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Pulmonary function tests are seldom performed in preschool children with asthma. The aim of this multicenter study was to compare pulmonary function in 74 preschool children with asthma (height of 90-130 cm) and 84 healthy control subjects. Functional residual capacity (helium dilution technique) and expiratory interrupter resistance (interrupter technique) were measured. As compared with control children, children with asthma had a significantly higher resistance (0.77 +/- 0.20 vs. 0.92 +/- 0.22 kPa. L-1. second, p < 0.001) and significantly lower specific expiratory interrupter conductance (p < 0.005) values. Resistance values were significantly higher in children with asthma with than without symptoms on exertion (p < 0.05). The effect of bronchodilator administration, expressed as the percentage of baseline and predicted resistance values, was significantly greater in children with asthma than in control subjects (-18.6 +/- 13.6% vs. -11.2 +/- 15.2%, p

Introduction: Given the complexity of the therapeutic management of irritable bowel syndrome (IBS), alternative non-pharmacological therapies are frequently offered to patients. The aim of this study was to conduct a systematic review in order to establish the current evidence base for non-pharmacological interventions (body-directed and mind-body therapies) in the management of IBS., Materials and Methods: The literature was searched in several electronic databases (PubMed (including Medline), Web of Science (Clarivate Analytics), Scopus (Elsevier), ScienceDirect (Elsevier), Cochrane Library (Wiley), and Wiley Online Library (Wiley)) for randomized controlled trials (RCTs) published in the English language from 1990 to 2020. Effectiveness outcomes were examined through the change in overall IBS symptoms or abdominal pain up to 12 months after treatment., Results: 11 studies (parallel-group RCTs) were identified that enrolled 1590 participants in total. Body-directed therapies (acupuncture and osteopathic medicine) showed a beneficial effect compared with standard medical treatment for overall IBS symptoms at 6 months follow-up, while no study found any difference between body-directed and sham therapies for abdominal pain or overall IBS symptoms. It was not possible to conclude whether hypnotherapy was superior to standard medical treatment or supportive therapy for overall IBS symptoms or abdominal pain due to discordant results., Conclusions: Although body-directed therapies such as acupuncture and osteopathic medicine may be beneficial for overall IBS symptoms, higher-quality RCTs are needed to establish the clinical benefit of non-pharmacological interventions for IBS. An important challenge will be the definition of the optimal control groups to be used in non-pharmacological trials., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this study., (Copyright © 2021 Florent Amsallem et al.)

Aim: Using a non-invasive lung function technique (interrupter resistance, Rint), we aimed to determine whether a dose-response to salbutamol could be detected in wheezy preschool children and if so, which dose of salbutamol should be administered to routinely evaluate bronchial reversibility., Method: Wheezy children (3 to <7 years) were enrolled in a prospective multicenter study. Rint was measured at baseline, and after random assignment to a first dose (100 or 200 μg) and a second dose (cumulative dose: 400, 600, or 800 μg) of salbutamol. Data were analyzed using mixed modeling approach with an inhibitory maximal effect (I max ) model, to account for a sparse sampling design. Simulations were performed to predict the percentage of children with significant Rint reversibility at several doses., Results: Final results were available in 99 children out of 106 children included. The model adequately fitted the data, showing satisfactory goodness-of-fit plots and a low residual error of 8%. Children with uncontrolled symptoms had lower I max (ie, showed less reversibility) compared to children with totally/partly controlled symptoms (0.23 vs. 0.31, P < 0.001). Dose to reach 50% of I max (D 50 ) was 51 μg. According to simulations, 88.1% of children with significant reversibility at dose 800 μg would already show significant reversibility at 400 μg., Conclusion: Interrupter resistance was able to measure a dose-response curve to salbutamol in wheezy preschool children, which was similar to that of older patients. Young children require a high dose of salbutamol to correctly assess airway bronchodilator response, especially these with poor symptom control., (© 2018 Wiley Periodicals, Inc.)

Background: Among the different techniques used to monitor lung disease progression in infants with CF diagnosed by Newborn screening (NBS), raised volume-rapid thoracic compression (RVRTC) remains a promising tool. However, the need of sedation and positive pressure ventilation considerably limits its clinical use. We recently described a semi-quantitative method to evaluate air trapping by chest tomography during quite breathing without sedation (CTqb score). This parameter is the radiological sign of airway obstruction and could be also used for lung disease follow-up in infants with CF. However, its discriminative power compared with RVRTC and correlation with lung function parameters are not known., Objectives: To compare the discriminative powers of the CTqb score and RVRTC parameters and to determine their correlation during the first year of life of infants with CF., Methods: In this multicenter longitudinal study, infants with CF diagnosed by NBS underwent RVRTC and CT during quite breathing at 10 ± 4 weeks (n = 30) and then at 13 ± 1 months of age (n = 28)., Results: All RVRTC parameters and the CTqb score remained stable between evaluations. The CTqb score showed a higher discriminative power than forced expiratory volume in 0.5 s (FEV 0.5 ; the main RVRTC parameter) at both visits (66% and 50% of abnormal values vs 30% and 28%, respectively). No correlation was found between CTqb score and , the different RVRTC parameters or the plethysmographic functional residual capacity, indicating that they evaluate different aspect of CF lung disease., (© 2017 Wiley Periodicals, Inc.)

Objective: To determine the efficacy of nasal continuous positive airway pressure (nCPAP) on respiratory distress symptoms and respiratory effort in young infants with acute respiratory syncytial virus bronchiolitis., Design: Prospective study., Setting: The paediatric intensive care unit of a university hospital., Patients: Twelve infants less than 3 months of age, with severe respiratory distress., Interventions: Respiratory distress was quantified with a specific scoring system. Oesophageal pressure (Pes) was measured during spontaneous ventilation before and after nCPAP, delivered through an infant-adapted ventilator. Simultaneous recording of gastric pressure (Pgas) was performed in the five oldest patients., Measurements and Results: The respiratory distress score decreased after nCPAP, particularly accessory muscles' use and expiratory wheezing. The breathing pattern was modified, with shorter inspiratory and longer expiratory time. Pes swings and PTPes(insp), two indices of inspiratory effort, were reduced by 54 (+/-4)% and 59 (+/-5)%. PTPgas(exp), an indicator of expiratory muscles activity, was completely abolished. A significant correlation was observed between the respiratory distress score and Pes swings at baseline and after nCPAP., Conclusions: In young infants with severe acute respiratory syncytial virus bronchiolitis, nCPAP rapidly unloads respiratory muscles and improves respiratory distress symptoms.

The present document is being produced on behalf of the French Society of the Physiology Task Force on standards for Infant Respiratory Function Testing whose aim is to provide guidelines for good laboratory practices according to the latest international recommendations. Application of such recommendations could be of particular value when attempting to develop standardized protocols in the scope of multi-centre trials. The first part resume these recommendations about apparatus, acquisition system and software for Infant Respiratory Function Testing. The second part focuses on physiological principles and practical considerations: calibration procedure, infant conditioning, tidal breathing measurements, and occlusion techniques for assessing passive respiratory mechanics, plethysmographic measurements of lung volume and airway resistance and forced expiratory flows measurements. The major problem when collecting lung function data is that of predicted values. Valid reference data, set up according to these recommendations, are, to date, still to be established. The last part of the document provides a review of the literature concerning infant respiratory function reference data and a resume of the most used of them. This document will clearly need to be updated regularly in response to advances in knowledge in this field.

The aims of this study were 1. To evaluate the measurement of resistance by interruption (Rint) of bronchoconstriction induced by inhalation of methacholine and 2. To determine a threshold of increase of resistance in young children to differentiate responders from non-responders. Forty-six children (mean age 5 [4.3-6.1] years) referred for methacholine challenge were tested by measurement of Rint and transcutaneous oxygen tension. A fall of 20% or more in oxygen tension from the baseline was used to define the responders. The children studied had a baseline Rint significantly higher than normal (0.84 [0.68-1.01] vs. 0.76 [0.60-0.90] kPa L(-1)s; p < 0.03). Forty-one children were responders and had an increase in Rint significantly different from the non-responders (p < 0/04). An increase in Rint of 35% distinguished responders from non-responders in young children with chronic cough. Interrupter resistance increases significantly during bronchial provocation in responding young children and may be used to measure the degree of bronchoconstriction.

Introduction: Measurement of maximal respiratory pressures against an occlusion has been used for a long time to assess respiratory muscle strength in the follow up of children with respiratory disease. In the early stage of disease this is the main test for diagnosing respiratory muscle involvement and the degree of that involvement. STATE OF KNOWLEDGES: The interpretation of the results is difficult on account of variability of the measurements and of the reference values. The aim of this article is to present, in the form of a literature review, the normal values available and the different determining factors as well as the advantages and limitations of these measurements., Perspectives: The use by all the centres undertaking maximal respiratory pressure measurements in children of methodological techniques similar to those presented in this revue could be the starting point for obtaining an identical range of reference values for all., Conclusion: Age, sex and the level of physical aptitude seem to be the most important determinants of maximal respiratory pressures. However, other methodological factors such as co-operation, training of the child in the performance of the manoeuvres and the type of device and protocol used, will all influence the results. These factors must be taken into consideration in order to diminish, as much as possible, the variability of the maximal pressures obtained.

Introduction: The evaluation of the ventilatory response of children during exercise is essential to determine its role in impaired exercise tolerance. The aim of this review is to describe the variables and the values of maximal ventilatory parameters observed in healthy children in the published literature., State of Art: The maximal ventilation (VEmax) and the tidal volume (VTmax) increase in a linear fashion with age and plateau in boys at 15 years, and in girls at 13 years. The main variables for the parameters connected to volume--VEmax and VTmax--are anthropometric characteristics, in particular, the lean body mass. Most studies show a value of 30 ml.kg(-1) for a VTmax on the total body mass in pre-puberty and a slight increase thereafter. The ventilatory reserves and the VTmax on vital capacity increase with age until respective values of 30% and 50% are reached at 17 years. The maximal parameters connected to time are independent of anthropometric characteristics. The TI/TTOT ratio (inspiratory time to total time of the respiratory cycle) is stable with a value of 0.5. The maximal respiratory frequency decreases slightly with age without differences between the genders., Perspectives and Conclusion: Only studies of larger numbers of children, proposing relationships derived from allometric equations, will be able to provide real reference values.

Pulmonary function tests have rarely been assessed in preschool children with cystic fibrosis (CF). The objective of this multicenter study was to compare pulmonary function in 39 preschool children with CF (height, 90-130 cm; 16 homozygous Delta F508) and in 79 healthy control children. Functional residual capacity (helium dilution technique) and expiratory interrupter resistance (Rint(exp)) (interrupter technique) were measured. As compared with control children, children with CF had significantly higher Rint(exp), expressed as absolute values and as Z-scores (1.05 +/- 0.36 versus 0.80 +/- 0.20 kPa.L(-1). second, p < 0.0001; and 1.31 +/- 1.72 versus 0.19 +/- 0.97, p < 0.0001), and significantly lower specific expiratory interrupter conductance (1.29 +/- 0.34 versus 1.63 +/- 0.43 kPa(-1). second, p < 0.0001). The effect of the bronchodilator salbutamol on Rint(exp) was not significantly different between children with CF and control children. Rint(exp) Z-scores were significantly higher in children with CF who were exposed to passive smoke (n = 8) (p < 0.03). Children with CF and with a history of respiratory symptoms (n = 31) had significantly higher functional residual capacity Z-scores (p < 0.02) and lower specific expiratory interrupter conductance Z-scores (p < 0.04). Genotype did not influence the data. We conclude that Rint(exp) and functional residual capacity measurements may help to follow young children with CF who are unable to perform reproducible forced expiratory maneuvers.

The interrupter technique estimates flow resistance. It entails occlusion of the airways during tidal breathing while flow and mouth pressure are recorded. This noninvasive technique is easy to use in young children. The aim of the present study was to measure inspiratory and expiratory interrupter resistance (Rint(insp), Rint(exp)) before and after bronchodilator administration in young healthy white children. We designed a multicenter study using a standardized procedure for Rint measurements. Centers in five French cities studied 91 children (48 boys and 43 girls; height, 92 to 129 cm; mean age 5.3 +/- 1.4 years). Mean values were not significantly different for Rint(insp) and Rint(exp) (0.78 +/- 0.21 versus 0.78 +/- 0.20 KPa x L(-1) x second). However, the difference between Rint(insp) and Rint(exp) decreased significantly with age and being positive before 5 years and negative later on (p < 0.02). Rint(insp) and Rint(exp) decreased significantly with height (Rint(insp) [KPa x L(-1) x second] = 2.289 - 1.37. 10(-2) x H [cm], Rint(exp) [KPa. L(-1) x second] = 2.021 - 1.12.10(-2) x H [cm]; p < 0.001). Bronchodilator (salbutamol) administration significantly decreased Rint(insp) and Rint(exp) (p < 0.001). Bronchodilator-induced changes (% of predicted values) in mean Rint(insp) and mean Rint(exp) were -15% (95% confidence interval, -46 to +15%) and -12% (95% confidence interval, -46 to +22%), respectively. Sex did not affect pre- or postbronchodilator values. Data from the present study may prove useful for testing lung function in young children with respiratory disorders who failed to cooperate with forced expiratory maneuvers.

Aerobic physical fitness, in children, is assessed by measurement of the maximal oxygen consumption during exercise testing. Representative norms of the studied population are required for interpretation. The aim of this article is to specify and review the available VO2max norms and factors of variation, including: sex, anthropometric characteristics (height, lean body mass and weight) and physical activity level. Ideally, VO2max norms should include lean body mass and physical activity with an allometric equation. Since such norms do not exist today, interpretation remains difficult. In France, the must satisfactory norms for non trained children include body mass without an allometric equation (boys: 47 +/- 2 ml.mn.-1 kg-1, girls: 40 +/- 3 ml.mn.-1 kg-1 with a post puberty decrease). Further studies on VO2max norms that include lean body mass and a physical activity questionnaire are required to improve exercise test interpretation in children.

Oral occlusion pressure, a neuro-muscular index of the activity of the respiratory centers, was measured in 2 groups of children: one of 43 "healthy" children, in order to establish a predictive equation according to age (Y = 1.23 + 8.30 X A-1) and another of children presenting with respiratory failure, either due to an impairment of the thoracic cavity (10 dorsal scoliosis) or to an impairment of the respiratory muscles (29 children with muscular dystrophy or spinal muscular atrophy). The occlusion pressure increases with the degree of the ventilation deficiency in children with scoliosis. It remains paradoxically normal in children with neuro-muscular disease, irrespective of the ventilation deficiency. In the latter, the respiratory centers activity being considered as normal, this situation would indicate their muscular incapacity to correctly express this activity. It would show a severe muscular deficiency with a high risk of occurrence of respiratory distress accidents.

This case of pulmonary alveolar microlithiasis emphasizes the rarity of the disease and its exceptional diagnosis in infants which relies on the pulmonary pathologic study. Besides allowing for diagnosis, the study of the alveolar brushing fluid permitted to describe for the first time pictures of post-necrotic cellular calcification which is probably responsible for the disease.

Respiratory function tests were performed in infants hospitalized for bronchiolitis immediately after the acute stage, in order to appreciate the function of the respiratory muscles. A study of the ventilatory mechanics, of the transdiaphragmatic pressure, of the ventilatory rate and of the blood gases was performed. Results were compared with those obtained in 10 "healthy" infants. They showed: a decrease in the dynamic compliance (DYN.C) (p less than 0.001) and an increase in the total pulmonary resistances (TPR) (p less than 0.05) providing evidence for the intensity of bronchial and bronchiolar obstruction; an increase in the abdominal and intrathoracic pressures difference (Pdi) (p less than 0.01) which may reach 3 times the normal value and which is proportional to the decrease in DYN.C. (r = 0.74; p less than 0.001), providing evidence for the intensification of the inspiratory diaphragmatic effort and of its adjustment to the degree of obstruction; a reverse of the abdominal pressure curve with respect to that in normal subjects, with an increased pressure level, providing evidence for abdominal distension and increased pressure during all the expiration, suggesting the active participation of the abdominal muscle to expiration; a change in the ventilatory rate, characterized by a high respiratory frequency, a decreased tidal volume, a shortened inspiratory time and a normal inspiratory time/total time ratio. this rate is opposed to that observed in older children with bronchial obstruction. It might optimize the respiratory muscles output, as at this age, they have not yet reached all their contractile capacity.