Lung ultrasound findings in asymptomatic healthy children with asthma

Abstract

Background Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress. However, very little is known about LUS findings in pediatric asthma. Objectives The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. Methods Eligible patients, aged 6−17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six‐zone scanning protocol. Presence of a LUS artifact was defined by one or more of the following: ≥3 B‐lines per intercostal space, pulmonary consolidation, and/or pleural abnormality. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. Results Fifty‐two patients were included. 10/52 (19.2%) patients demonstrated the presence of LUS artifacts: 8 with ≥3 B‐lines, 1 with consolidation >1 cm, and 7 with subpleural consolidations <1 cm, 1 with a pleural line abnormality. Artifacts were seen in the right anterior and lateral zones in 60% of participants and were limited to 1−2 intercostal space(s) within one lung zone in all participants. No association was found between presence of LUS artifacts and asthma control or severity. Conclusion To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. LUS artifacts in asthmatic children can be seen outside of acute exacerbations. Such baseline findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.

Pleural line slope in point of care ultrasound assessment of paediatric wheeze may reflect respiratory effort

“…We also found a moderate correlation between pleural line slope and excursion. Subpleural infiltrates on POCUS were consistent with those in asthmatic children described elsewhere 8 …”

“…Subpleural infiltrates on POCUS were consistent with those in asthmatic children described elsewhere. 8 In a child without lower airway obstruction, the relationships between the ultrasound probe, chest wall and pleura are consistent throughout the respiratory cycle, resulting in the flat tracing of the pleural line. In a child with lower airway obstruction and increased respiratory effort, the peaks of pleural retraction can be appreciated both qualitatively and quantitatively.…”

Pediatric pulmonology 2022 year in review: Asthma

“…Marzook et al performed lung ultrasounds in six lung zones for children aged 6–17 years with symptomatic and asymptomatic asthma in an outpatient clinic visit. In this prospective, cross‐sectional study, the authors found that 19% of children with asthma had evidence of a lung artifact, with a predominance in the right anterior and lateral lung zones 3 . Importantly, there was no association between presence of an artifact and asthma control or severity.…”

“…In this prospective, cross-sectional study, the authors found that 19% of children with asthma had evidence of a lung artifact, with a predominance in the right anterior and lateral lung zones. 3 Importantly, there was no association between presence of an artifact and asthma control or severity. For optimal comparison, further investigation is needed to understand baseline lung ultrasounds in healthy children.…”

Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting

“…The main ultrasound findings in children with asthma are B lines, pulmonary consolidations, and/or pleural abnormality. These artifacts can be seen both outside of acute exacerbations [43] and during exacerbations. In particular, Dankoff et al showed that pathologic lung ultrasound scans performed in asthmatic patients accessing the emergency department were related to increased antibiotic use, prolonged length of stay in the emergency department, and increased rate of hospitalization [44].…”