Grammeniatis Vasilis, Priftis Kostas, Douros Konstantinos
Paediatrics, General Hospital of Ioannina G. Hatzikosta, Ioannina, GRC.
Third Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC.
Cureus. 2025 Feb 3;17(2):e78441. doi: 10.7759/cureus.78441. eCollection 2025 Feb.
Spirometry is the most common and straightforward examination following the mandatory initial steps of personal history and physical examination when assessing chronic and/or recurrent lung symptoms in children, especially cough or specific conditions that can impact lung function. When dealing with a chronic cough (lasting more than four weeks), it is not uncommon to find that no specific clues regarding the cause of the cough can be deduced from the patient's history alone. Moreover, clinical examinations can be quite normal without any abnormal lung sounds. In the next step (spirometry), surprisingly, as the child forcefully expels the air from the lungs, you can hear secretions moving along the bronchi as the rapidly moving air drifts excessive sputum to the upper airways. Less commonly, forceful exhalation during spirometry may uncover a brassy or honking sound, indicating potential collapsibility of the tracheal walls. Secretions in the bronchi can imply specific conditions, such as protracted bacterial bronchitis or suppurative bronchitis. Additionally, forced exhalation may uncover sputum in other chronic lung conditions, such as cystic fibrosis or primary cilia dyskinesia. The presence of tracheomalacia is an important parameter, as it can precipitate several respiratory symptoms, ranging from prolonged cough in acute bronchitis to recurrent and/or chronic wet cough. In conclusion, forceful exhalation during spirometry has the potential to uncover secretions in the bronchi or even tracheomalacia that might otherwise go unnoticed. Before watching the flow-volume loop or interpreting the results of the spirometry parameters, we should first "hear" the spirometry.
在评估儿童慢性和/或复发性肺部症状，尤其是咳嗽或可能影响肺功能的特定病症时，肺活量测定是继个人病史和体格检查等必要初始步骤之后最常见、最直接的检查。当处理慢性咳嗽（持续超过四周）时，仅从患者病史中往往无法推断出咳嗽原因的具体线索。此外，临床检查可能完全正常，没有任何异常肺部声音。在下一步（肺活量测定）中，令人惊讶的是，当孩子用力从肺部呼出空气时，随着快速流动的空气将过多痰液带到上呼吸道，你可以听到分泌物在支气管中移动的声音。较少见的情况是，肺活量测定期间的用力呼气可能会发现一种刺耳或雁叫声，表明气管壁可能存在塌陷。支气管中的分泌物可能意味着特定病症，如迁延性细菌性支气管炎或化脓性支气管炎。此外，用力呼气可能会在其他慢性肺部疾病中发现痰液，如囊性纤维化或原发性纤毛运动障碍。气管软化的存在是一个重要参数，因为它可能引发多种呼吸道症状，从急性支气管炎中的持续性咳嗽到反复和/或慢性湿性咳嗽。总之，肺活量测定期间的用力呼气有可能发现支气管中的分泌物甚至气管软化，否则这些情况可能会被忽视。在查看流量-容积环或解读肺活量测定参数结果之前，我们应该先“听”一下肺活量测定。
