title: Volumetric capnography to detect ventilation inhomogeneity in children and adolescents with controlled persistent asthma.
abstract: OBJECTIVE
  To study changes in the variables of volumetric capnography in children and adolescents with asthma compared with a control group and to investigate their changes with the use of bronchodilators and bronchial provocation test with methacholine.
  
  
  METHODS
  One hundred and three patients with controlled persistent asthma and 40 healthy volunteers participated in the study. All of them underwent volumetric capnography and spirometry. All asthmatics repeated the tests after bronchodilator use. Among 103 asthma patients, 33 underwent methacholine challenge test, and measures were recorded on three occasions: before and after methacholine and after bronchodilator use.
  
  
  RESULTS
  Compared with the control group, asthmatics had an increase in the slope of phase III normalized by tidal volume and decreases in tidal volume, forced expiratory volume in one second, forced vital capacity, rate of obstruction and forced expiratory flow between 25 to 75% of forced vital capacity. After bronchodilator use, there was an increase in spirometric variables, volume of anatomic dead space, and decrease in the slope of phase II normalized by tidal volume, but the slope of phase III normalized by tidal volume did not change. After methacholine, there was an increase in this variable, which decreased after bronchodilator use.
  
  
  CONCLUSIONS
  The increase in the slope of phase III normalized by tidal volume in asthma patients suggests that these patients have ventilation inhomogeneity in the distal air spaces, which may reflect chronic structural disorders or reversible acute changes seen on the bronchial provocation test.
authors.affiliation: Universidade Estadual de Campinas, Rua Jasmim 750, Campinas, SP, Brazil. ccb.almeida@gmail.com
authors.forename: Celize C B
authors.initials: CC
authors.lastname: Almeida
authors.forename: Armando A
authors.initials: AA
authors.lastname: Almeida-Júnior
authors.forename: Maria Angela G O
authors.initials: MA
authors.lastname: Ribeiro
authors.forename: Marcos T
authors.initials: MT
authors.lastname: Nolasco-Silva
authors.forename: José Dirceu
authors.initials: JD
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D001985:Bronchial Provocation Tests / Q000379:methods*; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019296:Capnography / Q000379:methods*; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D013147:Spirometry; D013990:Tidal Volume / Q000187:drug effects*
chemical_list: D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents; D016210:Methacholine Chloride