Home⇛The PCMC Journal⇛vol. 13 no. 2 (2017)

Tidal breathing analysis as a tool for asthma diagnosis in children aged six months to five years

Jenni Rose A. Dela Cruz | Leanne B. Santos | Liwayway Icawat | Vizhandreb A. Baltazar | Mary Therese M. Leopando

Discipline: medicine by specialism

 

Abstract:

BACKGROUND: The diagnosis of asthma is difficult to establish using spirometry in children below 5 years old. Tidal breathing analysis (TBA) can provide useful information about lung function in infants and young children, as it is effort-independent. OBJECTIVES: To determine if baseline and post-bronchodilator ratios of the time and volume until peak expiratory flow to the total expiratory time and volume, (tPEF/tE and VPEF/VE) can distinguish asthmatics from normal children. METHODS: This is a cross-sectional study wherein 146 children ages 6 months to 5 years old completed TBA before and 15 minutes after administration of 250μg of salbutamol via nebulization. Children 3 years old and below who did not cooperate were given sedation with oral diphenhydramine (1mg/kg/dose). The tPEF/tE and VPEF/VE were compared between the controls and asthmatics. RESULTS: In children below 2 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 29.6 ± 13.8and 22.0 ± 6.6. The area under the curve (AUC) was 0.649 attPEF/tE of 32.250, with a sensitivity and specificity of 50% and 97%. The baseline VPEF/VE of asthmatics and non-asthmatics were 32.7 ±12.4 and 26.0 ± 4.9.AUC was 0.661 atVPEF/VEof34.500, with a sensitivity and specificity of 50% and 97%.In subjects 2 to 5 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 35.3 ± 14.7 and 35.0 ± 13.1. The baseline VPEF/VE were 37.0 ± 12.3 and 36.7 ± 10.7. After salbutamol nebulization, the tPEF/tE of asthmatics and non-asthmatics in all ages were 30.9±13.7 and 27.9± 10.8. The VPEF/VE were 34.1± 11.4 and 30.9± 9.0. CONCLUSION: Baseline tPEF/tE and VPEF/VE can distinguish asthmatics from non-asthmatics in children below 2 years old. However, baseline tPEF/tE and VPEF/VE in children 2 to 5 years old and postbronchodilator tPEF/tE and VPEF/VE in all ages could not distinguish asthmatics from non-asthmatics after nebulization with 250μg of salbutamol.



References:

  1. Warner JO, Naspitz CK; International Pediatric Asthma Consensus Group. Third international pediatric consensus statement on the management of childhood asthma. Pediatr Pulmonol. 1998;25:1–17.
  2. FitzGerald M, et al. Global Strategy for Asthma Management and Prevention. 2012.
  3. FitzGerald M, et al. Global Strategy for Asthma Management and Prevention. Updated 2015.
  4. D’Urzo A, Tamari I, Bouchard J, et al. New spirometry interpretation algorithm: Primary Care Respiratory Alliance of Canada approach. Can Fam Physician. 2011;57:1148–1152.
  5. Stocks J, et al. Plethysmographic measurements of lung volume and airway resistance. Eur Respir J. 2001;17:302–312.
  6. Beydon N, Davis S, Lombardi E, Allen J, Arets G, Aurora P, et al. An official ATS/ERS statement: Pulmonary function testing in preschool children. Am J Respir Crit Care Med. 2007;175:1304–1345.
  7. Bickel S, Popler J, Lesnick B, Eid N. Impulse oscillometry interpretation and practical application. Chest. 2014;146(3):841–847.
  8. Lødrup KC, Mowinckel P, Carlsen KH. Lung function measurements in awake compared to sleeping newborn infants. Pediatr Pulmonol. 1992;12:99–104.
  9. Quanjer PH, Stocks J, Polgar G, et al. Compilation of reference values for lung function measurements in children. Eur Respir J. 1989;2(Suppl 4):184s–261s.
  10. Bouhuys A. The clinical use of pneumotachography. Acta Med Scand. 1957;159:91–103.
  11. Lødrup Carlsen KC, Carlsen KH. Lung function in awake healthy infants in the first five days of life. Eur Respir J. 1993;6:1496–1500.
  12. Takishima T, et al. Flow-volume curves during quiet breathing, maximum voluntary ventilation, and forced vital capacity in obstructive lung disease. Scand J Respir Dis. 1967;48:384–393.
  13. Venturina JN, Jiao AG, Dela Cruz JR. Reference values of tidal breathing analysis in healthy Filipino children aged 1 month to five years. Unpublished.
  14. Reyes-De Leon A, De Leon N, Estepar E. Values of tidal breathing analysis in Filipino infants and children aged 0–6 years in selected areas around Philippine Heart Center. Philippine Heart Center Journal. 2006;12(3):27–35.
  15. Totapally BR, Demerci C. Tidal breathing flow-volume loops in bronchiolitis in infancy: The effect of albuterol. Crit Care. 2002;6:160–165.
  16. Schmalisch G, Wilitzki S, Wauer RR. Differences in tidal breathing between infants with chronic lung disease and healthy controls. BMC Pediatr. 2005;5:36.
  17. Allen JL, Greenspan JS. Interaction between chest wall motion and lung mechanics in normal infants and infants with BPD. Pediatr Pulmonol. 1991;11:37–43.
  18. Morris MJ, Lane DJ. Tidal expiratory flow patterns in airflow obstruction. Thorax. 1981;36:135–142.
  19. Carlsen KH, Lødrup Carlsen KC. Tidal breathing analysis and response to salbutamol in awake young children with and without asthma. Eur Respir J. 1994;7:2154–2159.
  20. Corpuz S. Validation of tidal breathing analysis in the diagnosis of asthma among Filipino children aged 1 month to 6 years. Unpublished.
  21. Philippine Consensus for the Management of Childhood Asthma. Revised ed. Philippine Academy of Pediatric Pulmonologists; Philippine Society of Allergy, Asthma and Immunology; Philippine Pediatric Society; 2002.
  22. Van der Ent CK, Brackel HJL, Van der Laag J, Bogaard JM. Tidal breathing analysis as a measure of airway obstruction in children aged three years and over. Am J Respir Crit Care Med. 1999;153:1253–1258.
  23. Palmer J, Allen J, Mayer O. Tidal breathing analysis. NeoReviews. 2004;5:186–193.
  24. Clarke JR, Aston H, Silverman M. Evaluation of tidal expiratory flow index in healthy and diseased children. Pediatr Pulmonol. 1994;17:285–290.
  25. Young S, Arnott J, Le Souëf PN, et al. Flow limitation during tidal expiration in symptom-free infants and the subsequent development of asthma. J Pediatr. 1994;124:681–688.
  26. Stocks J, Dezateux CA, Jackson EA, et al. Analysis of tidal breathing parameters in infancy: How variable is tPEF/tE? Am J Respir Crit Care Med. 1994;150:1347–1354.
  27. Martinez FD, Morgan WJ, Wright AL, et al. Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. N Engl J Med. 1988;319:1112–1117.
  28. Cutrera R, Filthcher SI, Merolla R, et al. Analysis of expiratory pattern for monitoring bronchial obstruction in school-age children. Pediatr Pulmonol. 1991;10:6–10.
  29. Houghton CM, Woodcock A, Singh D. Comparison of lung function methods for assessing dose-response effects of salbutamol. Br J Clin Pharmacol. 2004;58(2):134–141.
  30. Onyango A. Training Course on Child Growth Assessment: Interpreting Growth Indicators. World Health Organization; 2008.

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