CYSTIC FIBROSIS

Correlation of forced oscillation technique in preschool children with cystic fibrosis with pulmonary inflammation

S Brennan^1,2, G L Hall^3,4, F Horak³, A Moeller³, P M C Pitrez^1,2,3, A Franzmann^1,2,3, S Turner³, N de Klerk^1,2, P Franklin^3,4, K R Winfield^1,2, E Balding³, S M Stick^1,2,3, P D Sly^1,2,3

¹ Telethon Institute for Child Health Research, Perth, Western Australia
² Centre for Child Health Research, University of Western Australia, Perth, Western Australia
³ Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia
⁴ School of Paediatric and Child Health, University of Western Australia, Perth, Western Australia

Correspondence to:
Correspondence to:
Dr S Brennan
Division of Clinical Sciences, TVW Telethon Institute for Child Health Research, P O Box 855, West Perth, WA 6872, Western Australia; shivs{at}ichr.uwa.edu.au

Background: Lung disease in cystic fibrosis (CF) is established in early childhood with recurrent bacterial infections and inflammation. Using spirometry, the effect of this early lung damage cannot be measured until a child is 6 years of age when some irreversible lung damage may already have occurred. Techniques for measurement of lung function in infants and young children include raised volume rapid thoracic compression (RVRTC) and low frequency forced oscillation (LFFOT). The aim of this study was to investigate the role of inflammation and infection on a population of infants and young children with CF and to determine whether lung function in this population (measured by LFFOT) is affected by early lung disease.

Methods: Lung function was measured by LFFOT in 24 children undergoing bronchoalveolar lavage (BAL) on 27 occasions as part of an annual programme while still under general anaesthesia. Following lung function testing, three aliquots of saline were instilled into the right middle or lower lobe. The first aliquot retrieved was processed for the detection of microbes, and the remaining aliquots were pooled to assess inflammatory markers (cytology, IL-8, NE, LTB₄).

Results: Inflammation (percentage and number of neutrophils) was significantly higher in children with infections (p<0.001, p = 0.04, respectively), but not in those with symptoms. Several markers of inflammation significantly correlated with LFFOT parameters (R, G, and ).

Conclusion: Infections and inflammation are established before symptoms are apparent. Inflammation is correlated with measures of parenchymal changes in lung function measured by LFFOT.

Abbreviations: BAL, bronchoalveolar lavage; CF, cystic fibrosis; , hysteresivity (ratio of damping to elastance); FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; Grs, tissue damping; Hrs, tissue elastance; IAW, inertance; IL, interleukin; LFFOT, low frequency forced oscillation technique; LTB₄, leukotriene B₄; MOF, mixed oral flora; NE, neutrophil elastase; Prs, transrespiratory pressure; Raw, tissue resistance; sCRS, specific respiratory system compliance; TCC, total cell count; Zrs, respiratory system impedance

Keywords: cystic fibrosis; children; forced oscillation technique

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