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Diagnostic utility of spirometry for children with induced laryngeal obstruction or chronic non-specific cough
Robert Brinton Fujiki1, Susan L Thibeault1
1Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States of America.
Insights
Spirometry is not effective for diagnosing or differentiating pediatric Induced Laryngeal Obstruction (ILO) or chronic cough from mild asthma. These conditions often present with normal spirometry results, unlike moderate to severe asthma.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Diagnostic Utility
Background:
- Distinguishing between pediatric respiratory conditions like Induced Laryngeal Obstruction (ILO), chronic non-specific cough, and asthma is clinically significant.
- Spirometry is a common tool for assessing lung function, but its utility in differentiating these specific conditions in children requires evaluation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of spirometry in differentiating children with ILO or chronic non-specific cough from those with mild or moderate to severe asthma.
Main Methods:
- A retrospective cross-sectional study analyzed spirometry data from children diagnosed with ILO, chronic non-specific cough, mild asthma, or moderate to severe asthma.
- Key spirometry parameters including FVC, FEV1, FEV1/FVC, and FEF25-75% were extracted and compared across groups.
Main Results:
- Children with ILO and chronic non-specific cough, as well as those with mild asthma, predominantly exhibited spirometry values within the normal range.
- Moderate to severe asthma cases showed significantly reduced FVC, FEV1, FEV1/FVC, and FEF25-75% compared to the other groups.
- Flow volume loops were generally normal in children diagnosed with ILO or chronic non-specific cough.
Conclusions:
- Spirometry alone is insufficient for diagnosing or differentiating ILO and chronic non-specific cough from mild asthma in children.
- The findings suggest judicious use of spirometry in this pediatric population, acknowledging its limitations.
- Further research is needed to identify optimal methods for distinguishing ILO and chronic non-specific cough from other pediatric respiratory conditions.
Purpose:
To determine the diagnostic utility of spirometry in distinguishing children with Induced Laryngeal Obstruction (ILO) or chronic non-specific cough (a.k.a. tic cough) from those with mild or moderate to severe asthma.
Methods:
Retrospective cross sectional design. Children diagnosed with ILO (N = 70), chronic non-specific cough (N = 70), mild asthma (N = 60), or moderate to severe asthma (N = 60) were identified from the electronic medical record of a large children's hospital. Spirometry was completed before ILO, non-specific cough, or asthma diagnoses were made by pediatric laryngologists or pulmonologists. Spirometry was performed following American Thoracic Society guidelines and was interpreted by a pediatric pulmonologist. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1), FEV1/FVC Ratio (FEV1/FVC), Forced Mid-Expiratory Flow 25--75 % (FEF25-75%), pulmonologist interpretation of flow volume loops, and overall exam findings were extracted from the medical record.
Results:
Ninety seven percent of children with ILO or chronic non-specific cough presented with spirometry values within normative range. Patients with ILO, non-specific cough, and mild asthma presented with FVC, FEV1, FEV1/FVC, and FEF25-75% values in statistically similar range. Children with moderate to severe asthma presented with significantly reduced FVC (p < .001), FEV1 (p < .001), FEV1/FVC (p < .001), and FEF25-75% (p < .001) values when compared with patients in the other groups. Flow volume loops were predominantly normal for children with ILO and non-specific cough.
Conclusions:
Findings indicate that ILO and chronic non-specific cough can neither be diagnosed nor differentiated from mild asthma using spirometry alone. Spirometry should therefore be used judiciously with this population, bearing in mind the limitations of the procedure. Future research should determine the most effective and efficient ways of delineating ILO and non-specific cough from other respiratory conditions in children.
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