What is the role of tests of lung function in the management of infants with lung disease?

Abstract

This review considers whether there is a role for lung function tests in the clinical management of infants with lung disease. The purpose of testing lung function in older subjects, the tests available for infants, and the practical problems of testing lung function in infants are considered. After reviewing all the facts, we suggest that there are four situations in which lung function testing should be recommended for infants, as follows: (1) the infant who presents with unexplained tachypnea, hypoxia, cough, or respiratory distress in whom a definitive diagnosis is not apparent from physical examination and other, less difficult investigations; (2) the infant with severe, continuous, chronic obstructive lung disease who does not respond to an adequate clinical trial of combined corticosteroid and bronchodilator therapy; (3) the infant with known respiratory disease of uncertain severity in whom there is need to justify management decisions; and (4) research and development. A review of 62 recent publications to determine how lung function tests are being used at the present time showed that they are being used overwhelmingly for research. The role of lung function testing in the clinical management of infants has not been established, and research is needed to clarify this situation. We suggest that such studies should explore the role of lung function tests in infants with specific symptoms, signs, or diagnoses, taking into account information from other types of investigation and the cost/benefit/risk ratios.

Clinical findings associated with abnormal lung function in children aged 3–26 months with recurrent respiratory symptoms

“…Instead, the clinicians should advise the parents to bring their child to the clinic for re‐evaluation when symptomatic. In complicated cases with troublesome symptoms but unconfirmed wheeze or failure to respond to conventional therapy, objective measures such as lung function testing could provide valuable information for supporting clinical decision‐making (15,21,22).…”

Infant lung function testing: available and useful methods

“…The most common reason why infants have undergone lung function measurement so far has been participation in research studies [9]. The clinical value or usefulness of adding ILFT to the traditional diagnostic set-up, such as chest radiography, CT of the lungs and bronchoscopy, is yet to be established, and there is a lack of scientific studies addressing which particular ILFT is most helpful when evaluating infants with specific symptoms or known respiratory disorders.…”

“…Other studies have compared, on a group level, lung function as measured with a specific method in sick and healthy subjects [9]. While ILFT is not yet an evidence-based diagnostic procedure, the same can be said about lung function testing in other age groups.…”

“…However, the time has now come for studies that will help clarify the role of ILFT as a routine clinical tool. Studies analysing which test is appropriate for a particular clinical situation are necessary, reporting the sensitivity and specificity of the test [9]. Normative data using the same method and equipment in a representative population of healthy subjects are highly desirable but not always available.…”

Re: ?What is the role of tests of lung function in the management of infants with lung disease?? by Godfrey et al. (Pediatr Pulmonol 2003;36:1-9): Interpretation and application of infant lung function tests

“…With great interest we read the paper by Godfrey et al 1 on the role of lung function testing in the clinical management of infants with lung disease. We fully agree with the proposed indications for infant lung function, with the conclusion that until now, most studies were researchoriented and that possible clinical applications have not been fully investigated.…”