Bronchial Lability and Responsiveness in School Children Born Very Preterm
|
|
- Jocelyn Stevens
- 6 years ago
- Views:
Transcription
1 Bronchial Lability and Responsiveness in School Children Born Very Preterm ANNA S. PELKONEN, ARJA L. HAKULINEN, and MARKKU TURPEINEN Department of Allergic Diseases, Helsinki University Central Hospital, and Helsinki City Maternity Hospital, Helsinki, Finland We evaluated bronchial lability and responsiveness in 29 prematurely born children (birth weight 1,250 g) 8 to 14 yr of age, 12 with histories of bronchopulmonary dysplasia (BPD). Flow-volume spirometry, a bronchodilator test, and histamine challenge at the office and home monitoring of peak expiratory flow (PEF) values twice daily for 4 wk with and without a 2 -agonist were performed with a novel device, the Vitalograph Data Storage Spirometer. The spirometric values at the office and the results of home monitoring were compared with those for a control group of children born at term. All spirometric values except FEV 1 /FVC were significantly lower in the BPD group than in the non-bpd group (p ). Ten children (83%) in the BPD group and four (24%) in the non-bpd group had subnormal spirometric values at the office, indicating bronchial obstruction. Of the children with obstruction, 79% reported respiratory symptoms during the preceding year, and 57% had increased diurnal PEF variation and/or responded to administration of a 2 -agonist during home monitoring or at the office. The BPD children were significantly more responsive to histamine than the non-bpd children (p 0.002). All spirometric values were significantly lower in both preterm groups than in the control group born at full term (p 0.01). In conclusion, regardless of BPD, bronchial obstruction, bronchial lability, and increased bronchial responsiveness are common in prematurely born children of school age. Pelkonen AS, Hakulinen AL, Turpeinen M. Bronchial lability and responsiveness in school children born very preterm. AM J RESPIR CRIT CARE MED 1997;156: (Received in original form October 9, 1996 and in revised form June 3, 1997) Supported by Astra Draco AB, Lund, Sweden. Presented in part at the international conference of American Thoracic Society in May 1995 in Seattle. Correspondence and requests for reprints should be addressed to Dr. Anna S. Pelkonen, Department of Allergic Diseases, Helsinki University Central Hospital, Meilahdentie 2, Helsinki, Finland. Am J Respir Crit Care Med Vol pp , 1997 Bronchopulmonary dysplasia (BPD) is a major cause of longterm morbidity in infants born prematurely. In follow-up studies of pulmonary function, BPD is associated with bronchial obstruction and hyperresponsiveness, persisting until school age or young adulthood (1 8). However, prematurely born children without BPD have also been observed to have obstructed airway function in childhood (8 13). Despite obstructive changes in spirometry, prematurely born children are often asymptomatic (2). The average surviving preterm baby today is more premature than previously. This may lead to increased severity of pulmonary disease and a poorer outcome. In our previous study of the pulmonary functional sequelae of extreme prematurity, significant bronchial obstruction was a common finding, regardless of BPD (14). However, only a few children complained of subjective respiratory symptoms. The clinical significance of these measurable functional abnormalities has not been clearly established. An important question is whether these obstructive changes are reversible and responsive to treatment. With the aim of evaluating bronchial lability and responsiveness (15) in every-day life in school children born very preterm, we recorded the diurnal variation of peak expiratory flow (PEF) and the response to an inhaled 2 -agonist, using a novel home spirometer. Bronchial responsiveness to histamine and to a 2 -agonist were also measured at hospital visits. METHODS Subjects The patients belonged to a group of very low birth weight (VLBW) infants ( 1,250 g) treated at the neonatal intensive care unit of the Children s Hospital, University of Helsinki, Finland, between 1980 and Among the total of 168 survivors, 70 children (42%) had required oxygen therapy for 28 d, and 22 children (13%) were still oxygen-dependent at the age of 36 postconceptional wk, which was used as the criterion of BPD (16). Of the 22 children with histories of BPD, 12 were traced and were able to participate in our study. Their gestational ages at birth and the duration of oxygen therapy did not differ significantly from those of the remaining BPD children who were not examined (median gestational age at birth: 27.0 versus 26.5 wk; median duration of oxygen therapy: 80.5 versus 78.5 d). Twenty children without BPD but comparable in birth weight and gestational age were also included; 17 of them completed the study. Neonatal data were collected from the hospital records (Table 1). The median duration of oxygen dependency was 81 d in the BPD children as compared with 35 d in the non-bpd children (p ). No significant differences in gestational age, birth weight, or sex were observed between these two groups. Ventilator treatment had been provided using a Baby Bird respirator. Four children had been treated with exogenous surfactant. Bronchoscopy was performed in five children (one non-bpd and four BPD children) because of respiratory distress after extubation. In these children, the duration of artificial
2 Pelkonen, Hakulinen, and Turpeinen: Bronchial Lability after Preterm Birth 1179 TABLE 1 NEONATAL DATA Characteristics BPD Group (n 12) Non-BPD Group (n 17) p Value Boys/girls 4/8 7/10 NS Birth weight, g 955 (620 1,200) 980 (690 1,240) NS Gestational age, wk 27 (24 30) 28 (25 35) NS Apgar score (1 min) 5 (1 8) 5 (1 10) NS Apgar score (5 min) 7 (3 10) 7 (2 9) NS Duration of ventilator treatment, d 53 (16 165) 9 (0 58) Duration of supplementary oxygen, d 81 (50 135) 35 (1 65) Duration of high oxygen ( 40%), d 26 (5 87) 1 (0 6) Postconceptional age when oxygen discontinued, wk 39 (36 44) 34 (29 35) Respiratory distress syndrome, n (%)* 10 (83%) 9 (53%) 0.05 Patent ductus arteriosus, n (%) 8 (67%) 7 (41%) NS Air leak, n (%) 1 (8%) 0 (0%) NS Sepsis, n (%) 2 (17%) 2 (12%) NS Tracheal/bronchial stenosis, n (%) 4 (33%) 1 (6%) NS Values expressed as medians (range) or as numbers (%) in given category. * Typical chest X-ray changes and acquirement of supplementary oxygen for at least 2 d. Requirement of pharmacologic or surgical closure. ventilation was prolonged, ranging from 45 to 165 d (median: 85 d). Tracheal or bronchial stenosis was found in all five children. The stenosis was treated with dilatations in one child, and tracheostomy was performed in another child. Depending on the grade of the stenosis, these five children were followed by rescopies up to the age of 1.5 to 6 yr. Bronchoscopies were discontinued when the stenosis was totally absent or only mild stenotic changes were observed. A group of 22 healthy, nonatopic local schoolchildren of the same age, all of whom were born at term, were recruited as a control group of spirometry. Lung function of seven control children was monitored twice daily at home for 4 wk. All these children were attending school and had no respiratory symptoms at the time of study. Selection was based on the date of birth. The principal investigator did not know the neonatal history of the premature children at the time of testing. Informed consent was obtained from the parents. The study was approved by the ethics committee of the hospital. Study Design In this cross-sectional study, the children visited hospital twice. All 29 study children underwent lung function testing with the same protocol and equipment. At the first hospital visit, clinical status, height, and weight were studied, and the child and the parent(s) were interviewed and filled in questionnaires, especially about the child s respiratory symptoms during the preceding year. Flow-volume spirometry and a bronchodilator test were performed, and the children were shown how to use a home spirometer. In addition, skin-prick tests were made. Lung function was monitored twice daily at home for 4 wk. The effect of a 2 -agonist was measured by performing spirometry every morning and evening before and after terbutaline inhalation. At the second visit, flow-volume spirometry and a histamine challenge test were performed, and the data of the home spirometer were downloaded. Skin tests were performed with the skin-prick technique, using eight major allergen extracts. A negative control solution and histamine hydrochloride (10 mg/ml) as a positive control were used. Atopy was defined as at least one wheal 3 mm in diameter as a reaction to an allergen in the absence of a response to the negative control solution. Familial atopy was defined as physician-diagnosed allergy among first-degree relatives. Lung Function Measurements Flow-volume spirometry was done with a pneumotachograph (Spirotrac III ; Vitalograph Ltd, Buckingham, UK). At least three technically correct forced expiratory curves should be made according to the acceptability criteria of the American Thoracic Society (ATS). The curve was reproducible if the largest FVC and FEV 1 and second largest FVC and FEV 1 from acceptable curves did not vary by 5% of reading (expressed as a percentage of the largest observed FVC and FEV 1 regardless of the curve on which it occurred) (17). The curve with the highest sum of FEV 1 and FVC values was selected for statistical analysis. Results of lung function tests were analyzed as percentages of predicted values, according to Polgar and Promadhat (18). Flow-volume spirometry was measured with the same method in the healthy children of the reference group. The following spirometric parameters were recorded: FVC, FEV 1, FEV 1 /FVC ratio, PEF, and forced expiratory flow at 50% and at 75% of FVC (FEF 50 and FEF 75 ). Bronchial obstruction was defined as at least two of the following spirometric values: FEV 1 80%, PEF 75%, or FEF 50 62% (18). In the bronchodilator test at the office, flow-volume spirometry was measured before and 15 min after inhalation of 0.5 mg terbutaline from a dry powder inhaler (terbutaline sulfate, 0.25 mg/dose; Bricanyl Turbuhaler ; Astra Draco AB, Lund, Sweden). During each terbutaline inspiration, peak inspiratory flow through the Turbuhaler (PIF TBH ) was recorded. The lowest acceptable PIF TBH value was 30 L/min (19). The changes in FEV 1 and PEF values after terbutaline were expressed as the differences (%) between the values before and after terbutaline inhalation ( FEV 1 and PEF). At home, lung function was recorded using a Vitalograph Data Storage Spirometer (Vitalograph) particularly designed for long-term recording and storage of lung function parameters. The device consists of a pneumotachograph and a computer. Before use, the device was calibrated with a standard volume (variation within 1%). After home recordings, the calibration was checked. The difference between these two calibration values (before and after home monitoring) was 5%. At home, FVC, FEV 1, PEF, and PIF TBH values were recorded. The test was repeated, a maximum of five times, until the results of the two best curves met the criteria of the ATS. If this was not achieved with five tests, failure was recorded. The spirometer stored the curve with the largest sum of FEV 1 and FVC in the built-in electronic diary. The compliance of inhalation therapy was recorded by measuring PIF TBH. During the first 2 wk of home monitoring, the children inhaled terbutaline 0.25 mg twice daily. They performed spirometry every morning and evening, before and 15 min after terbutaline inhalation. The data from the home spirometer were analyzed after 4 wks of monitoring. Home monitoring with the same method was also performed in the seven healthy children of the control group. The number of PEF increments 15% after terbutaline was used for the analysis (20). Diurnal PEF variation of the whole 4 wk of recordings was calculated as the difference between the morning and evening PEF values and was expressed as the percentages of the greater PEF value. The number of PEF 20% was used in the analysis. PEF 20% has been shown to be a good indicator of bronchial lability (21, 22). The number of positive terbutaline responses and the number of PEF 20% were expressed as the percentages of all tests during
3 1180 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL TABLE 2 DEMOGRAPHIC DATA AT ENTRY BPD Group (n 12) Non-BPD Group (n 17) Full-term Control Group (n 22) p Value Age, yr 10.4 ( ) 11.7 ( ) 10.8 ( ) NS Height, cm ( ) ( ) ( ) NS Height, SD-units 1.2 ( )* 0.7 ( ) 0.3 ( ) Weight, kg 31.4 ( ) 35.4 ( ) 36.5 ( ) NS Height-related weight, % (24) 4.0 ( ) 3.0 ( ) 0.5 ( ) NS Values expressed as medians (range). * Significantly different from full-term control group (p 0.014). home monitoring (Figure 2). The mean PEF value, defined as the mean of the morning PEF values during the last week of home monitoring, was used in the correlation analysis of spirometric data at home and at the office. Airway responsiveness to histamine, expressed as the histamine dose (mg) resulting in a 15% decrease in FEV 1 (PD 15 FEV 1 ), was determined using an automatic, inhalation-synchronized, dosimetric jet nebulizer (Spira Elektro 2; Respiratory Care Centre, Hämeenlinna, Finland) (23). The device incorporates a turbine flow sensor for monitoring tidal volume and inspiratory flow. With a two-bar driving pressure, the airflow to the nebulizer is 7.5 L/min. The nebulization time is 0.4 s, set to start at 100 ml after the beginning of inspiration. During the test, the child is breathing with a tidal volume of 0.3 to 0.5 L. The peak inspiratory flow is not allowed to exceed 0.5 L/s during administration of the aerosol. One, four, eight, and 16 tidal inspirations of buffered histamine diphosphate in saline solution with concentration of 4 and 16 mg/ml are employed using a four-step dosage scheme. The calculated noncumulative doses of histamine to the lungs and airways at each step are 0.025, 0.1, 0.4, 0.8, and 1.6 mg, respectively. The FEV 1 measured with a pneumotachograph is used to determine the response to histamine. The PD 15 FEV 1 will be determined by plotting manually the dose of histamine against the percent fall in FEV 1 using a logarithmic scale for the histamine doses. The PD 15 FEV 1 is obtained by linear interpolation between the last two points. PD 15 FEV mg histamine is considered normal for adults (23). Reference values for children are not yet available. After the last histamine dose, 0.5 mg terbutaline was given. Terbutaline was inhaled from a metered-dose inhaler with a valved spacer device (Nebuhaler; Astra Draco AB). If the child had a respiratory infection, the test was not performed until 2 wk after the infection had ended. The children were not allowed to use 2 -agonists for at least 12 h before the challenge test. Statistical Methods Results of lung function tests were analyzed as percentages of predicted values (Polgar and Promadhat). The significances of the differences between the three study groups were tested using one-way analysis of variance for normally distributed data. The normality of the data distribution was confirmed with a Kolmogorov-Smirnov onesample test. A Kruskall-Wallis nonparametric test was used if the distribution was not normal or if the variances were not homogeneous. The Fisher exact test and the Mann-Whitney test were used for assessing the significance of differences between the two groups. Spearman s rank correlation (r s ) was used in analysis for the association between current symptoms and the lung function parameters. Multiple stepwise regression analysis was used to evaluate the relationship between the neonatal (independent variable) and current pulmonary function (dependent variable) data. The following neonatal variables were evaluated: birth weight, duration of oxygen therapy (FI O and FI O2 0.21), duration of ventilator treatment, postconceptional age when oxygen was discontinued, and the history of tracheal/bronchial stenosis. Statistical analyses were performed using the Statgraphics computer program. RESULTS Patients Age, absolute height and weight, and weight expressed as a percentage of the mean weight of children of same sex and height (24) did not differ between the groups (Table 2). Heights as SD in relation to age of the BPD children were significantly lower than those of the full-term control children (p 0.014). History of Respiratory Symptoms and Atopy Fourteen children (48%) had had dyspneic symptoms at least once and, in addition, two children had suffered from continuous coughing for 3 wk during the previous year. Five children had asthma diagnosed by a physician. Four of them were receiving continuous budesonide inhalation therapy and one child in the BPD group used 2 -agonists during infections. The groups did not differ in individual or familial atopy or in parental smoking. Atopy was found in 17% of patients in the BPD group and in 29% in the non-bpd group. The respective percentages of familial atopy was 50% versus 41%. The percentages of parental smoking were high in both groups: 50% in the BPD group and 47% in the non-bpd group. Basic Lung Function Ten children (83%) in the BPD group and four (24%) in the non-bpd group had subnormal spirometric values at the office indicating bronchial obstruction. The children with the history of tracheal or bronchial stenosis had bronchial obstruction at school age. Of the children with obstruction, 11 (79%) reported respiratory symptoms during the past year, nine children had dyspneic symptoms, and two children had prolonged coughing. One child with the history of tracheal stenosis had severe symptoms and was not able to perform the histamine challenge test or carry out home monitoring. All spirometric values except FEV 1 /FVC were significantly lower in the BPD group than in the non-bpd group (Figure 1). When the children with a history of tracheal/bronchial stenosis were excluded from the analyses, the difference in FEV 1 and PEF values between the groups still remained significant. All spirometric values were significantly lower in both preterm groups than in the full-term control group (p 0.01; Figure 1). Bronchodilator Test and Diurnal PEF Variation In the bronchodilator test at the office, none of the study children had a significant response to terbutaline ( FEV 1 15%) (20). Five children had FEV 1 10% (one non-bpd and four BPD children). There was no significant difference between the BPD and non-bpd groups; the median FEV 1 was 5.8% (range: 5.1 to 14.3%) in the BPD group and 1.4% (range: 2.1 to 12.2%) in the non-bpd group. During the 2 wk of recording at home, PEF increments 15% after terbutaline were observed at least three times ( 11%, expressed as the percentages of all tests during home monitoring) in 31% of the patients. According to this definition, none of the seven control children had positive bronchodilator test at home. The difference between BPD group
4 Pelkonen, Hakulinen, and Turpeinen: Bronchial Lability after Preterm Birth 1181 Figure 1. FEV 1, FVC, and FEV 1 /FVC (A) and PEF, FEF 50, and FEF 75 (B) values as percentages of predicted values of the children in different study groups (open circles: history of tracheal/bronchial stenosis). Medians are expressed as horizontal lines. Significant differences are expressed in the figure. and healthy control group was significant (p 0.01) (Figure 2). Six children (21%) had diurnal PEF variation 20% at least four times ( 14% of all tests) during home monitoring. According to this definition, none of the control children had abnormal diurnal PEF variation (Figure 2). A significant response in the bronchodilator test and/or abnormal diurnal PEF variation were observed in 11 of all 29 children tested (38%) and in eight (57%) of the 14 children with verified obstruction. The number of acceptable individual measurements made at home was high: 92% (range: 76 to 99%). Spirometric PEF values at the office showed a good correlation with the mean morning PEF values of the last week of home monitoring (r s 0.82, p 0.001).
5 1182 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL Figure 3. The result of histamine challenge test as PD 15 FEV 1 of the children in different study groups (open circles: history of tracheal/ bronchial stenosis). Medians are expressed as horizontal lines. Significant difference is expressed in the figure. FEF 75. Duration of oxygen therapy had an association with PD 15 FEV 1 values (Table 3). Neither gestational age nor birthweight was associated with the spirometric data or bronchial responsiveness. According to Spearman s rank correlation test, symptoms during the previous year correlated inversely with FEV 1, FEV 1 /FVC, FEF 50, and FEF 75 values at the office and with PD 15 FEV 1 values (range of r 0.37 to 0.47; p 0.05 for all). DISCUSSION Figure 2. The number of PEF measurements with an increment 15% after terbutaline and diurnal PEF variations 20% during home monitoring expressed as the percentages of all tests during home monitoring (open circles: history of tracheal/bronchial stenosis). Medians are expressed as horizontal lines. Significant difference is expressed in the figure. Bronchial Responsiveness Median histamine PD 15 FEV 1 was significantly lower in the BPD group than in the non-bpd group; 0.8 (range: 0.06 to 1.6) versus 1.6 (range: 0.44 to 1.6) (p 0.002; Figure 3). No significant differences were observed between the non- BPD group and the healthy adult control group (median PD 15 FEV 1 : 1.6 versus 1.6 mg) (23). Association of Neonatal Variables with Subsequent Lung Function In stepwise multiple regression analysis, the duration of ventilator treatment was significantly associated with FVC, FEV 1, and FEF 50. The history of tracheal/bronchial stenosis and the duration of oxygen therapy were associated with PEF and At the office, we used conventional flow-volume spirometry, the bronchodilator test, and the dosimetric histamine challenge test. At home, lung function was recorded with a novel device, a computerized home spirometer. Monitoring pulmonary function throughout successive days provides information that might be missed with the single snapshot obtained at the office. Home monitoring is therefore an important way to measure changes in pulmonary function, both within a day and from day to day. The presence of bronchial lability is reflected by reduced PEF values during the early morning hours (15). However, absolute values of PEF obtained with standard devices, such as mini-flow meters, may be inaccurate, especially in children (25). The new computerized home spirometer affords the following advantages: (1) compliance control of spirometry and medication by recording the time of measurement and inhalation of the drug, (2) control of the repeatability and acceptability of measurements, and (3) the possibility to calibrate the device (26). In the present study, 92% of the measurements during home monitoring were acceptable according to the ATS criterion. In addition, PEF at the office showed a strikingly good correlation with the home recordings. This suggests that the study children had learned correctly the technique to perform spirometry and also that both devices were comparable. Bronchial Obstruction The finding of bronchial obstruction in our BPD children agrees with earlier observations (1 8). However, in our children, the level of obstruction was more severe, possibly because of the difference in selection; our children were more
6 Pelkonen, Hakulinen, and Turpeinen: Bronchial Lability after Preterm Birth 1183 TABLE 3 STEPWISE MULTIPLE REGRESSION ANALYSIS: ASSOCIATION OF NEONATAL VARIABLES WITH SUBSEQUENT LUNG FUNCTION Lung Function Parameter Independent Variable Regression Coefficient Standard Error p Value R 2 values (adjusted) FVC Duration of ventilator treatment, d FEV 1 Duration of ventilator treatment, d FEF 50 Duration of ventilator treatment, d FEF 75 Duration of high oxygen (FI O2 0.04), d Tracheal/bronchial stenosis (yes/no) PEF Postconceptional age when oxygen discontinued, wk Tracheal/bronchial stenosis (yes/no) PD 15 FEV 1 Duration of supplementary oxygen, d premature than those examined in previous studies. As the numbers of VLBW survivors have increased, mild to moderate obstructive airway dysfunction at school age has been found in children without a history of BPD, as in our study (8 14). The definition of BPD that we used (oxygen dependency at the age of 36 postconceptional wk) (16) seems to be a sensitive predictor of abnormal pulmonary outcome in VLBW children at school age; 83% of the BPD children had bronchial obstruction. However, bronchial obstruction was also observed in 24% of the non-bpd children. We found that bronchial obstruction was associated with the duration of mechanical ventilation. This suggests a close association of the severity and/or the duration of the neonatal treatment with pulmonary function at school age. In contrast to previous studies (3, 9, 11), birth weight and gestational age were not associated with pulmonary function, obviously because of the narrow range of gestational ages in our children. In agreement with a previous study (27), FVC was significantly smaller in both our preterm groups than in the control group. Because plethysmographic measurements were not performed in the present study, it is not certain that these lower FVC values really do reflect smaller thoracic gas volumes or air trapping because of bronchial obstruction. Bronchial Responsiveness and Lability In contrast to previous studies, we found that none of our children showed a significant response to a 2 -agonist in the conventional bronchodilator test at the office. A weak response was noticed in 17% of the children, all but one in the BPD group. In a previous study by Northway and colleagues (2), responsiveness of 10% in the bronchodilator test was observed in 44% of the patients with a history of BPD as compared with our 33%. Andreasson and coworkers and Kleine and associates also found that in the prematurely born and ventilated children of school age, after 2 -agonist inhalation, FEV 1 was higher than in the reference group, regardless of BPD (4, 5). During home monitoring, the bronchodilator test was positive in 43% of our study children with obstruction. In addition, 36% of these children had increased diurnal PEF variation, indicating bronchial lability. None of our control children had abnormal diurnal PEF variation or positive bronchodilator test during home monitoring. Our observation is in accordance with the criteria used in adults (21). We found that BPD children were significantly more responsive to histamine than non-bpd children and normal healthy, adult subjects. At school age, bronchial hyperresponsiveness has been observed not only in children with BPD (2, 6) but also in prematurely born children without BPD (10, 11, 28). In contrast to previous reports (2), we obtained data on respiratory symptoms from the majority of the children with verified obstruction. In our study, a significant association was noticed between respiratory symptoms and PD 15 FEV 1 values. This suggests that airway responsiveness is of clinical significance. Those children whose PD 15 FEV 1 was 1 mg were all symptomatic. Similarly, Chan and colleagues reported a strong relationship between respiratory symptoms and airway responsiveness (13). In asthma, bronchial hyperresponsiveness is associated with inflammation of the bronchial mucosa. In BPD, however, this association has not been verified. In symptomatic, low birth weight children of school age with increased airway responsiveness, treatment with inhaled beclomethasone dipropionate had no significant effect on bronchial responsiveness (29). In contrast to Chan and colleagues (13), we observed an association between PD 15 FEV 1 and the duration of oxygen treatment, suggesting that bronchial hyperresponsiveness may be a sequel of airway damage during neonatal respiratory therapy. In conclusion, bronchial obstruction, bronchial lability, and increased bronchial responsiveness are common in school children born very preterm, regardless of BPD. Half of the children with obstruction responded to a 2 -agonist or had abnormal diurnal PEF variation. However, the variability of the bronchial obstruction could be detected only by recording PEF values at home for a longish period. The possible inflammatory basis and the benefits of long-term treatment remain to be assessed in future studies. References 1. Hakulinen, A., K. Heinonen, E. Länsimies, and O. Kiekara Pulmonary function and respiratory morbidity in school-age children born prematurely and ventilated for neonatal respiratory insufficiency. Pediatr. Pulmonol. 8: Northway, W. H., Jr., R. B. Moss, K. B. Carlisle, B. R. Parker, R. L. Popp, P. T. Pitlick, I. Eichler, R. L. Lamm, and B. W. Brown, Jr Late pulmonary sequelae of bronchopulmonary dysplasia. N. Engl. J. Med. 323: Bader, D., A. D. Ramos, C. D. Lew, A. C. G. Platzker, M. W. Stable, and T. G. Keens Childhood sequelae of infant lung disease: exercise and pulmonary function abnormalities after bronchopulmonary dysplasia. J. Pediatr. 110: Andreasson, B., M. Lindroth, W. Mortensson, and N. W. Svenningsen Lung function eight years after neonatal ventilation. Arch. Dis. Child. 64: Kleine, M. J. K., C. M. Roos, W. J. Voorn, H. M. Jansen, and J. G. Koppe Lung function 8 18 years after intermittent positive pressure ventilation for hyaline membrane disease. Thorax 45: Smyth, J. A., E. Tabachnik, W. J. Duncan, B. J. Reilly, and H. Levison Pulmonary function and bronchial hyperreactivity in long-term survivors of bronchopulmonary dysplasia. Pediatrics 68: Blayney, M., E. Kerem, H. Whyte, and H. O Brodovich Bronchopulmonary dysplasia: improvement in lung function between 7 and 10 years of age. J. Pediatr. 118: Parat, S., G. Moriette, M.-F. Delaperche, P. Escourrou, A. Denjean, and
7 1184 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL C. Gaultier Long-term pulmonary outcome of bronchopulmonary dysplasia and premature birth. Pediatr. Pulmonol. 20: Mansell, A. L., J. M. Driscoll, and L. S. James Pulmonary followup of moderately low birth weight infants with and without respiratory distress syndrome. J. Pediatr. 110: Bertrand, J.-M., S. P. Riley, J. Popkin, and A. L. Coates The longterm pulmonary sequelae of prematurity: the role of familial airway hyperreactivity and the respiratory distress syndrome. N. Engl. J. Med. 312: Galdes-Sebaldt, M., J. R. Sheller, J. Grogaard, and M. Stahlman Prematurity is associated with abnormal airway function in childhood. Pediatr. Pulmonol. 7: Lebourges, F., G. Moriette, M. Boule, M. F. Delaperche, J. P. Relier, and C. Gaultier Pulmonary function in infancy and in childhood following mechanical ventilation in the neonatal period. Pediatr. Pulmonol. 9: Chan, K. N., A. Elliman, E. Bryan, and M. Silverman Clinical significance of airway responsiveness in children of low birthweight. Pediatr. Pulmonol. 7: Hakulinen, A. L., A.-L. Järvenpää, M. Turpeinen, and A. Sovijärvi Diffusing capacity of the lung in school-aged children born very preterm, with and without bronchopulmonary dysplasia. Pediatr. Pulmonol. 21: Enright, P. L., M. D. Lebowitz, and D. W. Cockroft Physiologic measures: pulmonary function tests. Am. J. Respir. Crit. Care Med. 149:S9 S Shennan, A. T., M. S. Dunn, A. Ohlsson, K. Lennox, and E. M. Hoskins Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 82: American Thoracic Society Standardization of spirometry 1987 update. Am. Rev. Respir. Dis. 136: Polgar, G., and V. Promadhat Pulmonary Function Testing in Children: Technics and Standards. W. B. Saunders, Philadelphia Pedersen, S., O. R. Hansen, and G. Fuglsang Influence of inspiratory flow rate upon the effect of a Turbuhaler. Arch. Dis. Child. 65: American Thoracic Society Lung function testing: selection of reference values and interpretative strategies. Am. Rev. Respir. Dis. 144: Hetzel, M. R., and T. J. H. Clark Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate. Thorax 35: Lebowitz, M. D The use of peak expiratory flow rate measurements in respiratory disease. Pediatr. Pulmonol. 11: Sovijärvi, A. R. A., L. P. Malmberg, K. Reinikainen, P. Rytilä, and P. A. Håkan Rapid dosimetric method with controlled tidal breathing for histamine challenge. Chest 104: Sorva, R., J. Perheentupa, and E. M. Tolppanen New format for a growth chart. Acta Paediatr. Scand. 73: Sly, P. D., P. Cahill, K. Willet, and P. Burton Accuracy of mini peak flow meters in indicating changes in lung function in children with asthma. B.M.J. 308: Nikander, K., and M. Turpeinen Selection of method for home peak flow measurements. Eur. Respir. J. 8(Suppl. 19):476A. 27. McLeod, A., P. Ross, S. Mitchell, D. Tay, L. Hunter, A. Hall, J. Paton, and L. Mutch Respiratory health in a total very low birthweight cohort and their classroom controls. Arch. Dis. Child. 74: MacLusky, I. B., D. Stringer, J. Zarfen, J. Smallhorn, and H. Levison Cardiorespiratory status in long-term survivors of prematurity with and without hyaline membrane disease. Pediatr. Pulmonol. 2: Chan, K. N., and M. Silverman Increased airway responsiveness in children of low birth weight at school age: effect of topical corticosteroids. Arch. Dis. Child. 63:
Effect of inhaled budesonide therapy on lung function in schoolchildren born preterm
RESPIRATORY MEDICINE (2001) 95, 565 570 doi:10.1053/rmed.2001.1104, available online at http://www.idealibrary.com on Effect of inhaled budesonide therapy on lung function in schoolchildren born preterm
More informationPeripheral blood lymphocyte subpopulations in schoolchildren born very preterm
F188 Department of Allergic Diseases Helsinki University Central Hospital Meilahdentie 2 POB 160 00029 Huch Finland A S Pelkonen H Suomalainen M Turpeinen Department of Paediatrics University of Oulu Oulu
More informationBudesonide treatment of moderate and severe asthma in children: A doseresponse
Budesonide treatment of moderate and severe asthma in children: A doseresponse study Soren Pedersen, MD, PhD, and Ove Ramsgaard Hansen, MD Kolding, Denmark Objective: The purpose of the study was to evaluate
More informationDaily versus as-needed inhaled corticosteroid for mild persistent asthma (The Helsinki early intervention childhood asthma study)
See Perspective, p 644 1 Department of Allergy, Helsinki University Hospital, Finland; 2 AstraZeneca R&D, Lund, Sweden Correspondence to: Dr M Turpeinen, Skin and Allergy Hospital, Department of Allergy,
More informationAn Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy
An Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy Housekeeping: I have no financial disclosures Learning objectives: Develop an understanding of bronchopulmonary dysplasia (BPD)
More informationduring infancy and at the age of 6 years have present follow up study, and one could not do the tests because of tetraplegia. Clinical data on the
Archives of Disease in Childhood, 1989, 64, 108-113 Lung function eight years after neonatal ventilation B ANDRItASSON,* M LINDROTH,* W MORTENSSON,t N W SVENNINGSEN,* AND B JONSONt Neonatal Intensive Care
More informationMeenu Singh, Joseph L. Mathew, Prabhjot Malhi, B.R. Srinivas and Lata Kumar
Comparison of Improvement in Quality of Life Score with Objective Parameters of Pulmonary Function in Indian Asthmatic Children Receiving Inhaled Corticosteroid Therapy Meenu Singh, Joseph L. Mathew, Prabhjot
More informationEffect of disease duration on dose response of inhaled budesonide in asthma
Respiratory Medicine (2008) 102, 1065 1072 Effect of disease duration on dose response of inhaled budesonide in asthma Olof Selroos a,b, a Mjölbolsta Hospital, Karis, Finland b SEMECO AB, Skogsvägen 5,
More informationFrequency of nocturnal symptoms in asthmatic children attending a hospital out-patient clinic
Eur Respir J, 1995, 8, 2076 2080 DOI: 10.1183/09031936.95.08122076 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1995 European Respiratory Journal ISSN 0903-1936 Frequency of nocturnal
More informationDo current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma?
Respiratory Medicine (2006) 100, 458 462 Do current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma? Haim S. Bibi a,, David Feigenbaum a, Mariana Hessen
More informationOn completion of this chapter you should be able to: discuss the stepwise approach to the pharmacological management of asthma in children
7 Asthma Asthma is a common disease in children and its incidence has been increasing in recent years. Between 10-15% of children have been diagnosed with asthma. It is therefore a condition that pharmacists
More informationPublic Assessment Report for paediatric studies submitted in accordance with Article 45 of Regulation (EC) No1901/2006, as amended.
Public Assessment Report for paediatric studies submitted in accordance with Article 45 of Regulation (EC) No1901/2006, as amended Bricanyl () DK/W/0017/pdWS/001 Rapporteur: Denmark Finalisation procedure
More informationDiagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma
Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma
More informationTreatment of acute asthmatic exacerbations with an increased dose of inhaled steroid
12 Paediatrics and Child Health, Dunedin School of Medicine, PO Box 913, University of Otago Medical School, Dunedin, New Zealand J Garrett Preventive and Social Medicine, Dunedin School of Medicine S
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationBronchial reactions to the inhalation of high-dose tobramycin in cystic fibrosis
Eur Respir J 2002; 20: 122 126 DOI: 10.1183/09031936.02.00264002 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2002 European Respiratory Journal ISSN 0903-1936 Bronchial reactions to the
More informationIs the correct use of a dry powder inhaler (Turbohaler) age dependent?
Is the correct use of a dry powder inhaler (Turbohaler) age dependent? Kris De Boeck, MD, PhD, Marek Alifier, MD, and Gerd Warnier, RN Leuven, Belgium Background: The metered-dose inhalers are the most
More informationSpirometry and Flow Volume Measurements
Spirometry and Flow Volume Measurements Standards & Guidelines December 1998 To serve the public and guide the medical profession Revision Dates: December 1998 Approval Date: June 1998 Originating Committee:
More informationPerforming a Methacholine Challenge Test
powder for solution, for inhalation Performing a Methacholine Challenge Test Provocholine is a registered trademark of Methapharm Inc. Copyright Methapharm Inc. 2016. All rights reserved. Healthcare professionals
More informationEffect of 1 year daily treatment with 400 µg budesonide (Pulmicort Turbuhaler ) in newly diagnosed asthmatics
Eur Respir J 1997; 10: 2210 2215 DOI: 10.1183/09031936.97.10102210 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 0903-1936 Effect of 1 year daily
More informationClinical efficacy of low-dose inhaled budesonide once or twice daily in children with mild asthma not previously treated with steroids
Eur Respir J 1998; 12: 1099 1104 DOI: 10.1183/09031936.98.12051099 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 0903-1936 Clinical efficacy of low-dose
More informationTeacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology
Title: Spirometry Teacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology I. Measurements of Ventilation Spirometry A. Pulmonary Volumes 1. The tidal
More informationLow Exhaled Nitric Oxide in School-Age Children with Bronchopulmonary Dysplasia and Airflow Limitation
Low Exhaled Nitric Oxide in School-Age Children with Bronchopulmonary Dysplasia and Airflow Limitation Eugenio Baraldi, Gea Bonetto, Franco Zacchello, and Marco Filippone Department of Pediatrics, School
More informationUNIT TWO: OVERVIEW OF SPIROMETRY. A. Definition of Spirometry
UNIT TWO: OVERVIEW OF SPIROMETRY A. Definition of Spirometry Spirometry is a medical screening test that measures various aspects of breathing and lung function. It is performed by using a spirometer,
More informationSPIROMETRY. Marijke Currie (CRFS) Care Medical Ltd Phone: Copyright CARE Medical ltd
SPIROMETRY Marijke Currie (CRFS) Care Medical Ltd Phone: 0800 333 808 Email: sales@caremed.co.nz What is spirometry Spirometry is a physiological test that measures the volume of air an individual can
More informationClinical effect of Diskus dry-powder inhaler at low and high inspiratory flow-rates in asthmatic children
Eur Respir J 1998; 11: 35 354 DOI: 1.1183/931936.98.11235 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 93-1936 Clinical effect of Diskus dry-powder
More informationAssessment of accuracy and applicability of a new electronic peak flow meter and asthma monitor
Eur Respir J 18; 12: 45 42 DOI: 18/1.8.5 Printed in UK - all rights reserved Copyright ERS Journals Ltd 18 European Respiratory Journal ISSN - 1 Assessment of accuracy and applicability of a new electronic
More informationOriginal Contributions
Original Contributions Comparison of a New Desktop Spirometer (Spirospec) with a Laboratory Spirometer in a Respiratory Out-Patient Clinic François Swart, Macé M Schuurmans MD, Johannes C Heydenreich,
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationCircadian rhythm of peak expiratory flow in asthmatic and normal children
Thorax 1;:10-1 Circadian rhythm of peak expiratory flow in asthmatic and normal children A J W HENDERSON, F CARSWELL From the Respiratory Research Group, Institute of Child Health, Royal Hospital for Sick
More informationMSRC AIR Course Karla Stoermer Grossman, MSA, BSN, RN, AE-C
MSRC AIR Course Karla Stoermer Grossman, MSA, BSN, RN, AE-C Explain the importance of objective measures in the management of asthma Explain the different types of objective measures used in the management
More informationEvolution of asthma from childhood. Carlos Nunes Center of Allergy and Immunology of Algarve, PT
Evolution of asthma from childhood Carlos Nunes Center of Allergy and Immunology of Algarve, PT allergy@mail.telepac.pt Questionnaire data Symptoms occurring once or several times at follow-up (wheeze,
More informationEVect of breathing circuit resistance on the measurement of ventilatory function
9 Department of Respiratory Medicine, The Alfred Hospital and Monash University Medical School, Melbourne, Victoria, Australia 311 D P Johns C M Ingram S Khov P D Rochford E H Walters Correspondence to:
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More information), the dose of histamine required to provoke a fall in FEV 1. of more than 20% (PD 20
Thorax 1999;54:103 107 103 Pulmonology, Isala Clinics/Weezenlanden Hospital, 00 GM Zwolle, The P L P Brand Pulmonology, Juliana The Hague, The E J Duiverman Pulmonology, Beatrix Groningen, The H J Waalkens
More informationBRONCHIAL LABILITY IN SCHOOLCHILDREN BORN VERY PRETERM
BRONCHIAL LABILITY IN SCHOOLCHILDREN BORN VERY PRETERM Anna Pelkonen Helsinki 2000 Allergy Unit, Skin and Allergy Hospital and Hospital For Children and Adolescents, University of Helsinki, Finland Bronchial
More informationPULMONARY FUNCTION. VOLUMES AND CAPACITIES
PULMONARY FUNCTION. VOLUMES AND CAPACITIES The volume of air a person inhales (inspires) and exhales (expires) can be measured with a spirometer (spiro = breath, meter = to measure). A bell spirometer
More informationComparison of Peak Expiratory Flow Variability Between Workers With Work- Exacerbated Asthma and Occupational Asthma*
CHEST Comparison of Peak Expiratory Flow Variability Between Workers With Work- Exacerbated Asthma and Occupational Asthma* Samah Chiry, MD; André Cartier, MD; Jean-Luc Malo, MD; Susan M. Tarlo, MD, FCCP;
More informationWhat do pulmonary function tests tell you?
Pulmonary Function Testing Michael Wert, MD Assistant Professor Clinical Department of Internal Medicine Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical
More informationSpirometry: FEVER DISEASE DIABETES HOW RELIABLE IS THIS? 9/2/2010 BUT WHAT WE PRACTICE: Spirometers are objective tools
SPIROMETRY PRINCIPLES, PROCEDURE AND QA Spirometry: Dr. Rahul Kodgule CHEST RESEARCH FOUNDATION, PUNE FEVER ISCHAEMIC HEART DISEASE DIABETES BUT WHAT WE PRACTICE: Spirometers are objective tools to diagnose
More informationAs-needed (intermittent) inhaled corticosteroid for mild asthma
1 3.2.2008 CIPP VIII 8 th International Congress on Pediatric Pulmonology, Nice 2008 As-needed (intermittent) inhaled corticosteroid for mild asthma Tari Haahtela, Professor Skin and Allergy Hospital,
More informationContent Indica c tion Lung v olumes e & Lung Indica c tions i n c paci c ties
Spirometry Content Indication Indications in occupational medicine Contraindications Confounding factors Complications Type of spirometer Lung volumes & Lung capacities Spirometric values Hygiene &
More informationFrom Chronic Lung Disease of Infancy to Asthma
From Chronic Lung Disease of Infancy to Asthma Mollie V. Anderson, CPNP Certified Pediatric Nurse Practitioner Pediatric Lung Care Bon Secours Medical Group St. Mary s Hospital 1 Mollie V. Anderson, CPNP
More informationValue of measuring diurnal peak flow variability in the recognition of asthma: a study in general practice
Eur Respir J ; : DOI:./.. Printed in UK - all rights reserved Copyright ERS Journals Ltd European Respiratory Journal ISSN - Value of measuring diurnal peak flow variability in the recognition of asthma:
More informationJosh Stanton and Michael Epton Respiratory Physiology Laboratory, Canterbury Respiratory Research Group Christchurch Hospital
Josh Stanton and Michael Epton Respiratory Physiology Laboratory, Canterbury Respiratory Research Group Christchurch Hospital Setting Scene Advancements in neonatal care over past 30 years has resulted
More informationLife-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
More informationExhaled Nitric Oxide: An Adjunctive Tool in the Diagnosis and Management of Asthma
Exhaled Nitric Oxide: An Adjunctive Tool in the Diagnosis and Management of Asthma Jason Debley, MD, MPH Assistant Professor, Pediatrics Division of Pulmonary Medicine University of Washington School of
More informationChronic Lung Disease Of Prematurity. Dr Jo Harrison
Chronic Lung Disease Of Prematurity Dr Jo Harrison 9.9.14 Chronic Neonatal Lung Disease Bronchopulmonary dysplasia (BPD) first described in 1967 by Northway Defined as O 2 dependence at 28 days post birth
More informationYoung Yoo, MD; Jinho Yu, MD; Do Kyun Kim, MD; and Young Yull Koh, MD
Original Research ASTHMA Percentage Fall in FVC at the Provocative Concentration of Methacholine Causing a 20% Fall in FEV 1 in Symptomatic Asthma and Clinical Remission During Adolescence* Young Yoo,
More informationARTICLE. Eija Piippo-Savolainen, MD; Sami Remes, MD, MPH; Senja Kannisto, MD; Kaj Korhonen, MD; Matti Korppi, MD
ARTICLE Asthma and Lung Function 20 Years After Wheezing in Infancy Results From a Prospective Follow-up Study Eija Piippo-Savolainen, MD; Sami Remes, MD, MPH; Senja Kannisto, MD; Kaj Korhonen, MD; Matti
More informationPulmonary Function Tests. Mohammad Babai M.D Occupational Medicine Specialist
Pulmonary Function Tests Mohammad Babai M.D Occupational Medicine Specialist www.drbabai.com Pulmonary Function Tests Pulmonary Function Tests: Spirometry Peak-Flow metry Bronchoprovocation Tests Body
More informationPULMONARY FUNCTION TEST(PFT)
PULMONARY FUNCTION TEST(PFT) Objectives: By the end of the present lab, students should be able to: 1. Record lung volumes and capacities and compare them with those of a typical person of the same gender,
More informationCorrespondence: C-G. Löfdahl Dept of Respiratory Medicine and Allergology University Hospital S Lund Sweden.
Eur Respir J 1997; 10: 2474 2478 DOI: 10.1183/09031936.97.10112474 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 0903-1936 Differences in bronchodilating
More informationNG80. Asthma: diagnosis, monitoring and chronic asthma management (NG80)
Asthma: diagnosis, monitoring and chronic asthma management (NG80) NG80 NICE has checked the use of its content in this product and the sponsor has had no influence on the content of this booklet. NICE
More informationPeak flow rate in relation to forced expiratory volume in hemp workers
Brit. J. industr. Med., 1971, 28, 159-163 Peak flow rate in relation to forced expiratory volume in hemp workers v v I E. ZUSKIN and F. VALIC Department of Occupational Health, Andrija Stampar School of
More informationClinical efficacy of montelukast in anti-inflammatory treatment of asthma and allergic rhinitis
Clinical efficacy of montelukast in anti-inflammatory treatment of asthma and allergic rhinitis Kim Hyun Hee, MD, PhD. Dept. of Pediatrics The Catholic University of Korea College of Medicine Achieving
More informationHome recording of PEF in young asthmatics: does it contribute to management?
Eur Respir J, 1996, 9, 872 879 DOI: 1.1183/931936.96.95872 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1996 European Respiratory Journal ISSN 93-1936 Home recording of PEF in young asthmatics:
More informationLecture Notes. Chapter 3: Asthma
Lecture Notes Chapter 3: Asthma Objectives Define asthma and status asthmaticus List the potential causes of asthma attacks Describe the effect of asthma attacks on lung function List the clinical features
More informationDiagnosis, Treatment and Management of Asthma
Diagnosis, Treatment and Management of Asthma Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.
More informationStarting with a Higher Dose of Inhaled Corticosteroids in Primary Care Asthma Treatment
Starting with a Higher Dose of Inhaled Corticosteroids in Primary Care Asthma Treatment THYS van der MOLEN, BETTY MEYBOOM-DE JONG, HELMA H. MULDER, and DIRKJE S. POSTMA Department of General Practice,
More informationThis is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationAsthma Management for the Athlete
Asthma Management for the Athlete Khanh Lai, MD Assistant Professor Division of Pediatric Pulmonary and Sleep Medicine University of Utah School of Medicine 2 nd Annual Sports Medicine Symposium: The Pediatric
More informationPersistent nocturnal cough in childhood: a population based study
Archives ofdisease in Childhood 1995; 73: 43-47 43 University of Aberdeen, Department of Child Health T K Ninan Department of Public Health L Macdonald Department of Medical Paediatrics, Royal Aberdeen
More informationROLE OF EARLY POSTNATAL DEXAMETHASONE IN RESPIRATORY DISTRESS SYNDROME
INDIAN PEDIATRICS VOLUME 35-FEBRUAKY 1998 ROLE OF EARLY POSTNATAL DEXAMETHASONE IN RESPIRATORY DISTRESS SYNDROME Kanya Mukhopadhyay, Praveen Kumar and Anil Narang From the Division of Neonatology, Department
More informationS P I R O M E T R Y. Objectives. Objectives 2/5/2019
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
More informationDR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL
DR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL Definition Guidelines contact complicated definitions Central to this is Presence of symptoms Variable airflow obstruction Diagnosis
More informationBronchial asthma. E. Cserháti 1 st Department of Paediatrics. Lecture for english speaking students 5 February 2013
Bronchial asthma E. Cserháti 1 st Department of Paediatrics Lecture for english speaking students 5 February 2013 Epidemiology of childhood bronchial asthma Worldwide prevalence of 7-8 and 13-14 years
More informationRespiratory Care in PICU Aerosol Therapy ส พ ชชา ชา แสงโขต โรงพยาบาลสมเด จพระป นเกล า
Respiratory Care in PICU Aerosol Therapy น.อ.หญ ง ส พ ชชา ชา แสงโขต โรงพยาบาลสมเด จพระป นเกล า Aerosol liquid droplets or solid particles suspended in a gas(air) visible like fog Aerosol vs Humidity Humidity
More informationTHE CHALLENGES OF COPD MANAGEMENT IN PRIMARY CARE An Expert Roundtable
THE CHALLENGES OF COPD MANAGEMENT IN PRIMARY CARE An Expert Roundtable This activity is supported by an educational grant from Sunovion Pharmaceuticals Inc. COPD in the United States Third leading cause
More informationDeterminants of the bronchodilation response to salbutamol on histamine-induced bronchoconstriction
Respiratory Medicine (2006) 100, 1760 1766 Determinants of the bronchodilation response to salbutamol on histamine-induced bronchoconstriction Heikki O. Koskela a,, Vesa Kiviniemi b, Minna K. Purokivi
More informationDifferential diagnosis
Differential diagnosis The onset of COPD is insidious. Pathological changes may begin years before symptoms appear. The major differential diagnosis is asthma, and in some cases, a clear distinction between
More informationPULMONARY FUNCTION TESTING. By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS)
PULMONARY FUNCTION TESTING By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases (CROD) Tehran University of Medical Sciences (TUMS) PULMONARY FUNCTION TESTS CATEGORIES Spirometry Lung volumes
More informationImportance of fractional exhaled nitric oxide in diagnosis of bronchiectasis accompanied with bronchial asthma
Original Article Importance of fractional exhaled nitric oxide in diagnosis of bronchiectasis accompanied with bronchial asthma Feng-Jia Chen, Huai Liao, Xin-Yan Huang, Can-Mao Xie Department of Respiratory
More informationA comparison of global questions versus health status questionnaires as measures of the severity and impact of asthma
Eur Respir J 1999; 1: 591±596 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 93-1936 A comparison of global questions versus health status questionnaires
More informationPeak expiratory flow and the resistance of the mini-wright peak flow meter
Eur Respir J, 1996, 9, 828 833 DOI: 10.1183/09031936.96.090828 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1996 European Respiratory Journal ISSN 0903-1936 TECHNICAL NOTE Peak expiratory
More informationSpirometry: Introduction
Spirometry: Introduction Dr. Badri Paudel 1 2 GMC Spirometry Spirometry is a method of assessing lung function by measuring the volume of air the patient can expel from the lungs after a maximal expiration.
More informationFVC to Slow Inspiratory Vital Capacity Ratio* A Potential Marker for Small Airways Obstruction
Original Research PSYCHOLOGICAL TESTING FVC to Slow Inspiratory Vital Capacity Ratio* A Potential Marker for Small Airways Obstruction Judith Cohen, MD; Dirkje S. Postma, MD, PhD; Karin Vink-Klooster;
More informationBETTER SPIROMETRY. Marijke Currie (CRFS) Care Medical Ltd Phone: Copyright CARE Medical ltd
BETTER SPIROMETRY Marijke Currie (CRFS) Care Medical Ltd Phone: 0800 333 808 Email: sales@caremed.co.nz What is spirometry Spirometry is a physiological test that measures the volume of air an individual
More informationnot reply to the letters, and 26 families made an Each child was seen with at least one parent. A one episode, or multiple episodes of croup and
Archives of Disease in Childhood, 1981, 56, 336-341 Croup, recurrent croup, allergy, and airways hyper-reactivity MAXIMILIAN ZACH, ANNA ERBEN, AND ANTHONY OLINSKY Department of Thoracic Medicine, Royal
More informationBronchial Provocation Results: What Does It Mean?
Bronchial Provocation Results: What Does It Mean? Greg King 1 Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards 2065 2 Woolcock Institute of Medical Research and Sydney Medical
More informationSpirometry: an essential clinical measurement
Shortness of breath THEME Spirometry: an essential clinical measurement BACKGROUND Respiratory disease is common and amenable to early detection and management in the primary care setting. Spirometric
More informationSwimming and Persons with Mild Persistant Asthma
Research Article TheScientificWorldJOURNAL (2007) 7, 1182 1188 TSW Child Health & Human Development ISSN 1537-744X; DOI 10.1100/tsw.2007.221 Swimming and Persons with Mild Persistant Asthma Mirjana Aranđelović*,
More informationCredential Maintenance Program
First Quarter of the Calendar 5 I. INSTRUMENTATION / EQUIPMENT 1 4 5 A. Set Up, Maintain, Calibrate 1 2 3 1. Blood gas analyzers 2. CO-oximeters / hemoximeters 3. Spirometers (for example, diagnostic,
More informationH.M. Boezen*, J.P. Schouten*, D.S. Postma**, B. Rijcken*
Eur Respir J, 1994, 7, 1814 1820 DOI: 10.1183/09031936.94.07101814 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1994 European Respiratory Journal ISSN 0903-1936 Distribution of peak expiratory
More informationGINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017
GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and
More informationInternational Journal of Medical Research & Health Sciences
International Journal of Medical Research & Health Sciences www.ijmrhs.com Volume 2 Issue 3 July - Sep Coden: IJMRHS Copyright @2013 ISSN: 2319-5886 Received: 23 th May 2013 Revised: 24 th Jun 2013 Accepted:
More informationEffect of particle size of bronchodilator aerosols on lung distribution and pulmonary function in patients
Thorax 1987;42:457-461 Effect of particle size of bronchodilator aerosols on lung distribution and pulmonary function in patients with chronic asthma D M MITCHELL, M A SOLOMON, S E J TOLFREE, M SHORT,
More informationbehaviour are out of scope of the present review.
explained about the test, a trial may be done before recording the results. The maneuver consists initially of normal tidal breathing. The subject then inhales to maximally fill the lungs. This is followed
More informationBusselton is a coastal city in southwestern Western
Obstructive airway disease in 46e65-year-old people in Busselton, Western Australia, 1966e2015 Arthur (Bill) Musk 1, Michael Hunter 2,3, Jennie Hui 2,4, Matthew W Knuiman 2, Mark Divitini 2, John P Beilby
More informationCONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION Method of maintaining low pressure distension of lungs during inspiration and expiration when infant breathing spontaneously Benefits Improves oxygenation
More informationStep-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide.
Step-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide. By: DR MOHD SHAMSUL AMRI Supervisor: Associate Professor Dr
More informationType of intervention Treatment. Economic study type Cost-effectiveness analysis.
Cost-effectiveness of salmeterol/fluticasone propionate combination product 50/250 micro g twice daily and budesonide 800 micro g twice daily in the treatment of adults and adolescents with asthma Lundback
More informationC.S. Ulrik *, V. Backer **
Eur Respir J, 1996, 9, 1696 1700 DOI: 10.1183/09031936.96.09081696 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1996 European Respiratory Journal ISSN 0903-1936 Increased bronchial responsiveness
More informationSpirometry in primary care
Spirometry in primary care Wednesday 13 th July 2016 Dr Rukhsana Hussain What is spirometry? A method of assessing lung function Measures volume of air a patient can expel after a full inspiration Recorded
More informationSupplementary Medications during asthma attack. Prof. Dr Finn Rasmussen PhD. DrMedSc. Near East University Hospital North Cyprus
Supplementary Medications during asthma attack Prof. Dr Finn Rasmussen PhD. DrMedSc. Near East University Hospital North Cyprus Conflicts of Interest None Definition of Asthma Airway narrowing that is
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationNoah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018
Postnatal Steroids Use for Bronchopulmonary Dysplasia in 2018 + = Noah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018 AAP Policy Statement - 2002 This statement is intended for
More informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More informationPulmonary Function Testing: Concepts and Clinical Applications. Potential Conflict Of Interest. Objectives. Rationale: Why Test?
Pulmonary Function Testing: Concepts and Clinical Applications David M Systrom, MD Potential Conflict Of Interest Nothing to disclose pertinent to this presentation BRIGHAM AND WOMEN S HOSPITAL Harvard
More informationAsthma Pathophysiology and Treatment. John R. Holcomb, M.D.
Asthma Pathophysiology and Treatment John R. Holcomb, M.D. Objectives Definition of Asthma Epidemiology and risk factors of Asthma Pathophysiology of Asthma Diagnostics test of Asthma Management of Asthma
More information