Can Plethysmography Identify Earlier Lung Function Changes in Asthmatic Children?

ORIGINAL ARTICLE
Sonila Borici, Anxhela Gurakuqi, Ilir Akshija, Luljeta Serbo

 
For citation: Borici S, Gurakuqi A, Akshija I, Serbo L. Can Plethysmography Identify Earlier Lung Function Changes in Asthmatic Children? International Journal of Biomedicine. 2024;14(4):569-574. doi:10.21103/Article14(4)_OA5
 
Originally published December 5, 2024
 

Abstract: 

Background: Although in recent years, it has been noted that spirometry provides little information about lung function in children with asthma, as spirometry is normal in most cases, international guidelines still recommend spirometry for diagnosing and monitoring children with asthma. Spirometry measures dynamic lung volumes, while plethysmography measures static lung volumes. The aim of this study was to evaluate the role of plethysmography in identifying functional phenotypes in children with asthma.
Methods and Results: This observational study included 93 patients (boys [66.7%] and girls [33.3%], mean age of 8.6±3.1years) diagnosed with bronchial asthma (GINA, 2020). All patients were classified according to asthma severity. All patients underwent spirometry and plethysmography measurements. The reference values of functional parameters were based on Zapletal data. Air trapping was detected in 78.5% of patients according to residual volume (RV) data, 77.4% of patients according to RV/total lung capacity [TLC] data, 58% of patients according to functional reserve capacity [FRC]/TLC data, and 57% according to FRC data. Only 26.9% of patients, according to TLC, had distension (hyperinflation). 12.3% of the patients had the so-called pseudo-restriction phenotype or small airway obstruction syndrome, which involves increased RV, decreased FVC, and normal TLC.
There was no statistically significant relationship between RV and FEV1 (r=-0.104, P=0.325). A weak negative correlation (r=-0.319, P<0.05) was found between RV/TLC and FVC. A weak negative correlation was determined between RV and age (r=-0.252, P=0.046). At the same time, we found a moderate positive correlation between TLC and RV/TLC (r=0.65, P<0.001). We studied the sensitivity and specificity of lung function variables (FEV1, FVC, FEF50, and specific airway resistance [sRaw]) to predict the presence of air trapping (RV>140%pred) and found none of these variables can discriminate the presence of air trapping.
Conclusion: Air trapping is the most common and earliest functional phenotype; thus, it is the most sensitive functional parameter for identifying functional abnormalities in asthma. It is present in all degrees of asthma severity. Spirometric variables cannot detect small-airway obstruction syndrome (air trapping); therefore, a plethysmographic measurement of pulmonary volumes is necessary. Functional physiological phenotypes such as air trapping, restriction, and pseudo-restriction are present in children with asthma and can only be identified by measuring lung volumes.

Keywords: 
asthma • children • plethysmography • air-trapping
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Received August 5, 2024.
Accepted September13, 2024.
©2024 International Medical Research and Development Corporation.