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False normal Lung Clearance Index in infants with cystic fibrosis due to software algorithms

Pinelopi Anagnostopoulou1,2, Sophie Yammine1, Anne Schmidt1,3

  • 1Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.

Pediatric Pulmonology
|August 19, 2015
PubMed

Insights

New analysis methods reveal elevated lung clearance index (LCI) in infants with cystic fibrosis (CF), challenging previous normal findings. This refined approach improves accuracy for infant lung function testing in CF research and clinical practice.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Physiology
  • Medical Device Software Validation

Background:

  • Lung clearance index (LCI) is a key marker for ventilation inhomogeneity, typically elevated in children with cystic fibrosis (CF).
  • Infants with CF often present with normal LCI despite detectable structural lung abnormalities, suggesting limitations in current analysis software.
  • This discrepancy highlights a potential issue with the algorithms used in standard software packages for analyzing infant lung function.

Purpose of the Study:

  • To challenge the validity of current software algorithms used for analyzing multiple breath washout (MBW) data in infants.
  • To compare the results obtained from current automatic software algorithms with refined manual algorithms.
  • To investigate the reasons behind potentially inaccurate LCI measurements in infants with CF.

Main Methods:

  • A comparison of multiple breath washout (MBW) results was conducted between current automatic software algorithms and refined manual algorithms.
  • The study included 17 asymptomatic infants with CF and 24 matched healthy term-born infants.
  • The primary methodological difference involved the calculation of molar mass differences to determine measurement completion.

Main Results:

  • The refined manual algorithm identified elevated LCI (>9) in 23% of infants with CF, whereas the automatic modus showed values below 8.3.
  • A statistically significant difference was observed between the means of the two analysis methods in infants with CF (paired t-test, P < 0.001).
  • Healthy infants exhibited normal LCI values with both analysis methods (n=47, paired t-test, P=0.79), and premature test completion was identified as a key issue with the automatic modus.

Conclusions:

  • The manual modus for analyzing MBW outcomes in infants provides more accurate LCI results compared to the automatic modus.
  • Accurate infant lung function data is crucial for effective clinical management and scientific advancement in pediatric respiratory diseases.
  • Recommendations include adopting the manual analysis method for MBW data in infants to ensure reliable assessment of lung function.
Abstract

Keywords:
cystic fibrosisinfant pulmonary functionmultiple breath washoutultrasonic flowmeter

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