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Annual Congress of Malaysian Thoracic Society Symposium 1B Lung Function Tests 6-MINUTE WALK TEST – A SIMPLE BUT VERY USEFUL TEST Chua Keong Tiong Malaysia There are various methods to assess the physiological impact of cardiopulmonary disorders. Detailed history taking is fundamental but at the same time very subjective and variable depending on patients’ perception and recollection of their symptoms. Therefore the objective physiological assessments are usually required in order to complete the assessment of individual patients before initiating the definite treatment. Among the clinical exercise tests, 6-minute walk test (6MWT) is easy to administer, better tolerated, and more reflective of activities of daily living than other walk tests. In this short presentation, I would like to share with you the indications, contraindication and the limitation of 6MWT. Addressing the important safety issues is essential to ensure no harm was made when performing the test. The technical aspect of 6MWT will be covered, focusing on the standardised method regarding location, required equipment, patient preparation and measurement as recommended by American Thoracic Society statement in 2002. Finally the variability and reproducibility of 6MWT are discussed together with interpretation of the result. 19
Annual Congress of Malaysian Thoracic Society Symposium 1C Paediatric Asthma Is there a rule for intermittent treatment in mild persistent asthma? Theresa Guilbert USA In children with mild persistent asthma, both American and International guidelines recommend the daily use of inhaled corticosteroids in low doses as the preferred treatment for the control of symptoms and asthma exacerbations. Often, parents or children have great difficulty adhering to daily treatment during long asymptomatic periods, and either use inhaled corticosteroids less frequently or discontinue treatment altogether. Guidelines also suggest weaning or withdrawal (step-down) of treatment after asthma control is achieved and maintained. Thus, challenges exist in the treatment of childhood mild asthma: when step-down asthma therapy and what treatment regimen will decrease the risk of asthma exacerbations. Emerging evidence suggest that the use of inhaled corticosteroids as rescue medication in combination with a bronchodilator can substantially decrease the frequency of asthma exacerbations that require prednisone. Moreover, in adults with mild asthma who took placebo twice daily, the use of beclomethasone plus albuterol as rescue was associated with substantially fewer exacerbations than was treatment with rescue albuterol alone, and with a similar frequency of exacerbations as with beclomethasone twice daily. Another recent study has shown that discontinuation of daily inhaled corticosteroids in children with well controlled, mild persistent asthma is associated with an increased risk of exacerbations. Furthermore, rescue beclomethasone lowered the risk of exacerbations and treatment failures, but to a lesser degree than does daily beclomethasone. Thus, in children with mild persistent asthma, use of rescue inhaled corticosteroid could be an effective step-down alternative to discontinuation of such treatment after asthma control is achieved. This rescue therapy may avoid the growth effects associated with use of daily inhaled corticosteroids. 20
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