Chest
Volume 133, Issue 1, January 2008, Pages 115-122
Journal home page for Chest

Original Research
ASTHMA
Feasibility of Repetitive Lung Function Measurements by Raised Volume Rapid Thoracoabdominal Compression During Methacholine Challenge in Young Infants

https://doi.org/10.1378/chest.07-1328Get rights and content

Background

The aim of the study was to evaluate the feasibility of lung function measurements by the raised volume rapid thoracoabdominal compression (RVRTC) technique during bronchial methacholine challenge in young infants.

Method

Four hundred two healthy infants were tested at 1 month of age with RVRTC during repeated methacholine challenges with quadrupling doses from 0.037 to 16.674 μmol.

Results

Measurement of baseline lung function was successful in 99% and the provocative dose (PD) was achieved in 79% of infants by forced expiratory volume in 0.5 s (FEV0.5). Additionally, the PD was successfully measured in 87% by transcutaneous oxygen pressure. No serious adverse events were observed during testing or after discharge from the clinic. The methacholine dose range was appropriate as PD could be determined in the majority of infants. FEV0.5 values in 21% of infants dropped > 40% during the test. Short-lasting, self-limiting episodes of hypoxemia of < 80% occurred in 1% of infants and bradycardia < 90 beats/min in 19% of infants. The most common observations by parents were changes in the patterns of sleeping (95%), eating (57%), and behavior (58%) of the infant after hospital discharge. The mean acceptability rating among parents was 8 on a scale from 1 to 10, with 13% rating ≤ 5. It took one operator 3 h to complete the test, with the actual lung function testing accounting for half the time.

Conclusion

This very comprehensive experience with standardized measurements of lung function by RVRTC during methacholine challenge in young infants in a single center leads us to conclude that the test is feasible and safe to perform in asymptomatic young infants.

Section snippets

Materials and Methods

The study included infants from the COPSAC birth cohort study,2 which includes 411 infants of mothers with asthma, excluding infants with gestational age of < 36 weeks, congenital abnormality, systemic illness, or a history of mechanical ventilation or lower airway infection. Parents gave written informed consent, and the study was approved by the local ethics committee ([KF]01-289/96 and [KF]01-227/97) and the Danish Data Protection Agency (1996-1200-360).

Success Rate

Lung function tests were completed by 402 infants (median age, 6 weeks [quartiles, 5 to 8 weeks]; median height, 56 cm [quartiles, 54 to 58 cm]; and weight, 5 kg [quartiles, 4.5 to 5.5 kg]). The success rate was 99% for the measurement of baseline lung function and 79% for PD determined by FEV0.5 (Table 3); 72 infants failed repeat measurements of FEV0.5 due to technical reasons or insufficient sedation. The technical difficulties were primarily glottic closure or preterm inspiration during

Discussion

There is a clinical need for lung function measurement in early life similar to the well-established role of lung function measurements later in childhood. Information on lung function would be valuable in young infants with bronchopulmonary dysplasia, cystic fibroses, extreme prematurity, anatomic anomalies, and similar disorders. Likewise, research151617 into lung disorders in early life needs objective assessments of lung function. Methods for lung function measurements have been available

Conclusion

Based on this large series of standardized measurements of baseline lung function and determination of bronchial reactivity by RVRTC during methacholine challenge testing, we conclude that the methods are safe and feasible, yet the requirement for sedation restricts its use to research and selected clinical cases.

ACKNOWLEDGMENT

We thank the parents of the infants studied for their participation and technician Lena Vind for her help in data collection.

References (41)

  • JR Clarke et al.

    Comparison of the squeeze technique and transcutaneous oxygen tension for measuring the response to bronchial challenge in normal and wheezy infants

    Pediatr Pulmonol

    (1993)
  • C Bez et al.

    Safety and tolerability of methacholine challenge in infants with recurrent wheeze

    J Asthma

    (2003)
  • S Young et al.

    The effect of age on oxygen desaturation during histamine inhalation challenge in normal infants

    Pediatr Pulmonol

    (1993)
  • MJ Hayden et al.

    Parental attitudes toward infant pulmonary function testing

    Pediatr Pulmonol

    (1998)
  • MJ Hayden et al.

    Methacholine responsiveness using the raised volume forced expiration technique in infants

    Am J Respir Crit Care Med

    (1997)
  • H Bisgaard et al.

    Lung function measurement in awake young children

    Eur Respir J

    (1995)
  • S Godfrey et al.

    What is the role of tests of lung function in the management of infants with lung disease?

    Pediatr Pulmonol

    (2003)
  • J Stocks

    Infant respiratory testing: is it worth all the effort?

    Pediatr Anaesth

    (2004)
  • J Stocks et al.

    Lung function in infants and young children with chronic lung disease of infancy: the next steps

    Pediatr Pulmonol

    (2007)
  • SC Ranganathan et al.

    Exploring the relationship between forced maximal flow at functional residual capacity and parameters of forced expiration from raised lung volume in healthy infants

    Pediatr Pulmonol

    (2002)
  • Cited by (24)

    • Pulmonary Function Tests in Infants and Children

      2019, Kendig's Disorders of the Respiratory Tract in Children
    • Blood lipid levels associate with childhood asthma, airway obstruction, bronchial hyperresponsiveness, and aeroallergen sensitization

      2016, Journal of Allergy and Clinical Immunology
      Citation Excerpt :

      Airway responsiveness was assessed by using a methacholine challenge test performed with a Wright nebulizer driven by air at 21 psi and a dynamic flow of 18 L/min starting with ab isotonic saline inhalation followed by 0.5 mg/mL methacholine, with subsequent doubling concentrations to a maximum of 64 mg/mL. The provocative dose of methacholine causing a 20% decrease in FEV1 from baseline (PD20) was the test outcome.22 Allergen-specific IgE levels were determined by using a screening method (ImmunoCAP, Phadiatop Infant; Pharmacia Diagnostics AB, Uppsala, Sweden) against the most common inhalant allergens in Denmark (cat, dog, horse, birch, timothy grass, mugwort, house dust mites, and molds).

    • Prenatal and postnatal genetic influence on lung function development

      2014, Journal of Allergy and Clinical Immunology
      Citation Excerpt :

      Maternal factors potentially influencing neonatal lung function included maternal sensitization determined by using specific IgE measurement (ImmunoCAP; Phadia AB, Uppsala, Sweden)20 on 0.35 kU/L or more to any common inhalant allergens,21 worsening of asthma during pregnancy, and similarity of genetic risk scores similar to childhood risk scores. All lung function measures were calibrated for body size and sex, as detailed earlier,4,17,18 and used as z scores. SNP allele dosages (taking into account imputation accuracy) were used, assuming additive genetic models.

    View all citing articles on Scopus

    This study was supported by Statens Sundhedsvidenskabelige Forskningsråd, Direktør Jakob Madsen & Hustru Olga Madsens Fond, Dagmar Marshalls Fond, and Dronning Louises Børnehospitals Forskningsfond.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    View full text