Lung function measurements in children - copsac

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pulmonary function test obtained by clinicians caring for children with respiratory diseases and invaluable as a screening test of general respiratory health. Younger children can rarely perform a maximal inspiration followed by a forced expiration sufficiently (29). Most schoolchildren are able to perform acceptable and repeatable spirometry that conforms to standard criteria (30, 31). Bronchial hyperresponsiveness Bronchial hyperreactivity (BHR) is a characteristic phenomenon in asthma, defined as an abnormal fall (FEV 1 ) in lung function (or rise in airway resistance) after direct or indirect airway challenge test with stimuli which induce increased airflow limitation. Test of BHR contributes to the asthma diagnose (32). Direct airway challenge tests (e.g. methacholine, histamine) cause airway narrowing by acting directly on their respective receptors on the bronchial smooth muscles. Methacholine challenge test are well established (33, 34) and guidelines have been published by the American Thoracic Society (35). The subject inhale increasing dose of methacholine until the FEV 1 falls by 20% or more and the provocative dose causing a 20% fall (PD 20 ) is calculated. A low PD 20 suggests severe bronchial responsiveness. Indirect airway challenge tests (e.g. exercise, hypertonic saline, cold air, mannitol, and adenosine) use non-allergic irritants that have no direct effect on the smooth airway muscles. Hyperventilation leads to dehydration of the cells in the airways, which induces release of bronchoconstricting mediators. Dry/cold air hyperventilation testing has a similar mechanism of osmotic dehydration. School children and adults traditionally use exercise test. This is applicable from the age of 7-8 years where adequate cooperation may be expected. For younger children Danish paediatricians developed a simple test, cold air provocation. The method is documented and has shown good predictive value and repeatability for asthma or ongoing asthma in preschool children. The test is positive if sRaw increases ≥3SD corresponding 20% or more (18, 36-38). Nitric oxide as an inflammatory marker Direct monitoring airway inflammation in respiratory diseases with bronchoscope taking biopsies or making broncho alveolar lavage (BAL) is limited in children because 8
of the invasive nature. In the last decade fractional exhaled nitric oxide (F E NO) has been studied as a non-invasive marker of eosinophilic airway inflammation (39, 40). F E NO has been correlated with BAL fluid and bronchial biopsies (41, 42). Studies have found higher concentration in subjects with asthma compared to healthy (43-46). Especially atopy seems to be a significant factor associated with a raised exhaled NO. In general F E NO has not correlated with lung function but positively associated with bronchial hyperresponsiveness (47, 48) and sensitive to changes in anti-inflammatory treatment (49). F E NO is now applied in the clinical setting as a supplement to the traditional lung function testing. 9
Page 1: Lung function measurements in child
Page 4 and 5: Contents Acknowledgements .........
Page 6 and 7: Acknowledgements The thesis was wri
Page 8 and 9: Introduction Symptoms of chronic re
Page 12 and 13: I. Accuracy of Wholebody Plethysmog
Page 14 and 15: Methods Designs Study I: Six center
Page 16 and 17: "Loops" on the screen showed the re
Page 18 and 19: We included age in the analysis of
Page 20 and 21: Normative data (study I) Mean sRaw
Page 22 and 23: Additional results sRaw measurement
Page 24 and 25: After correcting the factory settin
Page 26 and 27: Normative data In the second part o
Page 28 and 29: II. -III. Lung function measurement
Page 30 and 31: of a diagnosis of asthma: Frequent
Page 32 and 33: Figure 8: Familial predisposition t
Page 34 and 35: Total twins 12.349 twin pairs Born
Page 36 and 37: Methods Designs Study II: Hospital
Page 38 and 39: Children less than 7 years were tes
Page 40 and 41: Ethics The two studies were approve
Page 42 and 43: FEV 0.5 (ml) Table 4: Baseline char
Page 44 and 45: lung symptoms, 19% said it was the
Page 46 and 47: symptoms in response to verified RS
Page 48 and 49: epigenetic factors. Acute environme
Page 50 and 51: detection changes in lung function
Page 52 and 53: that small airways were not the dis
Page 54 and 55: onciolitis. There is an increasing
Page 56 and 57: further studies are needed to inves
Page 58 and 59: Summary The Ph.D. thesis is based o
Page 60 and 61:
Danish summary (Dansk resumé) Denn
Page 62 and 63:
References Reference List (1) Lum S
Page 64 and 65:
(25) Aurora P, Gustafsson P, Bush A
Page 66 and 67:
(50) Klug B, Bisgaard H. Repeatabil
Page 68 and 69:
(76) Meissner HC. Economic impact o
Page 70 and 71:
(101) Young S, Arnott J, O'Keeffe P
Page 72 and 73:
(125) Bisgaard H, Hermansen MN, Lol
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(151) Walton RP, Johnston SL. Role
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disease in otherwise healthy infant
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changes in asthma control. Am J Res
Page 81:
Paper I
Page 84 and 85:
CHEST Original Research Accuracy of
Page 86 and 87:
Figure 1. Center agreement study: l
Page 88 and 89:
observer as well as a common observ
Page 90 and 91:
sRaw (kPa*s) Figure 1 Online: Cente
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Page 95 and 96:
54 55 56 57 INTRODUCTION Respirator
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97 98 99 100 Lung function test Chi
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141 142 143 144 Mean gestational ag
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186 187 188 189 190 The discordant
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232 233 234 235 236 237 viruses and
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278 ACKNOWLEDGMENTS 279 280 281 282
Page 107 and 108:
335 336 (21) Bisgaard H, Nielsen KG
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394 395 396 (42) Wu P, Dupont WD, G
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455 456 457 (64) Bisgaard H, Herman
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488 489 Table 1: Comparison of clin
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Paper III
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Abstract Background: Two-three perc
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RA 08 TSM 133; Respiratory Care Cen
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prospectively if baseline lung func
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who do not develop RSV bronchioliti
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Acknowledgements We thank all the c
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(24) ATS/ERS statement: raised volu
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(53) Stein RT, Sherrill D, Morgan W
Page 132 and 133:
Figure 1: Flow chart COPSAC cohort
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Lung function measurements in children - copsac

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