Spirometric pulmonary function in 3‐ to 5‐year‐old children

Abstract

Forced expiratory maneuvers are routinely used in children, 6 years of age and older for the diagnosis and follow-up of respiratory diseases. Our objective was to establish normative data for an extensive number of parameters measured during forced spirometry in healthy 3- to 5-year-old children. Children aged between 3 and 5 years were tested in 11 daycare centers. Usual parameters, including FEV1, FVC, PEF, FEF(25-75), FEF25, FEF50, FEF75, and Aex were measured and analyzed in relation to sex, age, height, and weight. In addition, the same analysis was performed for FEV0.5 and FEV0.75. One hundred sixty-four children were recruited for testing including 87 girls and 77 boys. Thirty-five were 3 years old, 63 were 4 years old, and 66 were 5 years old. Overall, 143 children (87%) accepted to perform the test and 128 children (78%) were able to perform at least two technically acceptable expiratory maneuvers. Analyses using different regression models showed that height was the best predictor for every parameter. In conclusion, the present study confirms that most healthy 3-5 years old children can perform valid forced expiratory maneuvers. In agreement with other studies, we found that height is the most important single predictor of various parameters measured on forced spirometry. The present study is the first to establish normative values for FEV0.75, as well as to demonstrate that Aex can be easily performed in the majority of children aged 3-5 years. These are likely important parameters of lung function in this age range.

Reference values for lung function: past, present and future

“…In the past 3 yrs reference equations have been published for: Brazilian adults [27], Polish adults [28], Chinese adults [29], Kazakh adolescents [30], Italian adults [31], and young children [32,33]. However, the abundance of unrelated studies can introduce new complexities, not least because most are not generalisable to any other population than the one in which they were collected.…”

“…However, the abundance of unrelated studies can introduce new complexities, not least because most are not generalisable to any other population than the one in which they were collected. Two exceptions to this were the Health Survey for England [32], which studied a large population (6,053 individuals) and included subjects from 16-90 yrs [31], and the recently published study by KUSTER et al [35] which was also based on a very large sample (8, predicted values as well as bias, particularly in elderly subjects who tend to overestimate their current height. Both of these studies were limited to older subjects, thereby excluding the complexities of puberty and growth spurts.…”

Reference Ranges for Spirometry Across All Ages

“…As part of the current exercise, NHANES III was reanalyzed to calculate FEV 0.75 , but because these data were not available from the other three datasets, they are currently limited to children older than 8 years, rather than the younger age group where they are most likely to be clinically useful. With the exception of some very recent reports on preschool spirometry (24,25), reference equations for FEV 0.75 in children remain limited and outdated. We are currently undertaking an international collaborative study to collate spirometric data in very young children, including FEV 0.75 (www.growinglungs.org.…”

“…Young children have relatively large airways compared with their lung volumes such that, during forced expiration, emptying may be virtually complete within 1 second. In such cases, FEV 1 largely reflects the FVC, suggesting that FEV 0.75 may be a more appropriate measure for young children (24,25). As part of the current exercise, NHANES III was reanalyzed to calculate FEV 0.75 , but because these data were not available from the other three datasets, they are currently limited to children older than 8 years, rather than the younger age group where they are most likely to be clinically useful.…”

Measurement of Interrupter Respiratory Resistance and Spirometry in Preschool Children: Influence of Respiratory Symptoms

“…was greatest, and where the maximum forced expiratory time was longer than 1 second in order to reach the residual volume or at least approach it. Overall, 76 children performed the spirometry correctly, while 27 children (26.2%) failed to do so, 18 of whom were (14). Baseline Rint is reported as measured values, percentages of predicted values and Z-scores calculated using published reference values (15).…”