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Pulmonary function testing for the diagnosis of asthma in preschool children
1COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Insights
Diagnosing asthma in young children is possible with various lung function tests. Objective measurements like spirometry and impulse oscillometry improve accuracy and prevent misdiagnosis.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Diagnostic Techniques
Background:
- Asthma diagnosis in preschool children presents challenges due to developmental limitations.
- Accurate diagnosis is crucial to prevent under- or overtreatment of pediatric asthma.
Purpose of the Study:
- To review current evidence on lung function techniques for diagnosing asthma in preschool children.
- To highlight the utility and limitations of various diagnostic tools in this age group.
Main Methods:
- Review of available lung function tests including spirometry, impulse oscillometry, whole-body plethysmography, and fractional exhaled nitric oxide (FeNO).
- Analysis of age-appropriateness and reliability of techniques for children aged 1-5 years.
- Inclusion of bronchodilator reversibility and bronchial challenge tests to enhance diagnostic sensitivity.
Main Results:
- Spirometry (from age 5), impulse oscillometry (>3 years), and whole-body plethysmography (>3 years) are key objective measures.
- Fractional exhaled nitric oxide (FeNO) (>5 years) serves as a promising adjunctive test.
- Bronchodilator reversibility and challenge tests can improve diagnostic accuracy.
Conclusions:
- Lung function testing can be reliably performed in preschool children (2-4 years) with trained personnel.
- Objective lung function measurements are vital for accurate asthma diagnosis and management in this population.
- A combination of tests may be necessary for definitive diagnosis.
Purpose Of Review:
To highlight the recent evidence of the lung function techniques used in preschool children to diagnose asthma.
Recent Findings:
Several techniques are available to measure lung function and airway inflammation in preschool children, including spirometry (from age 5 years), impulse oscillometry (>3 years), whole-body plethysmography (>3 years), fractional exhaled nitric oxide (FeNO) (>5 years), multiple breath washout (>3 years), structured light plethysmography (>1-2 years) and impedance pneumography (>1 years). If applicable, measuring forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) ratio using spirometry is useful (cut-off < 80% predicted or below lower limit of normal [LLN] defined as z-score < -1.64) for diagnosing preschool asthma. For those unable to perform spirometry, whole-body plethysmography (sRaw > 1.6 kPa/s) and impulse oscillometry (Rrs and Xrs at 5 Hz z-score > 2) may be useful. Adding a bronchodilator reversibility test (FEV1 increase > 12%, sRaw decrease > 25-30%, Rrs at 5 Hz decrease > 40%) or a bronchial challenge test, for example, exercise test (FEV1 decrease > 10%), may improve the sensitivity of these tests. Elevated FeNO (>25-35 ppb) is a promising adjunctive test for diagnosing preschool asthma.
Summary:
With trained personnel, lung function testing can be done with high reliability even in children between 2 and 4 years of age. To avoid over and undertreatment of asthma, objective measurement of lung function is clinically important in preschool children.
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