常规肺通气功能检测在儿童哮喘评估中的应用

目的探讨哮喘病情与肺功能指标变化特点,为哮喘规范化治疗提供客观依据。方法采用肺功能测定系统对25例哮喘患儿于急性期、缓解期6个月及1年分别行常规肺通气功能测定,比较各期实测值与预计值比值之间的差异。结果哮喘患儿的症状与肺功能指标呈现出一致性,急性期大气道指标用力肺活量(FVC)、1秒钟用力呼气量(FEV1)、最大呼气峰流量(PEF)及75%、50%、25%肺活量时用力呼气流速(FEF25、50、75)、中段呼气流速(MMEF75/25)等实测值与预计值比值均降低,治疗6个月后FVC、FEV1等大气道功能指标基本恢复,1年后小气道功能指标FEF50、75及MMEF75/25等指标恢复。结论肺功能指标在哮喘的病情评估方面具有重要作用,对于哮喘治疗具有重要指导作用。     

The influence of pulmonary function testing on the management of asthma in children

OBJECTIVE: To assess how often in a single encounter that pulmonary function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone. STUDY DESIGN: Children with asthma (n = 367, age 4 to 18 years) performed spirometry before clinical evaluation. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the spirometry results. Any changes based on the test results were documented. RESULTS: Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of visits. This frequency was not affected by the patient's age, disease severity, symptom control, or exam findings. When spirometry did not change treatment decisions, the provider was more likely to maintain therapy (58%) than to increase (17%) or decrease (24%) therapy. In contrast, when spirometry did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy. CONCLUSION: Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.     

Pediatric pulmonary function testing in asthma.

Pulmonary function testing is an important tool in the management of asthma. Lung function can be readily assessed in both the office and patient's home. This article reviews spirometry, peak flow meters, and bronchial challenge testing. Their interpretation and clinical use are presented as well.     

Evaluation of systematic pulmonary function testing for asthma in children aged three to five years]

Pulmonary function testing is not usually done in the preschool child, despite the recent data showing early deterioration in airway function in asthma. METHODS: We evaluated feasibility and clinical interest of flow-volume loop by forced expiratory maneuver and measure of airway resistance by interrupter technique (interrupter resistance), before and after inhalation of salbutamol, in 75 children aged three to five years seen in the ambulatory setting for asthma. RESULTS: Feasibility rate (92%) and reproducibility rate (91%) of those techniques were good, so that 84% of the cases could be exploited (63 children of 75). We found few significant associations between clinical parameters and flow-volume loop. We found a significant association between elevated interrupter resistance at basis and night-symptoms (P = 0.03), between diminished interrupter resistance after salbutamol and exercise-symptoms (P = 0.03), symptoms in the ambulatory setting (P = 0.02) and absence of inhaled corticosteroid treatment (P = 0.046). Pulmonary function testing resulted in treatment modification in 14% of cases. CONCLUSION: Our study shows that flow-volume loop and measure of airway resistance by interrupter technique can be done with a good reproducibility in the preschool child. Interrupter resistance appears to be better correlated than flow-volume loop with usually evaluated clinical parameters.     

Clinical implications of pulmonary function testing in preschool children

There is increasing recognition of the need for objective physiological measurements of lung function during the preschool years in order to identify and treat early lung disease before irreversible structural changes occur; monitor disease progression and efficacy of therapeutic interventions and distinguish the various wheezing phenotypes that occur in this age group, all of which require different management strategies. While preschool pulmonary function tests are undoubtedly excellent research tools , their role in the clinical management of the individual young child remains more controversial. In particular, further work is required to establish information on the within-subject, between occasion variability and the relative sensitivity and specificity of each technique, as well as developing more appropriate prediction equations for this age group, before they can be used confidently in the clinical management of individual child. This review examines the various challenges facing paediatricians who are responsible for children with respiratory diseases such as asthma, wheezing, cystic fibrosis and chronic lung disease following preterm delivery and summarises recent recommendations from an ATS/ERS Task Force.     

肺功能检测在儿童哮喘诊治中的意义

目的探讨肺功能检测在儿童哮喘诊治中的指导意义。方法采用肺功能仪和Super-spiro软件分别测定哮喘儿急性发作期和缓解期的呼吸生理参数。结果发作期及缓解期大气道功能均以最大呼气流速峰值(PEF)敏感,小气道功能以用力呼气25%流速(FEF25)、用力呼气50%流速(FEF50)敏感,缓解期大部分患儿小气道功能仍有轻度损害。结论小气道功能在病情判定、疗效观察及随访中有重要意义。     

肺功能检测在儿童哮喘诊治中的意义

目的 探讨肺功能检测在儿童哮喘诊治中的指导意义。方法 采用肺功能仪和Superspiro软件分别测定哮喘儿急性发作期和缓解期的呼吸生理参数。结果 发作期及缓解期大气道功能南以最大呼气流速峰值（PEF）敏感，小气道功能以用力呼气25％流速（FEF25）、用力呼气50％流速（FEF50）敏感，缓解期大部分患儿小气道功能仍有轻度损害。结论 小气道功能在病情判定、疗效观察及随访中有重要意义。     

Assessment of asthma severity and asthma control in children

National and international guidelines for asthma recommend the assessment and documentation of severity as the basis for patient management. However, studies show that there are problems with application of the severity assessment to children in clinical practice. More recently, asthma control has been introduced as a method to assess the adequacy of current treatment and inform asthma management. In this article we review the application and limitations of the severity assessment and the asthma-control tools that have been tested for use in children. A system of using asthma severity for disease assessment in the absence of treatment and using asthma-control assessment to guide management decisions while a child is receiving treatment appears to be a promising approach to tailor treatment to improve care and outcomes for children with asthma.     

肺功能小气道功能评价在儿童哮喘中的应用进展

支气管哮喘(简称哮喘)是一种儿童时期最常见的慢性气道疾病,以慢性气道炎症和气道高反应性为特征。小气道功能的评估在哮喘的诊疗过程中具有重要的意义。该文就小气道的定义、肺功能检查方法及其在哮喘临床诊断和管理中应用的研究进展进行阐述。     

哮喘和咳嗽变异性哮喘儿童肺常规通气功能的比较

目的：比较哮喘与咳嗽变异性哮喘（CVA）患儿肺常规通气功能的变化。方法：选择2010年 5月至2011年5月确诊为哮喘或CVA的患儿140例,分为哮喘急性发作组（发作组,50例）、哮喘缓解组（缓解组,50例）和CVA组（40例）;同期正常健康体检儿童30例作为对照组。测定4组儿童用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、最大呼气峰流速(PEF)、用力呼气25%流速(FEF25)、用力呼气50%流速(FEF50)、用力呼气75%流速(FEF75)、最大呼气中期流速(MMEF75/25)等7项肺功能指标。结果：发作组患儿各项肺功能指标如大气道指标FVC、FEV1、PEF、FEF25及小气道指标FEF50、FEF75、MMEF75/25的实际值/预计值平均水平均<80%,且以FEF50、FEF75、MMEF75/25等小气道指标下降为著。CVA组患儿小气道指标FEF75、MMEF75/25实际值/预计值的平均水平<80%。发作组各项肺常规通气功能指标均低于对照组;缓解组、CVA组FVC、FEV1、FEF25及 MMEF75/25实际值/预计值的平均水平低于对照组;发作组各项肺功能指标均明显低于缓解组和CVA组;CVA组与缓解组各项肺功能指标差异均无统计学意义。结论：哮喘急性发作期患儿存在大小气道功能障碍,以小气道功能障碍为主;CVA患儿以小气道功能轻微障碍为主,与哮喘缓解期相似。     

Chronic night cough and asthma severity in children with stable asthma

The relationship between night cough and other indices of asthma severity was studied in 21 children with clinically stable asthma and persistent night cough. Overnight cough was quantified and related to symptom scores, oxygen saturation (S_aO₂) during sleep, evening and morning peak flow recordings and daytime tests of lung function. In the index group the median number of coughing episodes was 23 (range 1–158). Only 4 children had counts of <10 overnight, similar to the comparison group of 12 children all of whom had counts of <10. There was a trend towards the association of overnight cough with reduced evening peak flow (r=–0.407,P=0.07) and reduced S_aO₂ (r=–0.36,P=0.10). Abnormalities in daytime tests of lung function were observed in 13 children. There was no relationship between night cough and daytime indices of lung function abnormality although children with more severe daytime abnormalities also had significant night cough. Conversely, five children with chronic night cough had normal daytime function.Conclusion Night-time cough in children with asthma is not simply a reflection of daytime lung function status, whereas, overnight S_aO₂ correlates well. Other factors need to be explored to explain the variability of night-time cough in these children.     

The effects of pharmacological treatment on pulmonary function in children with exercise-induced asthma

The effects of two therapeutic regimens were investigated in eleven boys and eight girls (8--13 years) with a history of exercise-induced asthma (EIA), who reacted with subjective signs of EIA and a decrease in FEV1.0 exceeding 10% after an exercise test. A test program (TP) including complete spirometry, bicycle ergometer and treadmill exercise tests preceded and followed by dynamic spirometry at one and five min after exercise, was performed before and after each treatment period. In 12 patients with sporadic medication before the trials, continuous peroral treatment with a combination of a beta 2-stimulating drug and a xanthine derivative for three weeks did not significantly improve TP data. In 13 children (six from the above group) who were already on continuous treatment as above, addition of disodium cromoglycate (DSCG) inhalations for 3--4 weeks improved the response to acute administration of a beta-receptor stimulatory aerosol but did not influence EIA. Seven of the children continued their DSCG treatment for one year. Minor improvement of EIA provoked by cycling but not by treadmill was seen after this. The ventilatory effort in relation to working intensity was lowered. No significant differences were found between treadmill running and cycling in provoking asthma.     

Infant pulmonary function testing

Pulmonary function tests in infants have been used for many years, but they have been largely relegated to specialized centers and research purposes. More recently, development of commercial equipment and newer techniques has allowed for more broad use and application of these tests. This review describes different techniques that have been used to study infants and toddlers, and their clinical applications.