Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough

John Saito, William T. Harris, Jonathan Gelfond, Terry L. Noah, Margaret W. Leigh, Robin Johnson, Stephanie D. Davis

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Assessing airway disease in young children with wheeze and/or cough is challenging. We conducted a prospective, descriptive study of lung function in children <3 years old with recurrent wheeze and/or cough, who had failed empiric antiasthma and/or antireflux therapy and subsequently underwent flexible bronchoscopy. Our goals were to describe radiographic, anatomical, microbiological, and physiological findings in these children, and generate hypotheses about their respiratory physiology. Plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) techniques were performed prior to bronchoscopy. Mean Z-scores (n = 19) were -1.34 for forced expiratory volume at 0.5 sec (FEV0.5), -2.28 for forced expiratory flows at 75% of forced vital capacity (FVC) (FEF75), -2.25 for forced expiratory flows between 25-75% of FVC (FEF25-75), 2.53 for functional residual capacity (FRC), and 2.23 for residual volume divided by total lung capacity (RV/TLC). Younger, shorter children had markedly depressed FEF75 and FEF25-75 Z-scores (P = 0.002 and P = <0.001, respectively). As expected, lower airway anatomical abnormalities, infection, and inflammation were common. Elevated FRC was associated with anatomical lower airway abnormalities (P = 0.03). FVC was higher in subjects with neutrophilic inflammation (P = 0.03). There was no association between other physiologic variables and bronchoscopic/bronchoalveolar lavage fluid findings. Half of those with elevated RV/TLC ratios (Z-score >2) had no evidence of chest radiograph hyperinflation. We conclude that in this population, plethysmography and RVRTC techniques are useful in identifying severity of hyperinflation and airflow obstruction, and we hypothesize that younger children may have relatively small airways caliber, significantly limiting airflow, and thus impairing secretion clearance and predisposing to lower airway infection.

Original languageEnglish (US)
Pages (from-to)709-719
Number of pages11
JournalPediatric pulmonology
Volume41
Issue number8
DOIs
StatePublished - Aug 1 2006

Fingerprint

Bronchoalveolar Lavage Fluid
Cough
Plethysmography
Thorax
Prospective Studies
Lung
Infection
Population

Keywords

  • Airway inflammation
  • Bronchitis
  • Bronchoscopy
  • Forced expiratory flows
  • Infant pulmonary function tests
  • Plethysmography
  • Raised volume technique

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough. / Saito, John; Harris, William T.; Gelfond, Jonathan; Noah, Terry L.; Leigh, Margaret W.; Johnson, Robin; Davis, Stephanie D.

In: Pediatric pulmonology, Vol. 41, No. 8, 01.08.2006, p. 709-719.

Research output: Contribution to journalArticle

Saito, John ; Harris, William T. ; Gelfond, Jonathan ; Noah, Terry L. ; Leigh, Margaret W. ; Johnson, Robin ; Davis, Stephanie D. / Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough. In: Pediatric pulmonology. 2006 ; Vol. 41, No. 8. pp. 709-719.
@article{62ea882ac32f436e9a980fb6e95c2d43,
title = "Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough",
abstract = "Assessing airway disease in young children with wheeze and/or cough is challenging. We conducted a prospective, descriptive study of lung function in children <3 years old with recurrent wheeze and/or cough, who had failed empiric antiasthma and/or antireflux therapy and subsequently underwent flexible bronchoscopy. Our goals were to describe radiographic, anatomical, microbiological, and physiological findings in these children, and generate hypotheses about their respiratory physiology. Plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) techniques were performed prior to bronchoscopy. Mean Z-scores (n = 19) were -1.34 for forced expiratory volume at 0.5 sec (FEV0.5), -2.28 for forced expiratory flows at 75{\%} of forced vital capacity (FVC) (FEF75), -2.25 for forced expiratory flows between 25-75{\%} of FVC (FEF25-75), 2.53 for functional residual capacity (FRC), and 2.23 for residual volume divided by total lung capacity (RV/TLC). Younger, shorter children had markedly depressed FEF75 and FEF25-75 Z-scores (P = 0.002 and P = <0.001, respectively). As expected, lower airway anatomical abnormalities, infection, and inflammation were common. Elevated FRC was associated with anatomical lower airway abnormalities (P = 0.03). FVC was higher in subjects with neutrophilic inflammation (P = 0.03). There was no association between other physiologic variables and bronchoscopic/bronchoalveolar lavage fluid findings. Half of those with elevated RV/TLC ratios (Z-score >2) had no evidence of chest radiograph hyperinflation. We conclude that in this population, plethysmography and RVRTC techniques are useful in identifying severity of hyperinflation and airflow obstruction, and we hypothesize that younger children may have relatively small airways caliber, significantly limiting airflow, and thus impairing secretion clearance and predisposing to lower airway infection.",
keywords = "Airway inflammation, Bronchitis, Bronchoscopy, Forced expiratory flows, Infant pulmonary function tests, Plethysmography, Raised volume technique",
author = "John Saito and Harris, {William T.} and Jonathan Gelfond and Noah, {Terry L.} and Leigh, {Margaret W.} and Robin Johnson and Davis, {Stephanie D.}",
year = "2006",
month = "8",
day = "1",
doi = "10.1002/ppul.20387",
language = "English (US)",
volume = "41",
pages = "709--719",
journal = "Pediatric Pulmonology",
issn = "8755-6863",
publisher = "Wiley-Liss Inc.",
number = "8",

}

TY - JOUR

T1 - Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough

AU - Saito, John

AU - Harris, William T.

AU - Gelfond, Jonathan

AU - Noah, Terry L.

AU - Leigh, Margaret W.

AU - Johnson, Robin

AU - Davis, Stephanie D.

PY - 2006/8/1

Y1 - 2006/8/1

N2 - Assessing airway disease in young children with wheeze and/or cough is challenging. We conducted a prospective, descriptive study of lung function in children <3 years old with recurrent wheeze and/or cough, who had failed empiric antiasthma and/or antireflux therapy and subsequently underwent flexible bronchoscopy. Our goals were to describe radiographic, anatomical, microbiological, and physiological findings in these children, and generate hypotheses about their respiratory physiology. Plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) techniques were performed prior to bronchoscopy. Mean Z-scores (n = 19) were -1.34 for forced expiratory volume at 0.5 sec (FEV0.5), -2.28 for forced expiratory flows at 75% of forced vital capacity (FVC) (FEF75), -2.25 for forced expiratory flows between 25-75% of FVC (FEF25-75), 2.53 for functional residual capacity (FRC), and 2.23 for residual volume divided by total lung capacity (RV/TLC). Younger, shorter children had markedly depressed FEF75 and FEF25-75 Z-scores (P = 0.002 and P = <0.001, respectively). As expected, lower airway anatomical abnormalities, infection, and inflammation were common. Elevated FRC was associated with anatomical lower airway abnormalities (P = 0.03). FVC was higher in subjects with neutrophilic inflammation (P = 0.03). There was no association between other physiologic variables and bronchoscopic/bronchoalveolar lavage fluid findings. Half of those with elevated RV/TLC ratios (Z-score >2) had no evidence of chest radiograph hyperinflation. We conclude that in this population, plethysmography and RVRTC techniques are useful in identifying severity of hyperinflation and airflow obstruction, and we hypothesize that younger children may have relatively small airways caliber, significantly limiting airflow, and thus impairing secretion clearance and predisposing to lower airway infection.

AB - Assessing airway disease in young children with wheeze and/or cough is challenging. We conducted a prospective, descriptive study of lung function in children <3 years old with recurrent wheeze and/or cough, who had failed empiric antiasthma and/or antireflux therapy and subsequently underwent flexible bronchoscopy. Our goals were to describe radiographic, anatomical, microbiological, and physiological findings in these children, and generate hypotheses about their respiratory physiology. Plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) techniques were performed prior to bronchoscopy. Mean Z-scores (n = 19) were -1.34 for forced expiratory volume at 0.5 sec (FEV0.5), -2.28 for forced expiratory flows at 75% of forced vital capacity (FVC) (FEF75), -2.25 for forced expiratory flows between 25-75% of FVC (FEF25-75), 2.53 for functional residual capacity (FRC), and 2.23 for residual volume divided by total lung capacity (RV/TLC). Younger, shorter children had markedly depressed FEF75 and FEF25-75 Z-scores (P = 0.002 and P = <0.001, respectively). As expected, lower airway anatomical abnormalities, infection, and inflammation were common. Elevated FRC was associated with anatomical lower airway abnormalities (P = 0.03). FVC was higher in subjects with neutrophilic inflammation (P = 0.03). There was no association between other physiologic variables and bronchoscopic/bronchoalveolar lavage fluid findings. Half of those with elevated RV/TLC ratios (Z-score >2) had no evidence of chest radiograph hyperinflation. We conclude that in this population, plethysmography and RVRTC techniques are useful in identifying severity of hyperinflation and airflow obstruction, and we hypothesize that younger children may have relatively small airways caliber, significantly limiting airflow, and thus impairing secretion clearance and predisposing to lower airway infection.

KW - Airway inflammation

KW - Bronchitis

KW - Bronchoscopy

KW - Forced expiratory flows

KW - Infant pulmonary function tests

KW - Plethysmography

KW - Raised volume technique

UR - http://www.scopus.com/inward/record.url?scp=33746636456&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33746636456&partnerID=8YFLogxK

U2 - 10.1002/ppul.20387

DO - 10.1002/ppul.20387

M3 - Article

C2 - 16779841

AN - SCOPUS:33746636456

VL - 41

SP - 709

EP - 719

JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

SN - 8755-6863

IS - 8

ER -