Feasibility of nitrogen multiple-breath washout in inexperienced children younger than 7 years

BackgroundMultiple breath washout (MBW) is an attractive test to assess ventilation inhomogeneity, a marker of peripheral lung disease. Systematic research on MBW feasibility in preschool children is scanty. ObjectivesWe assessed feasibility of nitrogen MBW in children aged 3-7 years in a clinical setting applying current ERS/ATS consensus. MethodsSixty-two children with asthma were enrolled in the Swiss rehabilitation center Hochgebirgsklinik Davos without MBW experience and prior to consensus release. Age range was 3.1-6.7 years. All children were naive to MBW, received training, and then aimed for triplicate nitrogen MBW within 20min. We afterward assessed the number of MBW attempts and successful tests according to consensus asking for three technically acceptable trials with functional residual capacity (FRC) measurements within 25% of median FRC. Secondly, factors related to success rate and FRC variability were assessed. ResultsOut of 205 MBW attempts in 62 children, 103 trials (50%) in 51 children were successful. Only 15 children (24%) achieved three valid trials as suggested by consensus. At least two valid trials were obtained in 37 children (60%). Age was positively correlated with success rate. FRC variability was inversely correlated with variability of tidal volume. ConclusionsMBW was only feasible in one quarter of inexperienced children <7 years applying strict consensus criteria. Low FRC variability and low breathing variability seem to be mutually exclusive at this age group. Specific consensus recommendations for MBW in preschool children seem, thus, warranted. Pediatr Pulmonol. 2016;51:1183-1190. (c) 2016 Wiley Periodicals, Inc.