Assessing respiratory function in young children: Developmental considerations - 18/08/11

Doi : 10.1016/j.jaci.2004.12.1112

Gary L. Larsen, MD ^a,^⁎ , June-Ku Brian Kang, MD ^a, Theresa Guilbert, MD ^b, Wayne Morgan, MD, CM ^b
^a From National Jewish Medical and Research Center, Denver
^b University of Arizona College of Medicine, Tucson

Reprint requests: Gary L. Larsen, MD, Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson St, Denver, Colorado 80206.

Denver, Colo, and Tucson, ArizThis activity is available for CME credit. See page 30A for important information.

Abstract

The purpose of this review is to provide practitioners and clinical investigators with an update on methods of assessing respiratory function in young children. The importance of this topic is presented in light of the natural history of asthma, as well as maturational changes that occur early in life in terms of airway development. Models of disease are cited to support the concept that injury of the mammalian airway early in postnatal life might have far-reaching consequences in terms of control of airway caliber and responsiveness. The methods currently available to measure respiratory function in our younger patients are outlined. The ability of children to perform the maneuvers necessary for this testing is considered as a function of age. Areas in which research and development are needed are highlighted.

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Key words : Airway development, childhood asthma, forced oscillation techniques, interrupter techniques, pulmonary function tests, spirometry, whole body plethysmography

Abbreviations used : COV, Crs, Fres, FVC, Irs, MEFV, NANCe, NANCi, PEFV, Pint, Pmo, Rint, Rrs, sRaw, Xrs, Zrs

Plan

Pathogenesis of asthma in infants and children

Maturation of immune responses and airway control

Models of airway dysfunction in developing species

Assessing respiratory function in young children

Spirometry in young children

Whole-body plethysmography

Interrupter techniques

Forced oscillation techniques

Summary

(Supported by a grant from GlaxoSmithKline, Inc, Research Triangle Park, NC)
Series editor: Harold S. Nelson, MD

Supported in part by grants HL 36577 and HL 67818 from the National Heart, Lung, and Blood Institute.
Disclosure of potential conflict of interest: J.-K. B. Kang—none disclosed. G. L. Larsen has consultant arrangements with GlaxoSmithKline, is on the Advair Pediatric Specialist Advisory Board, and receives grants/research support from HL36577 and HL67818 from the National Heart, Lung, and Blood Institute. T. Guilbert has consultant arrangements with GlaxoSmithKline; receives grants/research support from GlaxoSmithKline; is on the Speaker's Bureau for GlaxoSmithKline, Astra Zeneca, SOMA (medical education programs), and Innovia Educational Institute; and is an Exchange Program Steering Committee Member. W. J. Morgan has a consultant arrangement with Genentech and is Chair of the Epidemiology Study of Cystic Fibrosis.