Forced expiratory manoeuvres in children: do they meet ATS and ERS criteria for spirometry?

Abstract

The aim of this study was to evaluate the applicability of American Thoracic Society and European Respiratory Society criteria for spirometry in children.Maximal expiratory flow/volume (MEFV) measurements from 446 school-age children, experienced in performing MEFV manoeuvres, were studied and acceptability (start-of-test (backward extrapolated volume as a percentage of forced vital capacity (FVC) (Vbe%FVC) or as an absolute value (Vbe), end-of-test (forced expiratory time (FET)) and reproducibility criteria (absolute and percentage difference between best and second-best FVC and forced expiratory volume in one second (FEV1) (DFVC, DFVC %, DFEV1 and DFEV1 %)) were applied to these manoeuvres.The Vbe%FVC criterion was met by 91.5%, the Vbe v0.15 L criterion by 94.8% and the Vbe v0.10 L by 60.1% of children. Vbe v0.15 L appeared to be a more useful parameter than Vbe%FVC. The FET criterion was met by only 15.3% of children. DFVC v0.2 L and DFEV1 v0.2 L were met by 97.1% and 98.4%, and DFVC v0.1 L and DFEV1 v0.1 L by 79.8% and 84.3% of the children, respectively. These criteria appeared to be less useful compared to percentage criteria (DFVC % and DFEV1 %). Even experienced children did not meet all international criteria for spirometry. However, most of their MEFV curves are useful for interpretation.Based on the performance of these children, a re-evaluation of criteria for maximal expiratory flow/volume measurements in children is proposed.

Sniff nasal inspiratory pressure in children with muscular, chest wall or lung disease

“…All of the patients were asked to perform at least three physician-accepted forced vital capacity (FVC) curves, and the curves with the highest FVC were used for the final analysis [18]. Results were expressed as a per cent of published values (% pred).…”

No positive effect of rhdnase on the pulmonary colonization in children with cystic fibrosis

“…Lung function was measured in all children from 4 years of age onwards using spirometry in conformity with international criteria [21]. For the measurements, a Lilly pneumotachometer system (Viasys, Masterscreen, Hochberg, Germany), was used and sex and height specific reference values were applied [22].…”

Paediatric spirometry guideline of the South African Thoracic Society: Part 1

“…Attaining a volume plateau is more important than the exhalation time in children. [23] Children are likely to have a shorter forced expiratory time (FET) than adults and hence the volume plateau may be completed in a shorter time: 3 s in children <6 years of age and 1 s in smaller, preschool children. [4,23] Throughout the procedure the technician must ensure that there is no leak at or obstruction of the mouthpiece while the child exhales immediately after maximal inspiration using maximal effort and exhales fully to the end of test.…”

“…[5] In children it is recommended that the VBE should be <12.5% of FVC or <80 ml, whichever is greater, [7] which differs from the VBE of <5% FVC and <150 ml required for adults. [5,23] The volume-time and flow-volume loops generated should be free of artefacts. This includes no coughing, glottic closure or occlusion of the mouthpiece.…”

“…Preschool and schoolage children may have difficulty achieving the traditional adult quality-control criteria; hence paediatric-specific definitions of test quality have been developed. [4,23] The technologist must first demonstrate the procedure (Table 3) using child-friendly language and strategies. The procedure may be either an exhalation-only manoeuvre only or an inhalation-exhalation manoeuvre, depending on the equipment available and information required.…”