Effect of pattern of preceding inspiration on FEV1 in asthmatic children

In adults, both peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1) are significantly influenced by the time course of the inspiration preceding the forced expiration. The aim of this study was to evaluate the effects of three different inspiratory manoeuvres on PEF, FEV1, and forced vital capacity (FVC) in asthmatic children. Twenty five symptomless asthmatic children performed forced expiration preceded by three different inspiratory manoeuvres, which consisted of: a rapid inspiration with a 2 s end-inspiratory breathhold (Manoeuvre No. 1); a rapid inspiration without an end-inspiratory breathhold (Manoeuvre No. 2); and a slow inspiration lasting about 5 s with an end-inspiratory breathhold of at least 4 s (Manoeuvre No. 3). All manoeuvres were performed in a randomly assigned sequence each morning for three consecutive days. In each session, the manoeuvres were repeated three times and the highest value was chosen. Both FVC and FEV1 obtained with Manoeuvre No. 3 were significantly lower than the corresponding values obtained with Manoeuvre Nos. 1 and 2. The mean (SD) FVC values were 2.76 (0.66) L with Manoeuvre No. 1, 2.67 (0.58) L with Manoeuvre No. 2 and 2.52 (0.52) L with Manoeuvre No. 3. The corresponding values of FEV1 were 2.25 (0.53), 2.22 (0.53) and 2.07 (0.44) L, respectively. By contrast, the values of PEF, obtained with a portable peak flow meter, were similar with the three different inspiratory manoeuvres. The results of this study show that in symptomless asthmatic children the preceding inspiratory manoeuvre may influence forced vital capacity and forced expiratory volume in one second. Hence, in order to reduce variability due to interference by physiological factors and so improve reproducibility of pulmonary function tests, the inspiratory manoeuvres must be accurately standardized.