Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit and Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK.
Children's Hospital, University Hospitals Leicester, Leicester, UK.
Eur Respir Rev. 2019 Nov 20;28(154). doi: 10.1183/16000617.0046-2019. Print 2019 Dec 31.
There is increasing evidence that ventilation heterogeneity and small airway disease are significant factors in asthma, with evidence suggesting that the small airways are involved from an early stage in childhood asthma. Spirometry is commonly used to monitor lung function in asthmatics; however, it is not sensitive to small airway disease. There has been renewed interest in multibreath washout (MBW) tests, with recognition of the lung clearance index (LCI) as a global index of abnormality in gas mixing of the lungs that therefore also reflects small airway disease. This review summarises the technical and practical aspects of the MBW/LCI in children, and the differences between commercially available equipment. Children with severe asthma are more likely to have an abnormal LCI, whereas most children with mild-to-moderate asthma have an LCI within the normal range, but slightly higher than age-matched healthy controls. Monitoring children with asthma with MBW alongside standard spirometry may provide useful additional information.
越来越多的证据表明，通气异质性和小气道疾病是哮喘的重要因素，有证据表明小气道在儿童哮喘的早期就已经受累。肺量测定法常用于监测哮喘患者的肺功能；然而，它对小气道疾病不敏感。多呼吸冲洗（MBW）测试重新受到关注，认识到肺清除指数（LCI）是肺部气体混合异常的整体指标，因此也反映了小气道疾病。这篇综述总结了 MBW/LCI 在儿童中的技术和实际方面，以及商业上可用设备之间的差异。严重哮喘的儿童更有可能出现异常的 LCI，而大多数轻度至中度哮喘的儿童的 LCI 在正常范围内，但略高于年龄匹配的健康对照。MBW 与标准肺量测定法一起监测哮喘儿童可能提供有用的额外信息。
