Multiple breath washouts in children can be shortened without compromising quality

Ahmad, Fatima; Irving, Samantha; Alton, Eric W.F.W.; Davies, Jane C.; Macleod, Kenneth; Rosenthal, Mark E.; Saunders, Clare; Bush, Andrew; Saglani, Sejal; Fleming, Louise

doi:10.1183/13993003.00791-2015

Cited by 12 publications

(7 citation statements)

References 8 publications

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“…Our data verify that the discriminative power successively decreases at earlier cut‐offs in MBW SF6 . This is in contrast to the findings in MBW N2 . The reasons for this relate to differences in study populations with varying degrees of lung disease, different physiological properties of the tracer gases, and different mathematical properties with regard to cut‐off values …”

Section: Discussionmentioning

confidence: 66%

“…As this is the first study assessing the impact of the cut‐off on MBW outcomes in infant SF 6 measurements, we were not able to perform a formal sample size calculation prior to the analyses. Our sample size was thus based on comparable MBW studies in older children assessing different cut‐off values . Given that the prevalence of structural lung pathologies, such as bronchiectasis in our population was presumably around 20% in infants with cystic fibrosis but in fact unknown, we did not apply Receiver Operating Characteristic statistics in this study.…”

Section: Discussionmentioning

confidence: 99%

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Lung clearance index and moment ratios at different cut-off values in infant multiple-breath washout measurements

et al. 2016

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Lung clearance index and moment ratios at different cut-off values in infant multiple-breath washout measurements

et al. 2016

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“…In consideration of this, shorter gas washout protocols, such as the LCI5% [5][6][7] and a new tidal single breath washout test (SBW) based on helium and sulfur hexafluoride (double-tracer gas (DTG)), seem promising to shorten the assessment of VI and to provide more specific estimates as to where in the airway tree VI may originate. These outcome variables are sensitive markers to detect diffusion-and diffusion-convection-dependent VI in lung diseases such as CF, asthma and chronic obstructive pulmonary disease (COPD) [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Alternative inert gas washout outcomes in patients with primary ciliary dyskinesia

et al. 2017

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The lung clearance index (LCI) derived from a nitrogen multiple breath washout test (N-MBW) is a promising tool to assess small airways disease in primary ciliary dyskinesia, but it is difficult to apply in routine clinical settings because of its long measuring time. In this study, we aimed to assess alternative indices derived from shorter washout protocols.49 patients with primary ciliary dyskinesia (mean age 14.7±6.6 years) and 37 controls (mean age 14.3±1.4 years) performed N-MBW and double-tracer gas (DTG) single-breath washout tests. Global (LCI and moment ratio (M/M)), conductive (S) and acinar ventilation inhomogeneity (DTG Slope III (S-DTG)) were determined for each individual. The main outcomes were 1) the ability to detect abnormal lung function from washout indices (>1.64 z-scores) and 2) measurement duration.The prevalence of abnormal values for LCI was 37 out of 47 (79%), for LCI was 34 out of 47 (72%), for M/M was 34 out of 47 (72%), for S was 36 out of 46 (78%) and for S-DTG was 12 out of 35 (34%). Mean±sd duration of measurement was 19.8±11.2 min for LCI, 10.8±4.6 min for LCI and 8.6±2.3 min for SCompared to standard LCI, ventilation inhomogeneity was detected by LCI, moment ratio and S with comparable sensitivity while measurement duration was significantly shorter. Longitudinal studies will show which outcome is most suitable and practical in terms of sensitivity, duration and variability within the course of primary ciliary dyskinesia lung disease.

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“…Spirometry can be performed in two-thirds of 2–5-year-old childen 64. Reversibility testing is harder to do in this age group since the changes with bronchodilators may be less than the baseline variance of the method,65 and lung clearance index is not useful in this context 66. Induced sputum can be obtained even in very young children and gives a better indication of any bacterial infection;67 however, it poorly reflects bronchoalveolar lavage eosinophilia in this age group, unlike in older children 68.…”

Section: Can We Do Better?mentioning

confidence: 99%

Infantile wheeze: rethinking dogma

Benedictis

Bush

2016

Arch Dis Child

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Wheeze is a common symptom in young children and is usually associated with viral illnesses. It is a major source of morbidity and is responsible for a high consumption of healthcare and economic resources worldwide. A few children have a condition resembling classical asthma. Rarer specific conditions may have a wheezy component and should be considered in the differential diagnosis. Over the last half century, there have been many circular discussions about the best way of managing preschool wheeze. In general, intermittent wheezing should be treated with intermittent bronchodilator therapy, and a controller therapy should be prescribed for a young child with recurrent wheezing only if positively indicated, and only then if carefully monitored for efficacy. Good multidisciplinary support, attention to environmental exposition and education are essential in managing this common condition. This article analyses the pathophysiological basis of wheezing in infancy and critically discusses the evolution of the scientific progress over time in this unique field of respiratory medicine.

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Multiple breath washouts in children can be shortened without compromising quality

Cited by 12 publications

References 8 publications

Lung clearance index and moment ratios at different cut-off values in infant multiple-breath washout measurements

Lung clearance index and moment ratios at different cut-off values in infant multiple-breath washout measurements

Alternative inert gas washout outcomes in patients with primary ciliary dyskinesia

Infantile wheeze: rethinking dogma

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