Value of tidal lung function in differentiating central and small intrathoracic airway obstructive lesions / 中华实用儿科临床杂志

Objective:To explore the value of tidal lung function in distinguishing central and small intrathoracic airway obstructive lesions.Methods:A total of 124 infants with intrathoracic obstructive diseases, including bronchiolitis obliterans (BO), bronchiolitis, airway foreign body, and airway stenosis, were confirmed in Children′s Hospital of Chongqing Medical University from April 2014 to June 2019 and selected as subjects, and 111 normal infants were enrolled as healthy control group.According to the location of lesions, these subjects suffering from intrathoracic obstructive diseases were divided into small airway lesion group(BO, bronchiolitis) and central airway lesion group(airway foreign body, airway stenosis). Lung function was assessed by plethysmography.Results:As for the ratio of time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE) and the ratio of volume to reach peak tidal expiratory flow to total expiratory volume (VPTEF/VE), all disease groups were lower than that in healthy control group TEF/TE: BO 13.2(10.3, 16.3)%, bronchiolitis 15.9 (13.2, 19.7)%, airway foreign body 24.5 (16.7, 30.7)%, airway stenosis 20.7 (16.1, 29.3)%, healthy control group 30.2(25.6, 36.5)%; VPTEF/VE: BO 18.2(17.8, 22.3)%, bronchiolitis 20.3(17.0, 21.6)%, airway foreign body 26.0(20.5, 30.7)%, airway stenosis 22.9(20.2, 29.1)%, healthy control group 31.5(28.1, 37.0)%]( P<0.05) and the lesion in the small airway lesion group was significantly lower than that in central airway lesion group.Compared with the healthy control group, the functional residual capacity (FRC)was higher in each disease group[BO (501.6±166.5) mL, bronchiolitis (334.6±149.6) mL, airway foreign body (392.2±130.1) mL, airway stenosis (350.1±127.9) mL, healthy control group (191.6±73.8) mL]( P<0.05). The ratio of peak expiratory flow to tidal expiratory flow at 25% remaining expiration(PF/TEF 25) was obviously higher in small airway lesion group than that in central airway lesion and healthy control group [BO 232.7(183.2, 261.2)%, bronchiolitis 186.4 (153.3, 247.7)%, airway foreign body 143.1(126.8, 168.9)%, airway stenosis 140.3(122.9, 186.0)%, healthy control group 132.3 (123.1, 147.8)%] ( P<0.05), while no significant differences were found between central airway lesion group and healthy control group ( P>0.05). There were no significant differences in effective airway resistance among all groups ( P>0.05). The tidal breathing flow volume (TBFV) curve shape of small airway lesion group showed the depression of expiratory phase to the transverse axis, while the slope of descending branch of expiratory phase had no significant increase in central airway lesion group. Conclusions:Combined with the increase in PF/TEF 25, the decrease in TPTEF/TE and VPTEF/VE is the characteristic of small airway obstruction.PF/TEF 25 is a sensitive index reflecting small airway obstruction.Combined with the value of lung function parameters, the shape of TBFV is helpful to distinguish central and small airway obstructive lesions.

Value of airway responsiveness measurement in the diagnosis of infant cough variant asthma / 中华实用儿科临床杂志

Objective:To explore the value of airway responsiveness measurement by the tidal lung function test combined with the bronchial provocation test (BPT) in the diagnosis of infant cough variant asthma (CVA), and to provide evidence for clinical diagnosis of CVA.Methods:The tidal lung function test and BPT test results of 131 cases of chronic cough (including 70 CVA cases and 61 non-CVA cases) treated in the Asthma Specialist Clinic of Children′s Hospital Affiliated to Chongqing Medical University from January 2018 to September 2018 were retrospectively analyzed.The results between CVA group and non-CVA group were compared.Results:There was no significant difference in the basal tidal lung function detection results between the CVA group and non-CVA group ( P>0.05). The positive rate of BPT in the CVA group was significantly higher than that in the non-CVA group (98.6% vs. 27.9%, χ2=30.757, P<0.01). Among the patients with positive BPT, the proportion of patients with moderate and severe positive reactions in the CVA group was significantly higher than that in the non-CVA group (40.0% vs. 3.3%, 15.7% vs. 0, χ2=24.894, 20.464, all P<0.01). During BPT test process, a significantly greater number of patients showed wheezing and a significant decrease in oxygen saturation(SpO 2) in the CVA group than in the non-CVA group (50.0% vs.0, 91.4% vs.45.9%, χ2=32.169, 36.544, all P<0.01), while the number of patients with severe cough and shortness of breath was similar in both groups (all P>0.05). After the application of bronchodilator or oxygen inhalation, the symptoms of polypnea and wheezing disappeared in all children.The values of the ratio of the time to reach peak tidal expiratory flow to total expiratory time[(TPTEF/TE)%] and the ratio of the volume required to reach peak tidal expiratory flow to total expiratory volume[(VPTEF/VE)%] recovered to more than 80% of the basic values and SpO 2 up to 95%. Conclusions:The tidal lung function test combined with the BPT test is of certain significance for the diagnosis and differential diagnosis of CVA infants.CVA can be better diagnosed based on the degree of BPT and the clinical manifestations during the course of the test.

Leukotriene D4 bronchial provocation test for detection of airway hyper-responsiveness in children / 南方医科大学学报

OBJECTIVE@#To explore the value of leukotriene D4 (LTD4) bronchial provocation test (BPT) in detection of airway hyper-responsiveness (AHR) in children.@*METHODS@#A total of 151 children aged 6 to 14 years, including 86 in remission of asthma and 65 with acute bronchitis, who were followed up in our respiratory clinic between November, 2017 and August, 2018. The children were randomly divided into LTD4 group (78 cases) and methacholine (MCH) group (73 cases). In LTD4 group, the 78 children underwent LTD4-BPT, including 46 with asthma and 32 children having re-examination for previous episodes of acute bronchitis; in MCH group, the 73 children underwent MCH-BPT, including 40 with asthma and 33 with acute bronchitis. MCH-BPT was also performed in the asthmatic children in the LTD4 group who had negative responses to LTD4 after an elution period. The major adverse reactions of the children to the two BPT were recorded. The diagnostic values of the two BPT were evaluated using receiver-operating characteristic (ROC) curve.@*RESULTS@#There was no significant difference in the results of basic lung function tests between LTD4 group and MCH group (>0.05). The positive rate of BPT in asthmatic children in the LTD4 group was significantly lower than that in the MCH group (26.1% 72.5%; < 0.05). The positive rate of BPT in children with previous acute bronchitis in the LTD4 group was lower than that in the MCH group (3.1% 15.2%). The positive rate of MCH-BPT in asthmatic children had negative BPT results in LTD4 group was 58.8%, and their asthma was mostly mild. The sensitivity was lower in LTD4 group than in MCH group (0.2609 0.725), but the specificity was slightly higher in LTD4 group (0.9688 vs 0.8485).The area under ROC curvein LTD4 group was lower than that in MCH group (0.635 0.787). In children with asthma in the LTD4 group, the main adverse reactions in BPT included cough (34.8%), shortness of breath (19.6%), chest tightness (15.2%), and wheezing (10.9%). The incidence of these adverse reactions was significantly lower in LTD4 group than in MCH group ( < 0.05). Serious adverse reactions occurred in neither of the two groups.@*CONCLUSIONS@#LTD4-BPT had high safety in clinical application of children and was similar to the specificity of MCH-BPT. However, it had low sensitivity, low diagnostic value, and limited application value in children's AHR detection.

Value of exhaled nitric oxide in remission stage of asthmatic children / 重庆医学

Objective To explore the value of exhaled nitric oxide evaluate the condition of children with asthma in clinical remission stage .Methods A total of 214 asthmatic children were divided into treatment group and control group .Tests of bronchial provocation and FeNO were performed at the same time .Results FeNO in treatment group was significantly lower than in control group ,while the level of PC20 FEV1 did not have obvious difference in two groups .The level of PC20 FEV1 was negatively correlated with FeNO ,regression equation was Y=35 .883-1 .074X(X= PC20 FEV1 ,Y= FeNO) .Conclusion FeNO is a reliable indicator to evaluate the control situation of non‐specific inflammation in asthmatic children .Combined with bronchial provocation test ,the diag‐nosis rate of asthma in clinical remission stage will significantly raised .

Effect of house dust mite vaccine on pulmonary function and inhaled corticosteroid doses in children with allergic asthma / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the dynamic changes of pulmonary function and inhaled corticosteroid (ICS) doses during subcutaneous immunotherapy (SCIT) with standardized house dust mite vaccine (Alutard) in children with mild to moderate allergic asthma.</p><p><b>METHODS</b>One hundred children with mild to moderate allergic asthma were randomized into SCIT group and control group for treatment with SCIT plus ICS and with ICS only, respectively. The pulmonary function and ICS doses were evaluated before and every 3 months during the 2 years of treatment.</p><p><b>RESULTS</b>No significant difference was found in the pulmonary functions between the two groups before the treatment (P>0.05). After 3 months of treatment, FEV1% and PEF% in SCIT group were significantly higher than those in the control group [(103.19∓2.07)% vs (97.52∓1.92)%, and (105.56∓3.21)% vs (96.35∓2.7)%, respectively]; at 21 months, FEF50% and FEF25% were significantly higher in SCIT group than in the control group [(105.69∓3.29)% vs (94.61∓3.12)%, and (106.60∓3.71)% vs (92.92∓3.31)%, respectively]. A significant difference was found in ICS doses between SCIT group and the control group after 9 months of treatment (147.14∓6.41 vs 170∓4.95 µg/day, P<0.05), and the difference increased as the treatment prolonged.</p><p><b>CONCLUSION</b>SCIT combined with ICS can improve the ventilation function of the large airways early after the commencement of treatment, but its effect on small airways can be delayed. SCIT for 2 years shows a good therapeutic effect and can reduce the doses of ICS in children with mild to moderate allergic asthma.</p>

Effects of ipratropium bromide oxygen nebulization on pulmonary function of young children with asthma / 重庆医科大学学报

Objective:To investigate the effects of ipratropium bromide(Atrovent)on pulmonary function of young children with asthma.Methods:Type2600 Pediatric Pulmonary Function machine(Sensor Medics,USA)was used to determine the pulmonary function of 30 asthmatic children before and after Atrovent nebulization.Results:After nebulizing with Atrovent,of all the seven indexes there were obvious increase in ?V50,?V25,%T-PF,%V-PF,ME/MI as compared with those before( P