vital capacity manoeuvre was intro- curves were introduced by Fry and Hyatt (1960), measurement of the who measured oesophageal pressure and the duced as a substitute for copyright. maximum breathing capacity, and to a large simultaneous flow during a series of vital capacity extent the use of such tests as the forced manceuvres made with varying effort. From expiratory volume in one second (F.E.V.,.0) has these records they constructed plots of the relation continued to be empirical and descriptive.
    [Show full text]
  • Monitoring Asthma in Children
    TASK FORCE REPORT ERS STATEMENT Monitoring asthma in children Mariëlle W. Pijnenburg1, Eugenio Baraldi2, Paul L.P. Brand3,4, Kai-Håkon Carlsen5, Ernst Eber6, Thomas Frischer7, Gunilla Hedlin8, Neeta Kulkarni9, Christiane Lex10, Mika J. Mäkelä11, Eva Mantzouranis12, Alexander Moeller13, Ian Pavord14, Giorgio Piacentini15, David Price16, Bart L. Rottier17, Sejal Saglani18, Peter D. Sly19, Stanley J. Szefler20, Thomy Tonia21, Steve Turner22, Edwina Wooler23 and Karin C. Lødrup Carlsen24,25 Affiliations: 1Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC – Sophia Children’sHospital, Rotterdam, The Netherlands. 2Women’s and Children’s Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy. 3Dept of Paediatrics/Princess Amalia Children’s Centre, Isala Hospital, Zwolle, The Netherlands. 4UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands. 5Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway. 6Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria. 7Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria. 8Depart of Women’s and Children’s Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children’s Hospital, Stockholm, Sweden. 9Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. 10Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany. 11Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland. 12Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece. 13Division of Respiratory Medicine, University Children’s Hospital Zurich, Zurich, Switzerland. 14Dept of Respiratory Medicine, University of Oxford, Oxford, UK.
    [Show full text]
  • Pulmonary Function Testing in Preschool Children: an Official ATS/ERS Statement
    American Thoracic Society Documents An Official American Thoracic Society/European Respiratory Society Statement: Pulmonary Function Testing in Preschool Children Nicole Beydon, Stephanie D. Davis, Enrico Lombardi, Julian L. Allen, Hubertus G. M. Arets, Paul Aurora, Hans Bisgaard, G. Michael Davis, Francine M. Ducharme, Howard Eigen, Monika Gappa, Claude Gaultier, Per M. Gustafsson, Graham L. Hall, Zolta´n Hantos, Michael J. R. Healy, Marcus H. Jones, Bent Klug, Karin C. Lødrup Carlsen, Sheila A. McKenzie, Franc¸ois Marchal, Oscar H. Mayer, Peter J. F. M. Merkus, Mohy G. Morris, Ellie Oostveen, J. Jane Pillow, Paul C. Seddon, Michael Silverman, Peter D. Sly, Janet Stocks, Robert S. Tepper, Daphna Vilozni, and Nicola M. Wilson, on behalf of the American Thoracic Society/ European Respiratory Society Working Group on Infant and Young Children Pulmonary Function Testing This official statement of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) was approved by the ATS Board of Directors, September 2006, and the ERS Executive Committee, December 2006 CONTENTS Sheila A. McKenzie, Peter J. F. M. Merkus, Paul C. Seddon, Peter D. Sly Section 1. The Next Frontier Summary Peter D. Sly (Chair), Nicole Beydon, Stephanie D. Davis, Claude Introduction Gaultier, Enrico Lombardi, Mohy G. Morris, Janet Stocks Background Section 2. Clinical Implications Procedures Sheila A. McKenzie (Chair), Paul Aurora, Francine M. Ducharme, Interpretation of Results Michael J. R. Healy, Bent Klug, Paul C. Seddon, Janet Stocks Conclusions and Future Directions Summary Section 6. The Forced Oscillation Technique Introduction Franc¸ois Marchal (Chair), G. Michael Davis, Francine M. Feasibility Ducharme, Graham L. Hall, Zolta´n Hantos, Ellie Oostveen What Is Normal? Summary Variability of a Test Introduction Diagnosing Respiratory Disorders Background Monitoring Disease Progress and Response to Interventions Procedures Conclusions and Future Directions Interpretation of Results Section 3.
    [Show full text]