Respiratory disease and respiratory physiology: Putting lung function into perspective: Paediatric asthma

Abstract

Dealing with paediatric asthma in daily practice, we are mostly interested in the airway function: the hallmark of asthma is the variability of airway patency. Various pulmonary function tests (PFT) can be used to quantify airway caliber in asthmatic children. The choice of the test is based on the developmental age of the child, knowledge of the diagnosis/underlying pathophysiology, clinical questions and reasoning, and treatment. PFT is performed to monitor the severity of asthma and the response to therapy, but can also be used as a diagnostic tool, and to study growth and development of the lungs and airways.This review aims to provide clinicians an overview of the differences in assessing PFT in infants and preschool children compared with older cooperative children, which tests are feasible in infants and young children, the limitations of and usefulness of these tests, and of their interpretation in these age groups. The Authors: Lara S. van den Wijngaart, MD, MSc, is a registrar paediatrics at the Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands. She also has a master's degree in health science and is involved in research on e-health in children with asthma. Jolt Roukema, MD, PhD, is a paediatric pulmonologist at the Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands. His interests are on innovation and diagnostic research in paediatrics, and he is currently involved in research and clinical projects on e-health in children with asthma and cystic fibrosis and patients with allergic rhinitis. Peter J.F.M. Merkus, MD, PhD, is paediatric pulmonologist at the Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands. He is involved in publications and guidelines on paediatric and infant lung function testing, and clinical research into diagnostic techniques and treatment in children with asthma and cystic fibrosis.

Fractional exhaled nitric oxide and multiple breath nitrogen washout in preschool healthy and asthmatic children

“…Airway remodeling is a key feature in adult asthma [32], and it appears to develop early in preschool years [33]. We demonstrated an elevated S cond in children with asthma, which theoretically corresponded to an impaired conductive airway zone; consequently, S cond had moderate discriminative power.…”

Use of Global initiative for asthma (GINA) guidelines in asthma management among paediatric residents in a Sub Saharan African country: a cross-sectional descriptive study

“…Even though asthma diagnosis can be made with history of symptoms and signs, particularly in children, proper classification and follow-up requires the use of physiological assessment of lung function. Spirometry is the gold standard for making a definitive asthma diagnosis [ 1 , 5 ]. Peak flow meters though more common, are more useful for monitoring progress in already diagnosed individuals [ 5 , 6 ].…”

Efeitos do inibidor específico para serinoprotease rBmTI-A em modelo experimental de inflamação pulmonar alérgica crônica em camundongos Balb/c

“…A camada epitelial é a primeira barreira natural de proteção das vias aéreas contra a entrada de alérgenos, microorganismos e outros poluentes ambientais (van den Wijngaart et al, 2015). Assim a ruptura epitelial desse tecido desempenha um papel relevante na amplificação da inflamação, por perda da sua função de barreira e alteração do transporte mucociliar, permitindo a penetração de alérgenos e prejudicando a liberação de enzimas que degradam mediadores inflamatórios (Bousquet et al, 2000).…”

“…Segundo Van den Wijngaart et al (2015), quando não ocorre o processo de tolerização, duas vias desempenham papel importante na patofisiologia da asma: uma, responsável pela fase imediata (ou aguda), e outra responsável pela fase tardia. Na primeira via (fase aguda), os linfócitos B são transformados em plasmócitos e na presença de citocinas, como as interleucinas IL-4 e IL-13, ocorre troca de imunoglobulina clássica (Ig) para IgE (Busse e Lemanske, 2001).…”

“…Na fase tardia, os antígenos apresentados por células dendríticas são transformados em pequenos peptídeos que interagem com as células reguladoras e estimulam a produção de linfócitos Th (van den Wijngaart et al, 2015). Durante a ativação dos receptores de células T em um ambiente de citocinas, células T CD4+ podem se diferenciar em linhagens definidas pelo padrão de produção de citocinas e fatores de transcrição em células T tipo Th1, Th2, Th17 e Th22; células T auxiliares e células T regulatórias (Vanaudenaerde et al, 2011).…”