Hopp Russell, Lee Junghyae, Bohan Heather
Department of Pediatrics, University of Nebraska Medical Center, 42nd and Emile St., Omaha, NE 68198, USA.
Children's Hospital and Medical Center, 8200 Dodge St., Omaha, NE 68114, USA.
Children (Basel). 2022 Sep 23;9(10):1454. doi: 10.3390/children9101454.
Small airway dysfunction remains a stepchild in the pediatric asthma care pathway. In brief, elements of the pulmonary function test (PFT) concerning smaller airway data remain less utilized. To further the value of the standard PFT we underwent a prospective Proof of Concept (POC) project, utilizing the outpatient performance of PFT tests in children 6-18 years during a 15-month period. The goal of the study was to determine if a priori the PFT represented a small airway disease pattern or not. Only the pulmonary function was used to make that distinction. Children 6-18 years with asthma who completed a PFT had their PFT as being characterized with or without a small airway dysfunction (SAD) designation, coded in the electronic medical record as an a priori decision using the code J98.4 (other disorders of lung) as a marker for electronic medical records retrieval. Subsequently, the results were analyzed between a group of 136 children designated (a priori) as having no small airway dysfunction in comparison to 91 children a priori designated as having small airway dysfunction. The a priori designation groups were post hoc compared for large and smaller airway function differences. Both large and smaller airway dysfunction were highly significantly different between the 2 groups, based solely on the initial division of the total group based on the decision the PFT represented a small airway pattern. We concluded the baseline pulmonary function test used in the evaluation of pediatric asthma has readily identifiable information regarding the presence of small airway dysfunction, and we characterized what was unique on the PFT based on that SAD classification.
小气道功能障碍在儿童哮喘治疗路径中仍然受到忽视。简而言之，肺功能测试（PFT）中有关较小气道数据的部分仍较少被利用。为了进一步提升标准PFT的价值，我们开展了一项前瞻性概念验证（POC）项目，利用15个月期间6至18岁儿童门诊PFT测试的结果。该研究的目的是预先确定PFT是否代表小气道疾病模式。仅使用肺功能来进行区分。完成PFT的6至18岁哮喘儿童，其PFT被标记为有或无小气道功能障碍（SAD），在电子病历中作为预先决定进行编码，使用代码J98.4（其他肺部疾病）作为电子病历检索的标记。随后，对136名预先指定为无小气道功能障碍的儿童与91名预先指定为有小气道功能障碍的儿童进行结果分析。对预先指定的两组进行事后比较，以分析大气道和小气道功能差异。仅基于根据PFT代表小气道模式的决定对总组进行的初始划分，两组之间的大气道和小气道功能障碍均存在高度显著差异。我们得出结论，用于评估儿童哮喘的基线肺功能测试具有关于小气道功能障碍存在的易于识别的信息，并且我们基于该SAD分类对PFT上的独特之处进行了描述。
