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Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and
John Saito1, William T Harris, Jonathan Gelfond
1Division of Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7220, USA.
Insights
Lung function tests in young children with recurrent wheeze reveal significant airflow obstruction and hyperinflation. These findings suggest smaller airway caliber may predispose them to infections.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
- Medical Diagnostics
Background:
- Assessing airway disease in young children presenting with wheeze or cough is clinically challenging.
- Children under three with recurrent respiratory symptoms often fail standard therapies, necessitating further investigation.
- Flexible bronchoscopy is a key diagnostic tool for evaluating persistent lower airway issues in this age group.
Purpose of the Study:
- To describe radiographic, anatomical, microbiological, and physiological findings in children under three with recurrent wheeze/cough who failed initial treatments.
- To generate hypotheses regarding the respiratory physiology underlying persistent wheeze and cough in young children.
- To evaluate the utility of plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) in assessing lung function.
Main Methods:
- Prospective, descriptive study involving 19 children under three years old with recurrent wheeze/cough.
- Lung function assessment using plethysmography and RVRTC prior to flexible bronchoscopy.
- Analysis of radiographic, anatomical, microbiological (bronchoalveolar lavage), and physiological data.
Main Results:
- Significant airflow obstruction was noted, with mean Z-scores for forced expiratory flows (FEF(75) and FEF(25-75)) being markedly depressed, especially in younger, shorter children.
- Elevated functional residual capacity (FRC) Z-scores (mean 2.53) were associated with anatomical lower airway abnormalities.
- Half of the children with elevated residual volume/total lung capacity (RV/TLC) ratios showed no radiographic signs of hyperinflation, and neutrophilic inflammation correlated with higher forced vital capacity (FVC).
Conclusions:
- Plethysmography and RVRTC are valuable tools for quantifying hyperinflation and airflow obstruction severity in young children with persistent respiratory symptoms.
- Hypothesize that younger children may experience significantly limited airflow due to small airway caliber, hindering secretion clearance and increasing susceptibility to lower airway infections.
- Findings highlight the complex interplay of anatomical, physiological, and inflammatory factors in pediatric airway disease.
Abstract:
Assessing airway disease in young children with wheeze and/or cough is challenging. We conducted a prospective, descriptive study of lung function in children <3 years old with recurrent wheeze and/or cough, who had failed empiric antiasthma and/or antireflux therapy and subsequently underwent flexible bronchoscopy. Our goals were to describe radiographic, anatomical, microbiological, and physiological findings in these children, and generate hypotheses about their respiratory physiology. Plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) techniques were performed prior to bronchoscopy. Mean Z-scores (n = 19) were -1.34 for forced expiratory volume at 0.5 sec (FEV(0.5)), -2.28 for forced expiratory flows at 75% of forced vital capacity (FVC) (FEF(75)), -2.25 for forced expiratory flows between 25-75% of FVC (FEF(25-75)), 2.53 for functional residual capacity (FRC), and 2.23 for residual volume divided by total lung capacity (RV/TLC). Younger, shorter children had markedly depressed FEF(75) and FEF(25-75) Z-scores (P = 0.002 and P = <0.001, respectively). As expected, lower airway anatomical abnormalities, infection, and inflammation were common. Elevated FRC was associated with anatomical lower airway abnormalities (P = 0.03). FVC was higher in subjects with neutrophilic inflammation (P = 0.03). There was no association between other physiologic variables and bronchoscopic/bronchoalveolar lavage fluid findings. Half of those with elevated RV/TLC ratios (Z-score >2) had no evidence of chest radiograph hyperinflation. We conclude that in this population, plethysmography and RVRTC techniques are useful in identifying severity of hyperinflation and airflow obstruction, and we hypothesize that younger children may have relatively small airways caliber, significantly limiting airflow, and thus impairing secretion clearance and predisposing to lower airway infection.
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