Ventilation inhomogeneity in infants with recurrent wheezing

Lu, Zihang; Foong, Rachel E.; Kowalik, Krzysztof; Moraes, Theo J.; Boyce, Ayanna; Dubeau, Aimée; Balkovec, Susan; Gustafsson, Per; Becker, Allan B.; Mandhane, Piush J.; Turvey, Stuart E.; Lou, Wendy; Ratjen, Félix; Sears, Malcolm R.; Subbarao, Padmaja

doi:10.1136/thoraxjnl-2017-211351

Cited by 7 publications

(6 citation statements)

References 39 publications

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“…Recently, the correlation between FeNO and LCI has been described in preschool wheezers, 39 but there is no direct linear relationship between FeNO and LCI in our data, although the two frequently exhibited concordant responses to triamcinolone. It may be that in preschool children more of the variability in LCI can be explained by inflammatory changes alone, whereas in older children with more established disease ventilation inhomogeneity may be multifactorial (eg, also due to distal airway remodeling) and thus less linear.…”

Section: Discussioncontrasting

confidence: 84%

Lung clearance index and steroid response in pediatric severe asthma

Irving

Fleming

Ahmad

et al. 2020

Pediatric Pulmonology

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Introduction Lung clearance index (LCI) is a measure of airway disease that has been shown to be abnormal in asthma. We hypothesized that LCI would be higher (worse) in children with severe therapy‐resistant asthma (STRA) compared with difficult asthma (DA) and healthy controls and that LCI would fall in response to parenteral steroids in STRA. Methods Sixty‐four children with asthma who were prescribed high‐dose asthma therapy (GINA steps 4 or 5) performed LCI and spirometry. Forty‐three had STRA and 21 DA. Thirty‐nine of forty‐three STRA patients attended for a clinically indicated bronchoscopy during which an intramuscular injection of triamcinolone was given. LCI, spirometry, and fractional exhaled nitric oxide (FeNO) were performed on the day of the bronchoscopy and repeated 4 weeks later. Results LCI was more abnormal in STRA (median: 7.40, range: 5.58‐12.34) than in DA (6.55, 5.77‐7.75), P = .0006, and healthy controls (6.53, 5.57‐7.35), P = .005. In contrast to the first second forced expired volume (FEV1), LCI improved following systemic steroids; of 20 STRA patients with an abnormal LCI at baseline, 13 improved following triamcinolone. LCI and FeNO responses were concordant. Conclusions There is a subgroup of children with STRA in whom LCI is elevated who improve following parenteral steroids. LCI may be a valuable additional domain in assessing steroid response in pediatric asthma.

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Section: Discussioncontrasting

confidence: 84%

Lung clearance index and steroid response in pediatric severe asthma

Irving

Fleming

Ahmad

et al. 2020

Pediatric Pulmonology

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“…Next, we assessed the clinical impact of the use of our novel reference equation on interpretation of LCI data from clinical groups. MBW data from 37 children diagnosed with recurrent wheeze have previously been reported from our center (11). These patients had a mean (range) age of 1.6 (0.62 to 2.93) years, 25 (68%) were male and 21 (57%) were Caucasian.…”

Section: To the Editormentioning

confidence: 97%

Newly developed multiple-breath washout reference equations from the CHILD Cohort Study: implications of poorly fitting equations

Dai

Kowalik

et al. 2020

ERJ Open Res

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The multiple-breath washout (MBW) test allows for the measurement of lung volumes, ventilation homogeneity and gas clearance curves during tidal breathing [1]. Lung clearance index (LCI), the most commonly reported parameter from the MBW test, is a marker of ventilation inhomogeneity and is associated with early lung disease. LCI is defined as the cumulative expired volume divided by the functional residual capacity (FRC). The currently accepted reference equation for LCI measured using sulfur hexafluoride (SF 6 ) shows a non-linear decrease as age and height increase, with height as an independent predictor from infancy to school-age [2]. In contrast, FRC shows a non-linear increase in FRC as age and height increase with males having higher measured FRC compared to female subjects.

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“…Finally, this study adds scientific evidence on the applicability of this method not only in patients undergoing cancer therapies but more generally in populations at risk of lung damage. In this sense, there are studies on the use of the MBW for infants with recurrent wheezing, 32 symptom‐controlled asthma, 33 post‐infectious bronchiolitis obliterans, 34 spinal muscular atrophy, 35 late preterm birth 36 …”

Section: Discussionmentioning

confidence: 99%

Lung clearance index: A new measure of late lung complications of cancer therapy in children

Parisi

Cannata

Manti

et al. 2020

Pediatric Pulmonology

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Introduction Childhood cancer survivors (CSs) might face an increased lifelong risk of lung function impairment. The lung clearance index (LCI) has been described as being more sensitive than spirometry in the early stages of some lung diseases. The aim of this study was to evaluate this index in a cohort of patients with a history of childhood cancer for the first time. Materials and Methods We evaluated 57 off‐treatment CSs aged 0–18 years old and 50 healthy controls (HCs). We used the multiple‐breath washout method to study LCI and spirometry. Results CSs did not show any differences from the controls in ventilation homogeneity (LCI 6.78 ± 1.35 vs. 6.32 ± 0.44; p: not significant [ns]) or lung function (FEV1 99.9 ± 11.3% vs. 103.0 ± 5.9% of predicted; p: ns; FVC 98.2 ± 10.3% vs. 101.1 ± 3.3% of predicted). LCI significantly correlated with the number of years since the last chemotherapy (r = .35, p < .05). Conclusions Our study describes the trend of LCI in a cohort of CSs and compares it with the results obtained from HCs. The results show that patients maintain both good values of respiratory function and good homogeneity of ventilation during childhood. Moreover, as LCI increases and worsens as the years pass after the end of the treatment could identify the tendency toward pulmonary fibrosis, which is typical of adult CSs, at an earlier time than spirometry.

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Ventilation inhomogeneity in infants with recurrent wheezing

Abstract: Ventilation inhomogeneity is present in clinically stable infants with recurrent wheezing.

Cited by 7 publications

References 39 publications

Lung clearance index and steroid response in pediatric severe asthma

Lung clearance index and steroid response in pediatric severe asthma

Newly developed multiple-breath washout reference equations from the CHILD Cohort Study: implications of poorly fitting equations

Lung clearance index: A new measure of late lung complications of cancer therapy in children

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