Pulmonary function testing: tools and applications in young children with asthma

Abstract

Many (pre-)school children with acute or chronic respiratory problems are seen every day by physicians, both in primary care and in hospitals. Although in many children these respiratory symptoms are self-limiting, it is important to recognise early in the course of the disease those children that are at risk to suffer from persistent respiratory diseases and to develop pulmonary function abnormalities and chronic airway remodelling. In most children diagnosis and treatment of respiratory disease are mainly based on medical history and physical examination. However, the evaluation of objective disease markers, e.g. pulmonary function could be helpful for the assessment of functional abnormalities. Especially in pre-school children respiratory function parameters are rarely available. Although recently several alternative methods have been developed, most have and can not be implemented for use in daily clinical practice and are currently only available in specialised centres. Many of these tests require difficult technical procedures, anaesthetic care or are even invasive. Clinical application of new or alternative pulmonary function tests in young children is only possible for techniques that are easily performed in children of all ages, do not require much time or sedation and show results quickly. They should be reproducible, cheap, able to distinguish healthy from diseased children, not invasive, applicable during spontaneous breathing, responsive to intervention and useful for follow up. Promising techniques that might fulfil (most of these) requirements are tidal breathing analysis, interrupter resistance measurement and impulse oscillometry. Adaptation of traditional techniques (MEFV) or standardisation of these newer techniques and availability of reference values might enable more widespread use of these techniques in daily practice. The studies described in this thesis addressed several aspects of pulmonary function testing in pre-school and school children.