Evidence of ventilatory constraints in healthy exercising prepubescent children

We assessed expiratory airflow limitation (expFL) in 18 healthy prepubescent children (6 girls and 12 boys, 10.1 +/- 0.3 years old), and examined how it might modulate regulation of tidal volume (V-T) during exercise. The children performed a maximal incremental exercise on a cycle ergometer, preceded and followed by pulmonary function tests. Throughout exercise, breathing flow-volume loops were plotted into the maximal flow-volume loop (MFVL) measured at rest. End-expiratory and end-inspiratory lung volumes were estimated by measuring expiratory reserve volume relative to forced vital capacity (ERV/FVC), and inspiratory reserve volume relative to forced vital capacity (IRV/FVC), respectively The expFL, expressed as a percentage of VT, was defined as the part of the tidal breath meeting the boundary of the MFVL. Ten children (FL) presented an expFL at peak exercise (range, 16-78% of VT), and the remaining 8 constituted a nonflow-limited group (NFL). At peak exercise, FL presented a higher IRV/FVC and lower ERV/FVC (P < 0.01) than NFL children, demonstrating two different exercise breathing patterns. These results suggest that the NFL regulated VT at high lung volume, avoiding expFL, while the FL breathed at low lung volume, leading to expFL. At peak exercise, FL presented lower values of minute ventilation (P < 0.05) and oxygen uptake (P < 0.05) than NFL. Nevertheless, oxygen arterial saturation and dyspnea were similar in the two groups. In conclusion, ventilatory constraints may occur in healthy prepubescent children and result in relative dynamic hyperinflation or expiratory flow limitation.