Practicability of nitrogen multiple-breath washout measurements in a pediatric cystic fibrosis outpatient setting.
BACKGROUND
Although lung clearance index (LCI) is a sensitive indicator of mild cystic fibrosis (CF) lung disease, it is rarely measured due to lengthy protocols and the commercial unavailability of multiple-breath washout (MBW) setups and tracer gases. We used a newly validated, commercially available nitrogen (N2 ) MBW setup to assess success rate, duration, and variability of LCI within a 20 min timeframe, during clinical routine. We also evaluated the relationship between LCI and other clinical markers of CF lung disease.


METHODS
One hundred thirty six children (83 with CF) between 4 and 16 years were studied in a pediatric CF outpatient setting. One hundred eighteen out of 136 children were naïve to MBW. Within 20 min, each child was trained, N2 MBW was performed, and LCI was analyzed. We assessed intra- and between-test reproducibility in a subgroup of children.


RESULTS
At least one LCI was feasible in 123 (90%) children, with a mean (range) of 3.3 (1.2-6.4) min per test. Two or more measurements were feasible in 56 (41%) children. Comparing LCI in CF versus controls, LCI mean (SD) was 12.0 (3.9) versus 6.1 (0.9), and the intra- and inter-test coefficient of repeatability was 1.00 versus 0.81 and 0.96 versus 0.62, respectively. LCI was correlated with spirometry, blood gases, and Pseudomonas aeruginosa infection.


CONCLUSIONS
Using available N2 MBW equipment, LCI measurements are practical and fast in children. LCI is correlated with markers of CF lung disease. Longer timeframes would be required for triplicate N2 MBW tests in inexperienced children.
Division of Respiratory Medicine, Department of Pediatrics, University Hospital of Bern, Bern, Switzerland.
Florian
F
Singer
Elisabeth
E
Kieninger
Chiara
C
Abbas
Sophie
S
Yammine
Oliver
O
Fuchs
Elena
E
Proietti
Nicolas
N
Regamey
Carmen
C
Casaulta
Urs
U
Frey
Philipp
P
Latzin
D000280:Administration, Inhalation; D000293:Adolescent; D001944:Breath Tests / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005540:Forced Expiratory Flow Rates; D006801:Humans; D008297:Male; D009584:Nitrogen / Q000008:administration & dosage / Q000493:pharmacokinetics*; D010045:Outpatients; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index
D009584:Nitrogen