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Single-breath counting: a pilot study of a novel technique for measuring pulmonary function in children
Syed Sameer Ali1, Charles O'Connell, Lawrence Kass
1Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, 17033, USA. sali@hmc.psu.edu
Insights
Single-breath counting (SBC) is an easy and effective method for assessing pediatric pulmonary function, correlating well with standard tests. This technique shows promise for measuring asthma severity in children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Peak expiratory flow rate (PEFR) is effort-dependent and problematic for assessing asthma severity in children.
- Standard pulmonary function tests like forced expiratory volume in 1 second (FEV₁) and FEV₁/FVC are accurate but often unavailable in emergency settings.
- A simpler, reliable method for assessing pediatric lung function is needed.
Purpose of the Study:
- To evaluate the feasibility of single-breath counting (SBC) in children.
- To determine the correlation between SBC and standard pulmonary function measures in pediatric patients.
Main Methods:
- Prospective observational study involving 67 children (ages 5-18) undergoing scheduled pulmonary function testing (PFT).
- Measurements included PEFR, FEV₁, FVC, forced expiratory flow 25%-75%, and FEV₁/FVC.
- Single-breath counting (SBC) was performed after PFT, with three attempts recorded and averaged. Correlation analysis used the Pearson coefficient.
Main Results:
- All 67 children successfully completed the SBC test.
- SBC demonstrated significant correlations with standard PFT measures: PEFR (r=0.55), FEV₁ (r=0.66), FVC (r=0.71), and forced expiratory flow 25%-75% (r=0.44).
- A negative correlation was found with FEV₁/FVC (r=-0.29).
Conclusions:
- Single-breath counting (SBC) is easily performed by children and correlates well with established pulmonary function tests.
- SBC shows potential as a tool for assessing asthma severity in pediatric populations.
- Further research is recommended to establish reference values and evaluate SBC's utility in emergency departments for acute asthma cases.
Introduction:
Although peak expiratory flow rate is the conventional way to measure asthma severity in adults, its use is problematic in children because it is effort dependent. Forced expiratory volume in 1 second (FEV₁) and the ratio of FEV₁ to forced vital capacity (FEV₁/FVC) are more accurate, but generally not available in the emergency department (ED). A better test is needed. Single-breath counting (SBC) is the measurement of how far an individual can count in a normal speaking voice after a maximal effort inhalation. The count is in cadence to a metronome set at 2 beats per second. Previous work has suggested that SBC correlates with standard measures of pulmonary function in adults. However, it has never been tested in children.
Objectives:
The aims of this study are to determine if SBC can be easily performed by children and to assess the correlation between SBC and standard measures of pulmonary function in a pediatric population.
Methods:
This was a prospective observational study of a convenience sample of children presenting to the pulmonary clinic for scheduled pulmonary function testing (PFT). Peak expiratory flow rate, FEV₁, FVC, forced expiratory flow 25% to 75%, and FEV₁/FVC were measured and recorded. After PFT, subjects were asked to perform SBC. Three attempts were allowed, and the average was recorded. Correlation was determined by the Pearson coefficient.
Results:
Sixty-seven children (ages 5-18 years, 64% male) were enrolled. All were able to understand and complete the testing. Indications for PFT included asthma and/or allergies (n = 44), cystic fibrosis (n = 9), and other chronic diseases (n = 14). The correlations (r) of SBC to peak expiratory flow rate, FEV₁, FVC, forced expiratory flow 25% to 75%, and FEV₁/FVC were 0.55, 0.66, 0.71, 0.44, and -0.29, respectively (P < .05 for all results).
Conclusion:
Single-breath counting is easy to perform in children, seems to correlate well with standard measures of pulmonary function, and shows promise for measuring asthma severity in children. Further work to define the range of reference SBC values (as a function of age and/or body size) and an evaluation of the utility of SBC in an ED population of acute asthmatics is indicated.
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