Chest
Clinical Investigations: Pulmonary FunctionMeasurement of Respiratory Resistance in the Emergency Department: Feasibility in Young Children With Acute Asthma
Section snippets
Design
We conducted a cross-sectional study of children aged 2 to 17 years presenting with an asthma exacerbation to the ED of the Montreal Children's Hospital from April to November 1991. The protocol was reviewed and approved by the Institutional Review Board, and informed consent for participation in the study was obtained from parents or guardians.
Subjects
Patients were eligible to participate if they had a clinical diagnosis of asthma confirmed by an emergency physician in accordance with the criteria of
Results
Of the 208 patients approached, 44 children were excluded because of the following: (1) the inability to perform the second assessment before discharge in 14 children, all of whom cooperated with Rfo; (2) exclusion criteria in 19 patients; and (3) the previous participation in this study of 11 subjects. The participation rate was 92% (150 subjects) for the remaining 164 eligible patients (Table 1). The median percent height-adjusted FEV1 and Rfo8 values22 were indicative of moderate obstruction
Discussion
Our study demonstrates that the technique of forced oscillation can be successfully used to measure respiratory resistance in previously untrained preschool children, aged 3 years and older, with an asthma exacerbation. In children aged 4 and 5 years, we observed the noticeable success rates of 40% and 83%, respectively, with the Rfo8 measurement, but only 0% and 17%, respectively, with spirometry. The high level of cooperation for Rfo8 was sustained in the 6- to 9-year-olds (76%) and the
Conclusion
With a substantial proportion of children aged 3 years or older cooperating reproducibly with the measurement of respiratory resistance by forced oscillation at 8 Hz, this technique is advantageous for objectively studying preschool-aged children in whom spirometry can seldom be reliably performed. Moreover, the Rfo8 allows the safe and objective evaluation of a significant proportion of the schoolaged patients who cannot reproducibly perform spirometry during an asthma exacerbation.
ACKNOWLEDGMENTS
We are indebted to Jacques Lauzon, BSc(N), for his diligent technical assistance and data collection; to Dr. David McGillivray, Director of the ED of the Montreal Children's Hospital, and to the ED medical and nursing staff for their collaboration.
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Presented, in part, at the Canadian Pediatric Society Meeting, Ottawa, Ontario, September 1992, and at the Ambulatory Pediatric Association Meeting, Washington, DC, May 1993.
Supported by the McGill University-Montreal Children's Hospital Research Institute.