OBJECTIVETo investigate the changes of pulmonary function and fractional exhaled nitric oxide (FeNO) in the standardized treatment of bronchial asthma in children.

METHODSA total of 254 children who were newly diagnosed with acute exacerbation of bronchial asthma were selected as asthma group, and they were divided into two subgroups: asthma with concurrent rhinitis and asthma without concurrent rhinitis. All patients received the standardized management and treatment for one year. The pulmonary function parameters included forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and mid-expiratory flow at 25%, 50%, and 75% of vital capacity (MEF25, MEF50, and MEF75). The FeNO levels were measured before treatment and at 3, 6, 9, and 12 months after treatment. Another 62 healthy children were selected as the control group, and the pulmonary function and FeNO levels were measured only once.

RESULTSDuring one year of standardized treatment, FEV1, PEF, MMEF, MEF25, MEF50, and MEF75 gradually increased, and FeNO levels gradually decreased (P<0.05). Indicators of large airway function, such as FEV1 and PEF, almost returned to normal after 6 months of treatment; indicators of small airway function, such as MMEF, MEF25, MEF50, and MEF75 almost returned to normal after 9 months of treatment; there were no significant differences in the above indices between the asthma group and the control group after one year of treatment (P>0.05). However, the asthma group had a significantly higher FeNO levels than the control group after one year of treatment (P<0.05). The asthmatic patients with concurrent rhinitis had significantly higher FeNO levels than those without concurrent rhinitis before treatment and 3 months after treatment (P<0.05). Before treatment, there was a significant negative correlation between FeNO levels and pulmonary function parameters (P<0.05).

CONCLUSIONSWith the standardized treatment of bronchial asthma in children, pulmonary function parameters gradually increase and FeNO levels gradually decrease. The recovery of large airway function occurs earlier than the recovery of small airway function. Furthermore, the effect of rhinitis on airway responsiveness should be noted.

Asthma ; physiopathology ; therapy ; Breath Tests ; Child ; Female ; Forced Expiratory Volume ; Humans ; Lung ; physiopathology ; Male ; Maximal Midexpiratory Flow Rate ; Nitric Oxide ; analysis ; Rhinitis ; physiopathology

PURPOSE: To evaluate the HRCT findings of hypersensitive pneumonitis and to correlate the findings with the results of the pulmonary function test (PFT). MATERIALS AND METHODS: Seven patients in whom hypersensitive pneumonitis was histologically confirmed (by transbronchial lung biopsy in two, thoracoscopic lung biopsy in one, open lung biopsy in two, and typical clinical and laboratory findings in two) were involved in this study. Their radiological patterns were assessed by HRCT and the extent of each finding was evaluated semi-quantitatively and correlated with the results of the pulmonary function test. RESULTS: The HRCT findings were as follows: lobular overinflation (n = 7), ground glass attenuation (n = 7), centrilobular nodule (n = 6), reticular opacity (n = 5), interlobular septal thickening (n = 3), consolidation (n = 2), and irregular subpleural line (n = 1). Five patients showed lower lung predominance and two, middle lung predominance. In all, a restrictive pattern and diminished diffusion capacity was noted. The grade score of reticular opacity showed significant correlation with forced vital capacity and forced expiratory volume. There was, however, no significant correlation between other HRCT findings and PFT results. Two patientsin whom lobular overinflation associated with parenchymal fibrosis was noted showed a decreased maximal midexpiratory flow rate of 25 -75. CONCLUSION: Lobular overinflation, ground-glass attenuation and centrilobular nodules are commonly observed in hypersensitive pneumonitis. The only significant correlation between each HRCT finding and the pulmonary function test was that between reticular opacity and both forced expiratory volume and forced vital capacity. In cases of chronic hypersensitive pneumonitis presenting as pulmonary fibrosis, associated lobular overinflation could be helpful for differential diagnosis.
Alveolitis, Extrinsic Allergic* ; Biopsy ; Diagnosis, Differential ; Diffusion ; Fibrosis ; Forced Expiratory Volume ; Glass ; Humans ; Hypersensitivity* ; Lung ; Maximal Midexpiratory Flow Rate ; Pneumonia ; Pulmonary Fibrosis ; Respiratory Function Tests* ; Vital Capacity

OBJECTIVEImpulse oscillation system (IOS) as an approach to lung function determination is suitable for children, especially for preschool children in that it only requires the individual to be examined to breathing stably with tidal volume. However, until now there have been no uniformly agreed criteria for positive bronchial reversibility test in clinical practice. A screening method was applied to seek for answer when this question in the hope of providing objective evidence for clinical diagnosis of respiratory diseases, esp. asthma.

METHODSOne hundred and fifty-six children patients during asthma attack were recruited randomly for this study from January to December, 2004. These patients included 103 boys and 53 girls aged from 5 to 18 years with mean age of 8.84 +/- 2.58 years, who visited the doctors in the Clinical and Educational Centre for Asthma, Capital Institute of Pediatrics and were diagnosed as asthma. Maximal expiratory flow volume and IOS lung function were determined followed by bronchodilator reversibility test in all patients. The sensitivity and specificity of IOS parameters, total respiratory impedance (Zrs), respiratory resistance at 5 Hz (R5) and reactance at 5 Hz (X5) for diagnosing asthma at different improvement levels after inhalation of bronchodilator were calculated respectively using forced expiratory volume in first second (FEV(1)) and maximal mid-expiratory flow (MMEF) as gold standard. And the regression equation between parameters of lung function which were determined with the two different methods was analyzed.

RESULTSAfter inhalation of bronchodilator, the lung function of the children was improved significantly (P < 0.01), with the FEV(1), MMEF increase and Zrs, R5, and X5 decrease. There were significantly positive correlations (P < 0.01) between the improvement rate of parameters of lung functions determined with the two methods, and the highest correlation coefficients existed between X5 and FEV(1) and MMEF (respectively 0.676, 0.571), correlation coefficients between X5 and Zrs ranked second (0.519 and 0.505, respectively). When an increase of FEV(1) equal to or greater than 15%, or increase of MMEF equal to or greater than 30% was used as reference for positive bronchial reversibility, the sensitivity and specificity were relatively high for considering positive bronchial reversibility test with at least 20% decrease of Zrs, R5, and 30% decrease of X5 with IOS lung function. The sensitivity and specificity of Zrs, R5 and X5 calculated from FEV(1) were 0.62, 0.51; 0.49, 0.54; 0.70, and 0.54, respectively. The sensitivity and specificity of Zrs, R5 and X5 calculated from MMEF were 0.63, 0.54; 0.53, 0.60; 0.60, and 0.58, respectively. The regression equation showed that the decrease of Zrs, R5 and X5 corresponding to 15% increase of FEV(1) and 30% increase of MMEF were 21.7%, 21.3%; 19.9%, 19.5%; 30.1%, and 29.6%, respectively.

CONCLUSIONWhen lung function is determined with IOS in children, only when decrease of Zrs and R5 is equal to or more than 20% and decrease of X5 is 30% or more after inhalation of bronchodilator, can the bronchial reversibility test be considered as positive.

Adolescent ; Asthma ; diagnosis ; Bronchodilator Agents ; administration & dosage ; Child ; Child, Preschool ; Female ; Forced Expiratory Volume ; Humans ; Male ; Maximal Midexpiratory Flow Rate ; Regression Analysis ; Respiratory Function Tests ; methods ; Sensitivity and Specificity

Small and large airways functions were studied in patients with hypertensive heart disease in slightly ro moderately compromised state functionally. In this study, the forced vital capacity and various flow paramaeters reflecting expiratory flow rate were determined from simultaneously recorded forced expiratory volume and maximal expiretory flow volume curves in 86 cases. The closing volume was measured by a single breath nitrogen mrthod in 57 cases and airway resistance with its related parameters by a body plethysmograph in 11 cases. These results were compared with those obtained from the same numbers of healthy controls matched for sex, age and height. In the patient group, the forced vital capadity and all the observed values of flow parameters, execpt for the ratio of the first second vital capacity to the forced vital capacity, were significantly reduced than those in the controls. When the remainder of flow parameters was volume-adjusted to the forced vital capacity, however, the mean of the peak expiratory flow rate and the maximal expiratory flow rate at the 75 percent of the vital capacity were not significantly different from that of controls. In contrast, the volume-adjusted values of maximal expiratory flow were remained significantly smaller than those in the controls. The closing volume and its ratio to the vital capacity were significantly larger in the patient group. Airway resistance and its related parameters revealed no significant differences between two groups. These findings suggest that the patients with hypertensive heart disease in a mild to moderate failure are associated with restrictive ventilatory impairment and a small airways obstruction, but with little or no large airway dysfunction.
Airway Resistance ; Closing Volume ; Forced Expiratory Volume ; Heart Diseases* ; Heart* ; Humans ; Maximal Expiratory Flow Rate ; Nitrogen ; Peak Expiratory Flow Rate ; Vital Capacity

In China there are 1,923,842 Korean Chinese, who live mostly (92.27%) in the country's three northeast provinces. In spite of this sizeable number, no spirometric data are available at present on them. The present study investigated normal spirometric reference values for the Korean Chinese children and adolescents. Spirometry was performed in 443 healthy Korean Chinese children and adolescents aged 8-18 yr with measurements of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF) and maximum mid-expiratory flow (MMEF). Reference equations for FEV1, FVC, PEF and MMEF were derived by using multiple regression analysis. All of the measured spirometric parameters correlated positively with height and age significantly (P < 0.001). The predicted values of FVC and FEV1 were higher than values obtained by using Caucasian and other Asian equations (P < 0.001). A set of spirometric reference equations has been derived using a relatively large, healthy, non-smoking young Korean Chinese population with a wide range of ages and heights, the results of which differ from those gained from several other reference equations. These reference equations should be used for evaluation of lung function in this population.
Adolescent ; Child ; China ; Female ; *Forced Expiratory Volume ; Humans ; Lung/*physiology ; Male ; Maximal Expiratory Flow Rate ; Peak Expiratory Flow Rate ; Reference Values ; Republic of Korea/ethnology ; Spirometry/*standards ; *Vital Capacity

The aim of this study is to develop backpropagation neural networks (BPNN) for better prediction of ventilatory function in children and adolescents. Nine hundred and ninety-nine healthy children and adolescents (500 males and 499 females) aged 10-18 years, all of the Han Nationality, were selected from Inner Mongolia Autonomous Region, and their heights, weights, and ventilatory functions were measured respectively by means of physical examination and spirometric test. Using the approaches of BPNN and stepwise multiple regression, the prediction models and equations for forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), forced expiratory flow at 25% of forced vital capacity (FEF25%), forced expiratory flow at 50% of forced vital capacity (FEF50%), maximal mid-expiratory flow (MMEF) and forced expiratory flow at 75% of forced vital capacity (FEF75%) were established. Through analyzing mean squared difference (MSD) and correlation coefficient (R) of the ventilatory function indexes, the present study compared the results of BPNN, linear regression equation based on this work (LR's equation), prediction equations based on the studies of Ip et al. (Ip's equation) and Zapletal et al. (Zapletal's equation). The results showed, regardless of sex, the BPNN prediction models appeared to have smaller MSD and higher R values, compared with those from the other prediction equations; and the LR's equation also had smaller MSD and higher R values compared with those from Ip's and Zapletal's equations. The coefficients of variance (CV) for FEF50%, MMEF and FEF75% were higher than those of the other ventilatory function parameters, and their increasing percentages of R values (ΔR, relative to R values by LR's equation) derived by BPNN were correspondingly higher than those of the other indexes. In sum, BPNN approach for ventilatory function prediction outperforms the traditional regression methods. When CV of a certain ventilatory function parameter is higher, the superiority of BPNN would be more significant compared with traditional regression methods.
Adolescent ; Child ; China ; Female ; Forced Expiratory Volume ; physiology ; Forecasting ; Humans ; Lung ; physiology ; Male ; Neural Networks (Computer) ; Peak Expiratory Flow Rate ; physiology ; Pulmonary Ventilation ; physiology ; Reference Values ; Sampling Studies ; Vital Capacity ; physiology

OBJECTIVETo assess the quality control for the maximal expiratory flow-volume (MEFV) curve in school-age children.

METHODSEight hundred and sixty-two children who had two or more MEFV manoeuvres were classified into ≥6-year-old (n=379), ≥8-year-old (n=210), ≥10-year-old (n=64), and 12-17-year-old groups (n=109). The parameters of quality control and concordance with quality control criteria for MEFV were compared between the two groups. In addition, patients who were diagnosed with asthma were classified into two groups, one with normal pulmonary function (n=155) and the other with abnormal pulmonary function (n=62), based on the results of spirometry. Differences in the parameters of quality control for spirometry were compared between the two groups.

RESULTSEight hundred and sixty-two children underwent 2 367 MEFV manoeuvres, 97.8% of which met the start of test criterion for backward extrapolated volume (VBE) of less than 0.15 L, with the highest concordance in the ≥6-year-old group and the lowest concordance in the 12-17-year-old group. Three hundred and eighty-one children (44.2%) met the end of test criterion for forced expiratory time (FET) and the concordance in children over 10 years of age was lower than that in children under 10 years of age (P<0.05). Differences in two best forced expiratory volume in first second (FEV1) and forced vital capacity (FVC) manoeuvres were within 150 mL in 91.9% and 84.8%, respectively, of the children. The parameters of quality control for spirometry were better for asthmatic children with abnormal pulmonary function compared with asthmatic children with normal pulmonary function (P<0.05).

CONCLUSIONSConcordance with the start of test criteria and the manoeuvre repeatability criteria is high, whereas the concordance with the end of test criteria is low. It is suggested that the concordance with the FET criteria should be improved.

Adolescent ; Age Factors ; Child ; Female ; Forced Expiratory Volume ; Humans ; Male ; Maximal Expiratory Flow-Volume Curves ; Quality Control

BACKGROUND: For the diagnosis or evaluation of airway obstruction in bronchial asthma and chronic obstructive lung disorders, various parameters derived from the forced expiratory volume curve and maximal expiratory flow volume cutie have been used. Recently the peak expiratory flow(PEF) measured by the peak flow meter is widely used because of its simplicity and convenience. But there were still no data of the predicted normal values measured by the peak flow meter in Korea. This study was to obtain the predicted normal value of PEF and to know the accuracy of this value 18 predict FEV1. METHOD: The measurements of PEF by the MiniWright peak flow meter and several parameters derived from the forced expiratory volume and maximal expiratory flow volume curves by the Microspiro HI 501(Chest Co.) were done in 129 men and 125 women without previous history of the respiratory diseases. The predicted normal values of parameters according tc the age and the height were obtained, and the regression equation of FEV1 by PEF was calculated. RESULTS: The predicted normal values of PEF(L/min) were 2.45 Age(year)+1.36 Height(cm)+427 in men and -0.96 Age(year)+2.01 Height(cm)+129 in women. FEFmax derived from the maximal expiratory flow volume cutie was less than by 125 L/min in men art 118 L/min in women respectively compared to PEF. FEV,(ml) predicted by PEF was 5.98 PEF(L/min) 303 in men and 4.61 PEF(L/min) 291 in women respectively. CONCLUSION: The predicted normal value of PEF measured by the peak flow meter was calculated and it could be used as a standard value of PEF while taking care of patients with airway obstruction FEV1, the gold standard of ventilatory function could be predicted by PEF to a certain extent.
Airway Obstruction ; Asthma ; Diagnosis ; Female ; Forced Expiratory Volume ; Humans ; Korea ; Lung ; Male ; Maximal Expiratory Flow-Volume Curves ; Reference Values

PURPOSE: To evaluate on the basis of the pulmonary function test the correlation between the extent of air trapping on HRCT with the severity of airway obstruction and also to identify the prognostic effect of the extent of air trapping after treatment of asthma. MATERIALS AND METHODS: Thirty five patients with clinically diagnosed bronchial asthma and air trapping, as seen on HRCT, were included in this study. We quantitatively analysed on HRCT the extent of air trapping and then statistically compared this with the clinical parameters of the pulmonary function test. We classified the patients into two groups on the basis of the pulmonary function test and clinical status : Group 1(N=35), the total number of asthmatic patients ; Group 2(N=18), relatively stable asthmatics without acute asthmatic attack who showed FEV1 of more than 80% of the predicted value. Using the functional parameters of PEFR, one of the objective indications of improvement in airway obstruction, we also classified the patients into three groups on the basis of interval between treatment and clinical improvement. The result of this was as follows ; group 1, asymptomatic group(initial PEFR within normal limit, N=7) ; group 2, early responder(improvement of PEFR within three hospital days, N=18) ; group 3, late responder(improvement of PEFRwithin fourteen hospital days should there be a number here). Using HRCT, we then statistically analysed the differences between the three groups in the extent of air trapping. RESULTS: Among the total of 35 asthmatics, the extent of air trapping on HRCT showed significant correlation with the FEV1(r=-0.6161, p<0.001) and MEFR(r=-0.6012, p<0.001). Among the relatively stable asthmatics who showed FEV1 of more than 80% of the predicted value, MEFR(r=-0.7553, p<0.001) and FEF75(r=-0.7529, p=0.012) showed statistically significant correlation with the extent of air trapping on HRCT, but there was no significant corrlation between air trapping on HRCT and FEV1. In the three groups of asthmatics classified on the basis of interval between treatment and clinical improvement, the extents of air trapping on HRCT in the asymptomatic, early responder and late responder groups was as follows: (mean valuse) 9.31%, 21.50% and 27.89%, respectively ; these differences were statistically significant. CONCLUSION: The extent of air trapping on HRCT in asthmatics showed positive correlation with FEV1 and MEFR. Quantitative analysis of air trapping on HRCT also provides prognostic information about a patient's response to treatment.
Airway Obstruction ; Asthma ; Humans ; Maximal Expiratory Flow Rate ; Peak Expiratory Flow Rate ; Respiratory Function Tests*

The purpose of this study is to establish COPD animal model by intra-tracheal instillation of bleomycin (BLM) once and exposure to cigarette smoke for continuous 27 d, and to observe the effects of the inhalation on the model. At the 29th day, blood samples were taken from cervical artery for blood-gas analysis and parameters of lung function were recorded. Bronchoalveolar lavage fluid (BALF) was collected to measure intercellular adhesion molecule-1 (ICAM-1) concentration. The results showed that atomization inhaled resveratrol could alleviate rat COPD lung injury accompanied by amelioration of pathological changes, increase the ratio of forced expiratory volume in 0.3 s (FEV0.3) and forced vital capacity (FVC), and decrease the ICAM-1 level in BALF. The ultimate reduction of inflammatory factors was involved, at least in part, in the mechanism of resveratrol effects.
Animals ; Bleomycin ; Blood Gas Analysis ; Bronchoalveolar Lavage Fluid ; chemistry ; Disease Models, Animal ; Female ; Forced Expiratory Volume ; drug effects ; Intercellular Adhesion Molecule-1 ; metabolism ; Lung ; pathology ; Lung Compliance ; drug effects ; Male ; Maximal Midexpiratory Flow Rate ; drug effects ; Pulmonary Disease, Chronic Obstructive ; chemically induced ; metabolism ; pathology ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Smoking ; Stilbenes ; pharmacology