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Updated: Nov 5, 2025
Quantitative Mapping of Specific Ventilation in the Human Lung using Proton Magnetic Resonance Imaging and Oxygen as a Contrast Agent
Published on: June 5, 2019
Ventilation heterogeneity in children with severe asthma
Amy G Nuttall1,2, Caroline S Beardsmore1,2, Erol A Gaillard3,4
1Department of Respiratory Sciences and Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory Theme, Leicester Royal Infirmary, University of Leicester, PO Box 65, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.
Insights
Ventilation heterogeneity (VH) is common in severe childhood asthma, unlike mild cases. Lung clearance index (LCI) via multiple breath washout testing detects this airway disease, offering a sensitive measure beyond spirometry for severe asthma management.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
- Asthma Research
Background:
- Small airway disease, marked by ventilation heterogeneity (VH), affects some children with asthma.
- Standard spirometry often fails to detect early small airway involvement in pediatric asthma.
- Multiple Breath Washout (MBW) testing is a method to quantify VH.
Purpose of the Study:
- To investigate the relationship between VH, asthma severity, and spirometry in children.
- To assess the utility of MBW testing, specifically the lung clearance index (LCI), in pediatric asthma.
- To compare VH in children with mild-moderate versus severe asthma.
Main Methods:
- Cross-sectional observational cohort study involving 37 children (5-16 years) with stable asthma (mild-moderate and severe GINA classification) and 7 healthy controls.
- Multiple Breath Nitrogen Washout (MBNW) testing was performed on all participants.
- Spirometry (FEV1 z-score) was conducted and correlated with LCI.
Main Results:
- The lung clearance index (LCI) was normal in controls and mild-moderate asthmatics.
- Abnormal LCI was found in 21% of children with severe asthma.
- LCI showed a negative correlation with FEV1 z-score, indicating higher LCI with lower FEV1.
Conclusions:
- Ventilation heterogeneity is more prevalent in children with severe asthma.
- LCI is a more sensitive indicator of small airway disease in children than FEV1.
- MBW testing, using LCI, shows promise for assessing and managing severe pediatric asthma.
Abstract:
Small airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We studied the relationship between VH, asthma severity, and spirometry in a cross-sectional observational cohort study involving children with stable mild-moderate and severe asthma by GINA classification and a group of healthy controls. Thirty-seven participants aged 5-16 years completed multiple breath nitrogen washout (MBNW) testing (seven controls, seven mild-moderate asthma, 23 severe asthma). The lung clearance index (LCI) was normal in control and mild-moderate asthmatics. LCI was abnormal in 5/23 (21%) of severe asthmatics. The LCI negatively correlated with FEV1 z-score.Conclusion: VH is present in asthmatic children and appears to be more common in severe asthma. The LCI was significantly higher in the cohort of children with severe asthma, despite no difference in FEV1 between the groups. This supports previous evidence that LCI is a more sensitive marker of airway disease than FEV1. MBNW shows potential as a useful tool to assess children with severe asthma and may help inform clinical decisions. What is Known: • Increased ventilation heterogeneity is present in some children with asthma • Spirometry is not sensitive enough to detect small airway involvement in asthma What is New • Lung clearance index is abnormal in a significant subgroup of children with severe asthma but rarely in children with mild-moderate asthma • Our data suggests that LCI monitoring should be considered in children with severe asthma.
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