Pulmonary Function Tests in Emergency Department Pediatric Patients with Acute Wheezing/Asthma Exacerbation

Abstract

Background. Pulmonary function tests (PFT) have been developed to analyze tidal breathing in patients who are minimally cooperative due to age and respiratory status. This study used tidal breathing tests in the ED to measure asthma severity. Design/Method. A prospective pilot study in pediatric patients (3 to 18 yrs) with asthma/wheezing was conducted in an ED setting using respiratory inductance plethysmography and pneumotachography. The main outcome measures were testing feasibility, compliance, and predictive value for admission versus discharge. Results. Forty patients were studied, of which, 14 (35%) were admitted. Fifty-five percent of the patients were classified as a mild-intermittent asthmatic, 30% were mild-persistent asthmatics, 12.5% were moderate-persistent asthmatics, and 2.5% were severe-persistent. Heart rate was higher in admitted patients as was labored breathing index, phase angle, and asthma score. Conclusions. Tidal breathing tests provide feasible, objective assessment of patient status in the enrolled age group and may assist in the evaluation of acute asthma exacerbation in the ED. Our results demonstrate that PFT measurements, in addition to asthma scores, may be useful in indicating the severity of wheezing/asthma and the need for admission.

Tidal breathing parameters measured by structured light plethysmography in children aged 2-12 years recovering from acute asthma/wheeze compared with healthy children

“…Although some asynchrony can be detected in healthy children (Sivan et al 1990;Newth and Hammer 2005), generally the thorax and abdomen move in phase in those without obstructive disease. However, when the work of breathing increases in children with acute asthma, movement of the abdomen precedes that of the thorax, resulting in a loss of this synchrony (Carlsen and Lodrup Carlsen 2010;Giordano et al 2012). The observation that within-subject variability in asynchrony is greater in children with asthma both between the thorax and abdomen and between the left and right hemithorax may suggest a compensatory mechanism in which spatial variability is introduced into the system when temporal variability is reduced.…”

pneuRIPTM: A Novel Respiratory Inductance Plethysmography Monitor

“…Pulmonary function (PF) testing and WOB indices are vital tools in the diagnosis of many pediatric respiratory diseases, as well as guiding pulmonary therapy [1,5,[9][10][11]. These tests and indices are currently available only for patients on ventilators.…”

“…Pulmonary function (PF) testing is a vital tool in the diagnosis and management of these pediatric respiratory diseases. Respiratory inductance plethysmography (RIP) and pneumotachography (PT) have been developed to analyze PF and tidal breathing in patients who are minimally cooperative because of their age or disease severity [9][10][11].…”

Quantitative Analysis of Thoracoabdominal Asynchrony in Pediatric Polysomnography

“…28 Another examined RIP as a possible clinical decision tool to predict admission of patients with asthma exacerbation from the emergency room. 29 Though a couple of studies have investigated quantitative use of RIP in infant sleep, only one looked at sleep in older children. In those studies, LBI avg was analyzed and found to predict OSA.…”