Forced expiratory maneuvers in children aged 3 to 5 years

Abstract

There is no consensus about reproducibility and reliability of spirometry in young children. We evaluated forced expiratory maneuvers from 98 children aged 3 to 5 years with a variety of respiratory disorders before and after bronchodilator treatment. Forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were analyzed for reproducibility by the American Thoracic Society criteria and for reliability based on the coefficient of variation (CV%). Over 90% of the patients cooperated, however, while 95% could exhale for at least 1 second, very few generated an FEV1 on all 6 "best" efforts. This clearly improved with age. Of all patients nearly 60% performed reproducible pre- and postbronchodilator sets of FVC but only 32% performed reproducible sets of FEV1. Based on the CV%, those patients who could reproducibly perform an FVC and FEV1 did it quite reliably (mean CV%, 9.38 and 7.01 for FVC and FEV1, respectively). We conclude that while some very young children can perform spirometry, reliability of performance cannot be assumed in this age group.

Efeito da terminação precoce da expiração nos parâmetros espirométricos em crianças pré-escolares saudáveis

“…In some studies of preschool children, the criterion adopted for curve termination is unclear, making it difficult to assess that criterion more accurately, as well as to make comparisons across studies. (2)(3)(4) Acceptability was found to increase with age, a finding that is in accordance with data in the literature. (4,6) Although the number of small children who were able to perform maneuvers in accordance with the 2007 ATS/ERS acceptability criteria was small (7.4% of those aged 3 years and 29.5% of those aged 4 years), with the acceptance of the ETE>10 group curves, FEV 0.5 could have been assessed in 20% more of the children tested, raising the proportion of preschool children with available FEV 0.5 data to 73%, which would justify the use of spirometry in this age group.…”

“…(1)(2)(3)(4)(5)(6)(7)(8)(9) The publication of reference values and study reports, showing that 40-90% of preschool children can perform spirometry appropriately, has promoted its use in clinical practice. (1)(2)(3)(4)(5)(6)(7)(8) The acceptability criteria for spirometry in adults, standardized by the American Thoracic Society (ATS), (10) cannot be applied to children, especially because of the brevity of the expiratory maneuver, usually lasting less than 2-3 s. The major technical limitation is early termination of exhalation (ETE), characterized by the sudden interruption of exhalation. To allow for ETE, the following criteria for acceptable curves have been proposed (5,8,9) : minimum flows ≤ 25% of the highest PEF; minimum flows ≤ 10% of the highest PEF; and minimum flows ≤ 0.3 L/s.…”

Lung function measurement in awake young children

“…However, children under 6-8 yrs are seldom able to reliably and reproducibly perform the manoeuvres required for these techniques [1,2]. The ZIOS and Rint measurements are performed during normal tidal breathing, they require only passive co-operation, and each measurement may be accomplished within less than 15 s. The methods are also noninvasive, apart from the closely fitted face-mask equipped with a mouthpiece.…”

“…In principle, measurement of lung function is essential for the diagnosis and the monitoring of such diseases. However, only children aged at least 6-8 yrs can be expected to co-operate reliably to perform reproducible forced respiratory manoeuvres [1,2] and to tolerate measurements within a whole body plethysmograph. For children under this age, lung function measurements are rarely performed, except for research purposes in infants, who may be studied during sedation.…”

Non specific bronchial hyperreactivity in infants

“…O desenvolvimento de técnicas e equipamentos capazes de avaliar a função pulmonar em lactentes permitiu a aplicação dos TBP inespecíficos nestes e em crianças menores [11][12][13][14] . Várias técnicas têm sido empregadas: a técnica da interrupção ou "interrupter technique" 15 , a de compressão ou "squeeze technique" 16,17 , a medida da pressão transcutânea de oxigênio 17,18 , ausculta traqueal ou pulmonar de sibilância, entre outras 11,[19][20][21] .…”