22 Progress in Respiration Research Editor: H. Herzog A. Zapletal, M. Šamánek, T. Paul Lung Function in Children and Adolescents Lung Function in Children and Adolescents Progress in Respiration Research Vol. 22 Series Editor H. Herzog, Basel Basel München Paris London New York New Delhi Singapore Tokyo Sydney Lung Function in Children and Adolescents A. Zapletal, Prague Co-authors M. Šamánek, T. Paul, Prague 59 figures and 283 tables, 1987 Basel München Paris London New York New Delhi Singapore -Tokyo Sydney Progress in Respiration Research Downloaded by: 37.44.204.49-11/29/2017 10:38:59 AM
Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 1987 by S. AG, P.O. Box, CH-4009 Basel (Switzerland) Printed in Switzerland by Thiir AG Offsetdruck, Pratteln ISBN 3-8055-4495-2 Contents Preface VII Studied Healthy Subjects 1 I. Static Lung Volumes and Lung Ventilation 4 Methods 5 Results 7 Discussion 11 Conclusions 12 II. Lung Elasticity 13 Methods 15 Results 20 Discussion 26 Conclusions 31 III. Airway Patency 32 Maximum Expiratory Flow Rates 32 Methods 38 Results and Discussion 40
Dynamic Lung Volumes 47 Methods 49 Results and Discussion 49 Conclusions 50 Airflow Resistance 51 Airway Resistance 52 Method 58 Results and Discussion 61 Lung (Pulmonary) Resistance 63 Results and Discussion 64 Conclusions 65 Contents VI Multiple-Breath Nitrogen Lung Washout Curve 66 Results and Discussion 67 Conclusions 67 IV. Work of Breathing 68 Method 73 Results 75 Discussion 77 Conclusions 81 V. Gas Exchange in the Lungs 83 Alveolar Ventilation, Respiratory Functional Dead Space and Its Ventilation, Oxygen Consumption and Elimination of Carbon Dioxide 83 Methods 84 Results and Discussion 84 Lung-Diffusing Capacity (Transfer Factor) 85 Method and Subjects 90 Results 91 Discussion 93 Conclusions 94 Summary 95 References 100 Addendum 113 Explanations to Tables 113
Subject Index 219 Preface During recent years, lung function testing in children has shown considerable progress and nowadays it contributes significantly when establishing diagnoses in children with respiratory diseases. Lung function testing has also become an indispensable diagnostic tool in pediatric cardiology, surgery, sports medicine as well as in other branches of pediatric and adolescent medicine. Numerous new methods have been introduced into the investigation of lung function in children thus making it possible to detect the minor abnormalities of lung function caused by disturbances of the respiratory system. In order to assess whether certain results of lung function tests are normal or pathological, one has to compare them with the reference ('normal') values of the tests also taking their physiological variability into account. A specific feature of pulmonary function tests in children is the fact that the test values change during growth and development. In the literature, reference values of some basic pulmonary function tests in various groups of children and adolescents have been published repeatedly [2, 4, 10-12, 28, 29, 36, 40, 41, 50-52, 57, 63, 89, 90, 91, 97, 124, 147, 149, 152]. In the present work we report on cross-sectional data of lung function tests obtained in the same group of healthy subjects, i.e. lung volumes and ventilation, results of lung elasticity indices, values of indices used for an assessment of abnormalities in the airway patency, lung mechanical work (work of breathing), and some indices of gas exchange in the lungs. Methodological procedures and the values for pulmonary function tests from healthy subjects are limited in this publication for the age group between 5 and 18 years. The latter are presented as regression equations in tables, complemented in some cases by their graphic expression. The data are given in traditional as well as SI units in the text (table 82). Main emphasis is put on the detailed description of methodical procedures of lung function testing used in the studied subjects. With respect to the fact that the methods described are somewhat identical with those used in adults, they are useful not only to pediatricians Preface VIII but also to those performing lung function tests in adolescents and adults. The book is not written as a textbook but to emphasis our own results as presented in tables and graphs, with the hope of making the evaluation
of lung function in patients easier for the investigator. Therefore, not all methods have been described but only those used for the data reported. The authors are indebted to all colleagues and co-workers of the Cardiopulmonary Laboratory and other departments of the University Hospital Motol in Prague dealing with respiratory problems in children and adolescents, Pediatric Clinic of the Hospital 'Pod Petrínem', as well as to co-workers of the Lung Sanatoriums for Children at Sumperk and Dolny Smokovec, whose cooperation helped in the 'birth' of this publication. The authors acknowledge the help of Dr. B. Zapletalová for her final preparations of the tables. Finally, we would like to thank the publishers, S., for their continued help and advice during the creation of this publication. Alois Zapletal