Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants

Abstract

Objectives: The aim of this study was to compare subjective measures (overall health assessment both by the study physician and the child’s mother) with objective measurements of forced expiratory volumes (FEV_t) and maximal flow at functional residual capacity v̇_maxFRC) in recurrently wheezy infants. Methods: Sixteen wheezy infants (12 boys) aged 8–26 months were studied. A clinical assessment at visit 1 was followed by the run-in period during which day- and nighttime asthma symptom scores were obtained. The actual study period consisted of 2 visits when patient’s lung function was assessed. The first of which was during an acute exacerbation (visit 2), while the second was when the infant was asymptomatic (visit 3). FEV_t were obtained by the raised volume rapid thoracic compression technique (RVRTC) and v̇_maxFRC by the tidal volume rapid thoracic compression technique (TVRTC). Results: Mean FEV_t but not mean v̇_maxFRC were significantly lower at visit 2 compared to visit 3 (FEV_0.5: p = 0.005, and FEV_0.75: p = 0.002; v̇_maxFRC: p = 0.15) and correlated well with overall health assessment by the study physician (FEV_0.5: r = 0.82, and FEV_0.75: r = 0.84), but not with the overall health assessment by the mother. Conclusions: We have shown in the present study that objective measurements of FEV_t from a raised lung volume correlate well with the overall health assessment by the study physician; this was in contrast to measurements of v̇_maxFRC in the tidal volume range. We therefore conclude that the RVRTC technique is a feasible method to assess and monitor obstructive lung disease in infancy.

The effect of montelukast on lung function and exhaled nitric oxide in infants with early childhood asthma

“…However, the treatment period was relatively short, and more significant changes in lung function may occur with longer anti-inflammatory treatment. The present findings are in accordance with the study of WILDHABER et al [36], which showed that objective measurements of FEVt correlate well with the overall health assessment of the study physician, but not the assessment of the caregiver.…”

“…Although they do not always appear to be reliable [35,36], they were used as an additional tool in the present study. Symptom scores were not a major outcome in the current study due to the short intervention period and their variable nature.…”

Infant Lung Function Testing – Moving into the Clinic Now?

“…The papers by Wildhaber et al [1] and Lagerstrand et al [2] in this issue of Respiration indicate that assessment of airway function may soon become a routine procedure for the evaluation of infants with chest disease and the assessment of response to therapy. Lung function tests for adults were developed to a large extent during the 1950s and then standardized during the next 2 decades.…”

“…Hopefully, the availability of the methods will make it possible to better characterize lung disease in individual infants and to assess their response to therapy objectively. Currently, this is accomplished to a large extent through parent's reporting and doctor's clinical assessment [1].…”

“…It is obvious from the two papers in this issue of Respiration [1,2] that measuring single parameters of airway function such as forced expiratory volumes (FEVt) [1] or maximum respiratory flow at functional residual capacity (V max FRC) [1,2] may not give the investigator a full picture of the airway function of the infant. It appears from the paper by Wildhaber et al [1] that measuring FEVt using the raised-volume rapid thoracic compression technique may be more informative than V max FRC obtained with the tidal thoracic compression technique.…”