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Breath Collection from Children for Disease Biomarker Discovery
Published on: February 14, 2019
Evaluation of the Double-Tracer Gas Single-Breath Washout Test in a Pediatric Field Study
Anne-Christianne Kentgens1, Johanna M Kurz1, Rebeca Mozun2
1Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Insights
The double-tracer gas single-breath washout test is feasible in schoolchildren, identifying age, BMI, and wheeze as predictors of peripheral airway function. However, test variability limits individual application.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
- Environmental Health
Background:
- Chronic pulmonary diseases may originate in early life, specifically in peripheral small airways.
- Predictors of ventilation inhomogeneity, a key indicator of peripheral airway function, are not well-studied in children.
Purpose of the Study:
- To assess the feasibility of the double-tracer gas single-breath washout (DTG-SBW) measurement in a pediatric field setting.
- To identify predictors of ventilation inhomogeneity (SIIIHe-SF6) in unselected schoolchildren.
Main Methods:
- A prospective, cross-sectional field study involving a mobile lung function unit in Swiss schools.
- DTG-SBW, fraction of exhaled nitric oxide (Feno), and spirometry were performed.
- Feasibility, repeatability, and associations of SIIIHe-SF6 with anthropometrics, wheeze, Feno, FEV1, and FEV1/FVC were evaluated.
Main Results:
- DTG-SBW was feasible in 1,449 of 1,782 children (81.3%), with a coefficient of variation of 39.8%.
- SIIIHe-SF6 showed weak positive associations with age and BMI.
- Children reporting wheeze had higher SIIIHe-SF6, which remained significant after adjusting for age and BMI.
Conclusions:
- DTG-SBW is a feasible method for assessing peripheral airway function in pediatric field studies.
- Population-level predictors of peripheral airway function in schoolchildren include age, body composition, and wheeze.
- Current variability in DTG-SBW measurements may limit its application at the individual level.
Background:
The early life origins of chronic pulmonary diseases are thought to arise in peripheral small airways. Predictors of ventilation inhomogeneity, a proxy of peripheral airway function, are understudied in schoolchildren.
Research Question:
Is the double-tracer gas single-breath washout (DTG-SBW) measurement feasible in a pediatric field study setting? What are the predictors of the DTG-SBW-derived ventilation inhomogeneity estimate in unselected schoolchildren?
Study Design And Methods:
In this prospective cross-sectional field study, a mobile lung function testing unit visited participating schools in Switzerland. We applied DTG-SBW, fraction of exhaled nitric oxide (Feno), and spirometry measurements. The DTG-SBW is based on tidal inhalation of helium and sulfur-hexafluoride, and the phase III slope (SIIIHe-SF6) is derived. We assessed feasibility, repeatability, and associations of SIIIHe-SF6 with the potential predictors of anthropometrics, presence of wheeze (ie, parental report of one or more episode of wheeze in the prior year), Feno, FEV1, and FEV1/FVC.
Results:
In 1,782 children, 5,223 DTG-SBW trials were obtained. The DTG-SBW was acceptable in 1,449 children (81.3%); the coefficient of variation was 39.8%. SIIIHe-SF6 was independently but weakly positively associated with age and BMI. In 276 children (21.2%), wheeze was reported. SIIIHe-SF6 was higher by 0.049 g.mol.L-1 in children with wheeze compared with those without and remained associated with wheeze after adjusting for age and BMI in a multivariable linear regression model. SIIIHe-SF6 was not associated with Feno, FEV1, and FEV1/FVC.
Interpretation:
The DTG-SBW is feasible in a pediatric field study setting. On the population level, age, body composition, and wheeze are independent predictors of peripheral airway function in unselected schoolchildren. The variation of the DTG-SBW possibly constrains its current applicability on the individual level.
Trial Registration:
ClinicalTrials.gov; No.: NCT03659838; URL: www.
Clinicaltrials:
gov.
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