Home⇛The PCMC Journal⇛vol. 15 no. 2 (2019)

Bronchodilator Challenge Test Using the Tidal Rapid Thoraco-AbdominalCompression Technique among Infants Aged 6-24 Monthswith Recurrent Wheezing

Ma. Lallaine G. Columna | Cristan Q. Cabanilla

 

Abstract:

BACKGROUND: A definite diagnosis of asthma during infancy is difficult. Asthma Predictive Index (API) is used to predict asthma at school age, but does not determine who among these actually have asthma. OBJECTIVES: This study aims to determine the bronchodilator response of infants with recurrent wheezing compared with normal control. METHODOLOGY: This cross sectional study included asymptomatic subjects aged 6-24 months with history of recurrent wheezing and age/sex matched controls. After sedation with chloral hydrate (Odan) at 50-75 mg/kg, a bronchodilator challenge test was performed with single dose 400 mcg salbutamol (Ventolin) MDI inhalation delivered via a spacer (Philips Respironic OptiChamber Diamond). Baseline and 15 minutes after salbutamol inhalation Maximum Flow at Functional Residual Capacity (V‘maxFRC) were determined using MasterScreen Paed/BabyBody Option Squeeze version 8.0. ANOVA and Pearson chi-square were used for the statistical analysis of data. RESULTS: Sixty-nine infants (23 previous wheezers and positive API, 23 previous wheezers with negative API and 23 controls) were included. There was a significant difference in the post bronchodilator challenge test V‘maxFRC between wheezers with positive API and controls (p= 0.047). There was no significant difference in other parameter among groups. CONCLUSION AND RECOMMENDATION: Absolute values of V‘maxFRC post bronchodilator challenge using the Tidal Rapid Thoracoabdominal compression technique may be used to identify current asthma among asymptomatic infants with recurrent



References:

  1. Ren C, Esther C, Debley J, Sokrider M, Yilmaz O, Amin N, Bazzy-Asaad A, Davis S, Durand M, Ewig J, Yuksel H, Lombardi E, Noah TT, Radford P, Ranganathan S, Teper A, Weinberger M, Broze J, Wilson K. Official American Thoracic Society Clinical Practice Guidelines: Diagnostic evaluation of infants with recurrent or persistent wheezing. Am J Respir Crit Care Med. 2009;7. Available from: https://www.ats.org
  2. Szefler SJ, Baker JW, Uryniak T, Goldman M, Sikoff PE. Comparative study of budesonide inhalation suspension and montelukast in young children with mild persistent asthma. J Allergy Clin Immunol. 2007;120(5):1043-50.
  3. Castro-Rodriguez JA. The asthma predictive index. Curr Opin Allergy Clin Immunol. 2011;11(3):157-61.
  4. Debley JS, Stamey DC, Cochrane ES, Gama KL, Redding GJ. Exhaled nitric oxide, lung function, and exacerbations in wheezy infants and toddlers. J Allergy Clin Immunol. 2010;125(5):1228-34.e13.
  5. Lesnick B, Davis S. Infant pulmonary function testing. Chest. 2011;139(5):1197-202.
  6. Davis SD, Rosenfeld M, Kerby GS, Brumback L, Kloster MH, Acton JD, Colin AA, Conrad CK, Hart MA, Hiatt PW, Mogayzel PJ, Johnson RC, Wilcox SL, Castile RG. Multicenter evaluation of infant lung function tests as cystic fibrosis clinical trial endpoints. Am J Respir Crit Care Med. 2010;182(11):1387-97.
  7. Cazzato S, Ridolfi L, Bernardi F, Faldella G, Bertelli L. Lung function outcome at school age in very low birth weight children. Pediatr Pulmonol. 2013;48(8):830-7.
  8. Baraldi E, Filippone M. Chronic lung disease after premature birth. N Engl J Med. 2007;357(19):1946-55.
  9. Ducharme FM, Tse SM, Chauhan B. Diagnosis, management, and prognosis of preschool wheeze. Lancet. 2014;383(9928):1593-604.
  10. Feher A, Castile R, Kisling J. Flow limitation in normal infants: a new method for forced expiratory maneuvers from raised lung volumes. J Appl Physiol. 1996;80(6):2019-25.
  11. Turner DJ, Stick SM, LeSouef KL, Sly PD, LeSouef PN. A new technique to generate and assess forced expiration from raised lung volume in infants. Am J Respir Crit Care Med. 1995;151(5):1441-50.
  12. Jiang G, Li A, Wang L, Qian L, Cao Y, Huang J, Wan C, Zhang X. Reference data for baby body-plethysmographic measurements in Chinese neonates and infants. Respirology. 2017;22(8):1606-12.
  13. Lai S-H, Liao S-L, Yao T-C, Tsai MH, Hua M-C, Yeh K-W, Huang J-L. Respiratory function in healthy Taiwanese infants: Tidal breathing analysis, passive mechanics, and tidal forced expiration. PLoS One. 2015;10(11):e0142797.
  14. Jones M, Castile R, Davis S, Kisling J, Filbrun D, Flucke R, Goldstein A, Emsley C, Ambrosius W, Tepper R. Forced expiratory flows and volumes in infants: Normative data and lung growth. Am J Respir Crit Care Med. 2000;161(2):353-9.
  15. Turner DJ, Lanteri CJ, LeSouef PN, Sly PD. Improved detection of abnormal respiratory function using forced expiration from raised lung volume in infants with cystic fibrosis. Eur Respir J. 1994;7(10):1995-9.
  16. Ranganathan SC, Hoo AF, Lum SY, Goetz I, Castle RA, Stocks J. Exploring the relationship between forced maximal flow at functional residual capacity and parameters of forced expiration from raised lung volume in healthy infants. Pediatr Pulmonol. 2002;33(6):419-28.
  17. Bar-Yishay E, Springer C, Hevroni A, Godfrey S. Relation between partial and raised volume forced expiratory flows in sick infants. Pediatr Pulmonol. 2011;46(5):458-63.
  18. Stick S, Arnott J, Turner D, Young S, Landau L, LeSouef P. Bronchial responsiveness and lung function in recurrently wheezy infants. Am Rev Respir Dis. 1991;144(5):1012-5.
  19. Prendeville A, Green S, Silverman M. Airway responsiveness in wheezy infants: Evidence for functional adrenergic receptors. Thorax. 1987;42(2):100-4.
  20. Shavit S, Cohen S, Goldman A, Dov LB, Avital A, Springer C, Hevroni H. Bronchodilator responsiveness in wheezy infants predicts continued early childhood respiratory morbidity. J Asthma. 2016;53(7):707-13.
  21. American Society of Anesthesiologists Task Force. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004-17.
  22. Ren CL, Robinson P, Ranganathan S. Chloral hydrate sedation for infant pulmonary function testing. Pediatr Pulmonol. 2014;49(12):1251-2.
  23. Sly PD, Tepper R, Henschen M, Gappa M. Tidal forced expirations. Series “Standards for Infant Respiratory Function Testing: ERS/ATS Task Force.” Eur Respir J. 2000;16(4):741-8.
  24. CareFusion. Instructions for use: MasterScreen Paed/BabyBody/Option squeeze. 2013;60.
  25. Pellegrino R, Viegi G, Brusasco V, Crapo R, Burgos F, Casaburi R, Coates A, Van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, Macintyre N, McKay R, Miller MR, Navajas D, Pederson OF, Wanger J. Interpretative strategies for lung function tests: ATS/ERS Task Force. Eur Respir J. 2005;26(5):948-68.
  26. Prendiville S, Green S, Silverman M. Paradoxical response to nebulised salbutamol in wheezy infants, assessed by partial flow-volume curves. Thorax. 1987;42(2):86-91.
  27. Hoo AF, Lum S, Mattes J, Stocks J. Manual of infant lung function tests. London: Imperial College London; 2014. p. 24-6.
  28. Goldstein AB, Castile RG, Davis SD, Filbrun DA, Flucke RL, McCoy KS, Tepper RS. Bronchodilator responsiveness in normal infants and young children. Am J Respir Crit Care Med. 2001;164(3):448-54.

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