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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.
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.
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