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Lung Function Assessment in Pediatric Asthma: Selecting the Optimal Tests for Clinical and Research Applications
Giulia Michela Pellegrino1, Alessandro Gobbi2,3, Marco Fantini4
1Dipartimento di Scienze Neuroriabilitative, Casa di Cura Igea, 20144 Milano, Italy.
Insights
Lung function tests are crucial for diagnosing and monitoring pediatric asthma. New methods like the forced oscillation technique (FOT) offer deeper insights into this complex airway disease.
Area of Science:
- Pediatric Respiratory Medicine
- Pulmonary Function Testing
- Asthma Research
Background:
- International pediatric respiratory societies recommend lung function tests for clinical practice and research.
- Lung function tests assess ventilatory function, aiding in the diagnosis and understanding of respiratory diseases.
- Childhood bronchial asthma, a common chronic condition, benefits significantly from lung function testing due to its complexity and variable airway obstruction.
Purpose of the Study:
- To review the utility of various lung function tests in managing pediatric asthma.
- To guide clinicians and researchers in selecting optimal methodologies for asthma diagnosis and follow-up.
- To explore the potential of emerging lung function technologies in asthma assessment.
Main Methods:
- Review of existing literature on lung function tests in pediatric asthma.
- Comparison of traditional methods (spirometry, interrupter technique) with newer technologies (multiple breath nitrogen washout, forced oscillation technique).
- Evaluation of diagnostic and monitoring capabilities of different tests.
Main Results:
- Spirometry and interrupter technique are established methods for childhood asthma diagnosis and monitoring.
- Newer techniques like multiple breath nitrogen washout and forced oscillation technique provide a more detailed understanding of asthma.
- Forced oscillation technique shows promise for improved measurement acceptability in less cooperative children, enabling home-based monitoring.
Conclusions:
- Lung function tests are essential for comprehensive pediatric asthma management.
- Emerging technologies offer advanced insights into the complex nature of asthma, including its structural and temporal disorganization.
- The forced oscillation technique presents a valuable tool for improving patient cooperation and expanding monitoring settings in pediatric asthma.
Abstract:
Recent documents from leading international pediatric respiratory societies have strongly encouraged the use of lung function tests in clinical practice and research. These tests can explore ventilatory function across its volumetric and temporal domains, providing information on the intrapulmonary location and extent of damage caused by respiratory diseases. The choice of which test to use in each case to investigate presenting respiratory symptoms depends on the patient's symptoms and the diagnostic-therapeutic phase being addresse d. In the most common and representative chronic pediatric condition-bronchial asthma-lung function tests play an especially important role due to the disease's complexity and the fluctuating nature of airway obstruction. This review aims to examine the potential of various lung function tests in asthma, helping clinicians and researchers to optimize diagnosis and follow-up with the most appropriate methodology. While spirometry and flow resistance measurements using the interrupter technique have historically been the cornerstones of diagnosis and clinical monitoring in childhood asthma, the advent of new technologies-such as multiple breath nitrogen washout (MBNW) and the forced oscillation technique (FOT)-is opening up the door to a more nuanced view of the disease. These tools allow for an evaluation of asthma as a structurally complex and topographically and temporally disorganized condition. FOT, in particular, facilitates measurement acceptability in less cooperative subjects, both in respiratory physiology labs and even at the patient's home.
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