Predicting the outcome of respiratory disease in wheezing infants using tidal flow-volume loop shape
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Keywords
Wheezing, Infant, Child, Asthma, Respiratory function test
Abstract
Introduction and objectives: Wheezing (RW) infants with a positive asthma predictive index (API+) have a lower lung function as measured by forced expiratory techniques. Tidal flow-volume loops (TFVL) are easy to perform in infants, and sedation is not necessary.
Materials and methods: A total of 216 wheezing infants were successfully measured, and 183 of them were followed for over a year. TFVL loops were classified into one of three categories depending of their geometric shape (symmetric, convex, and concave). Respiratory rate (Rr), presence of API+, and the number of exacerbations during the following year were also recorded.
Results: Children with concave loops had more exacerbations in the following year (OR = 6.8 [IC95% 3.33;13.91]). Infants API + were also significantly more related to concave loops (OR = 10.02 [IC 95% 4.53; 22.15]). Rr was higher in infants with concave loops (44+/−15.5 vs. 36.6 +/−12.6; p < 0.01).
Conclusion: Infants with a concave TFVL have a higher probability of experiencing exacerbations in the following year, and are at a higher risk of suffering asthma.
References
2. Sly PD, Tepper R, Henschen M, Gappa M, Stocks J. Tidal forced expirations. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/American Thoracic Society. Eur Respir J. 2000;16(Oct (4)):741-8.
3. Durang M, Rigatto H. Tidal volume and respiratory frequency in infants with bronchopulmonary dysplasia (BPD). Early Hum Dev. 1981;5(Feb (1)):55-62.
4. Rosenfeld M, Allen J, Arets BHGM, Aurora P, Beydon N, Calogero C, et al. An official American Thoracic Society workshop report: optimal lung function tests for monitoring cystic fibrosis, bronchopulmonary dysplasia, and recurrent wheezing in children less than 6 years of age. Ann Am Thorac Soc. 2013;10 (Apr (2)): S1-11.
5. Keklikian E, Sanchez-Solis M, Bonina AJ, Meneguzzi A, PastorVivero MD, Mondejar-Lopez P, et al. Do risk factors for persistent asthma modify lung function in infants and young children with recurrent wheeze? Pediatr Pulmonol. 2010;45(Sep (9)):914-8.
6. Lødrup Carlsen KC. Tidal breathing at all ages. Monaldi Arch Chest Dis. 2000;55(Oct (5)):427-34.
7. Totapally BR, Demerci C, Zureikat G, Nolan B. Tidal breathing flow-volume loops in bronchiolitis in infancy: the effect of albuterol. Crit Care. 2002;6(Apr (2)):160-5.
8. Lødrup Carlsen KC, Stenzler A, Carlsen KH. Determinants of tidal flow-volume loop indices in neonates and children with and without asthma. Pediatr Pulmonol. 1997;24(Dec (6)):391-6.
9. Lodrup Carlsen KC, Carlsen KH, Nafstad P, Bakketeig L. Perinatal risk factors for recurrent wheeze in early life. Pediatr Allergy Immunol. 1999;10(May (2)):89-95.
10. Stick SM, Burton PR, Gurrin L, Sly PD, LeSouëf PN. Effects of maternal smoking during pregnancy and a family history of asthma on respiratory function in newborn infants. Lancet. 1996;348(Oct 19(9034)):1060-4.
11. Martinez FD, Morgan WJ, Wright AL, Holberg CJ, Taussig LM. Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. N Engl J Med. 1988;319 (Oct 27(17)):1112-7.
12. Martinez FD, Helms PJ. Types of asthma and wheezing. Eur Respir J Suppl. 1998;27(Jul):3s-8s.
13. Melbye H, Garcia-Marcos L, Brand P, Everard M, Priftis K, Pasterkamp H. Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians’ classification of lung sounds from video recordings. BMJ Open Respir Res. 2016;3(1):e000136.
14. Mallol J, Aguirre V, Barrueto L, Wandalsen G, Tepper R. Effect of inhaled fluticasone on lung function in infants with recurrent wheezing: a randomised controlled trial. Allergol Immunopathol (Madr). 2009;37(Apr (2)):57-62.
15. Greenough A, Naik S, Itakura Y, Yüksel B, Cheeseman P, Nicolaides KH. Perinatal lung function measurements and prediction of respiratory problems in infancy. Physiol Meas. 1998;19 (Aug (3)):421-6.
16. Aston H, Clarke J, Silverman M. Are tidal breathing indices useful in infant bronchial challenge tests? Pediatr Pulmonol. 1994;17 (Apr (4)):225-30.
17. Williams EM, Madgwick RG, Thomson AH, Morris MJ. Expiratory airflow patterns in children and adults with cystic fibrosis. Chest. 2000;117(Apr (4)):1078-84.
18. Schmalisch G, Wilitzki S, Wauer RR. Differences in tidal breathing between infants with chronic lung diseases and healthy controls. BMC Pediatr. 2005;(Sep 8(5)):36.
19. Wildhaber JH, Sznitman J, Harpes P, Straub D, Möller A, Basek P, et al. Correlation of spirometry and symptom scores in childhood asthma and the usefulness of curvature assessment in expiratory flow-volume curves. Respir Care. 2007;52(Dec (12)):1744-52.
20. Leonhardt S, Ahrens P, Kecman V. Analysis of tidal breathing flow-volume loops for automated lung-function diagnosis in infants. IEEE Trans Biomed Eng. 2010;57(Aug (8)):1945-53.
21. Castro-Rodríguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med. 2000;162 Oct (4 Pt 1):1403-6.
22. Amin P, Levin L, Epstein T, Ryan P, LeMasters G, Khurana Hershey G, et al. Optimum predictors of childhood asthma: persistent wheeze or the Asthma Predictive Index? J Allergy Clin Immunol Pract. 2014;2(Oct (6)):709-15.
23. Depner M, Fuchs O, Genuneit J, Karvonen AM, Hyvärinen A, Kaulek V, et al. Clinical and epidemiologic phenotypes of childhood asthma. Am J Respir Crit Care Med. 2014;189 (Jan 15(2)):129-38.
24. Morris MJ, Lane DJ. Tidal expiratory flow patterns in airflow obstruction. Thorax. 1981;36:135-42.
25. Stick SM, Ellis E, LeSouef P, Sly P. Validation of respiratory inductance plethysmography (Respitrace ¨ ¨) for the measurement of tidal breathing parameters in newborns. Pediatr Pulmonol. 1992;14(Nov (3)):187-91.
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