Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States of America.
Department of Surgery, University of Wisconsin - Madison, Madison, WI, United States of America.
Am J Otolaryngol. 2024 Jul-Aug;45(4):104316. doi: 10.1016/j.amjoto.2024.104316. Epub 2024 Apr 23.
To determine the diagnostic utility of spirometry in distinguishing children with Induced Laryngeal Obstruction (ILO) or chronic non-specific cough (a.k.a. tic cough) from those with mild or moderate to severe asthma.
Retrospective cross sectional design. Children diagnosed with ILO (N = 70), chronic non-specific cough (N = 70), mild asthma (N = 60), or moderate to severe asthma (N = 60) were identified from the electronic medical record of a large children's hospital. Spirometry was completed before ILO, non-specific cough, or asthma diagnoses were made by pediatric laryngologists or pulmonologists. Spirometry was performed following American Thoracic Society guidelines and was interpreted by a pediatric pulmonologist. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV), FEV/FVC Ratio (FEV/FVC), Forced Mid-Expiratory Flow 25--75 % (FEF), pulmonologist interpretation of flow volume loops, and overall exam findings were extracted from the medical record.
Ninety seven percent of children with ILO or chronic non-specific cough presented with spirometry values within normative range. Patients with ILO, non-specific cough, and mild asthma presented with FVC, FEV, FEV/FVC, and FEF values in statistically similar range. Children with moderate to severe asthma presented with significantly reduced FVC (p < .001), FEV (p < .001), FEV/FVC (p < .001), and FEF (p < .001) values when compared with patients in the other groups. Flow volume loops were predominantly normal for children with ILO and non-specific cough.
Findings indicate that ILO and chronic non-specific cough can neither be diagnosed nor differentiated from mild asthma using spirometry alone. Spirometry should therefore be used judiciously with this population, bearing in mind the limitations of the procedure. Future research should determine the most effective and efficient ways of delineating ILO and non-specific cough from other respiratory conditions in children.
确定肺量测定术在鉴别喉内阻塞（ILO）或慢性非特异性咳嗽（又名抽动性咳嗽）与轻度或中重度哮喘患儿中的诊断效用。
回顾性病例对照设计。从一家大型儿童医院的电子病历中确定 ILO（N=70）、慢性非特异性咳嗽（N=70）、轻度哮喘（N=60）或中重度哮喘（N=60）患儿。ILD、非特异性咳嗽或哮喘的诊断由儿科喉科医生或肺病科医生进行，肺量测定术按照美国胸科学会指南进行，并由儿科肺病专家进行解读。用力肺活量（FVC）、第 1 秒用力呼气量（FEV）、FEV/FVC 比值（FEV/FVC）、用力中期呼气流速 25-75%（FEF）、肺科医生对流量-容积环的解读以及总体检查结果均从病历中提取。
97%的 ILO 或慢性非特异性咳嗽患儿的肺量测定值在正常范围内。ILO、非特异性咳嗽和轻度哮喘患儿的 FVC、FEV、FEV/FVC 和 FEF 值在统计学上无显著差异。中重度哮喘患儿的 FVC（p<0.001）、FEV（p<0.001）、FEV/FVC（p<0.001）和 FEF（p<0.001）值明显降低，与其他组患儿相比差异具有统计学意义。ILD 和非特异性咳嗽患儿的流量-容积环主要为正常。
研究结果表明，仅通过肺量测定术既不能诊断 ILO 或慢性非特异性咳嗽，也不能将其与轻度哮喘区分开来。因此，在对这类人群使用肺量测定术时应谨慎，牢记该操作的局限性。未来的研究应确定最有效和高效的方法来区分 ILO 和非特异性咳嗽与儿童其他呼吸道疾病。
