Zihang Lu, Foong, Rachel E., Kowalik, Krzysztof, Moraes, Theo J., Boyce, Ayanna, Dubeau, Aimee, Balkovec, Susan, Gustafsson, Per Magnus, Becker, Allan B., Mandhane, Piush J., Turvey, Stuart E., Lou, Wendy, Ratjen, Felix, Sears, Malcolm, Subbarao, Padmaja, and Lu, Zihang
Background: The care of infants with recurrent wheezing relies largely on clinical assessment. The lung clearance index (LCI), a measure of ventilation inhomogeneity, is a sensitive marker of early airway disease in children with cystic fibrosis, but its utility has not been explored in infants with recurrent wheezing.Objective: To assess ventilation inhomogeneity using LCI among infants with a history of recurrent wheezing compared with healthy controls.Methods: This is a case-control study, including 37 infants with recurrent wheezing recruited from outpatient clinics, and 113 healthy infants from a longitudinal birth cohort, the Canadian Healthy Infant Longitudinal Development study. All infants, at a time of clinical stability, underwent functional assessment including multiple breath washout, forced expiratory flows and body plethysmography.Results: LCI z-score values among infants with recurrent wheeze were 0.84 units (95% CI 0.41 to 1.26) higher than healthy infants (mean (95% CI): 0.26 (-0.11 to 0.63) vs -0.58 (-0.79 to 0.36), p<0.001)). Nineteen percent of recurrently wheezing infants had LCI values that were above the upper limit of normal (>1.64 z-scores). Elevated exhaled nitric oxide, but not symptoms, was associated with abnormal LCI values in infants with recurrent wheeze (p=0.05).Conclusions: Ventilation inhomogeneity is present in clinically stable infants with recurrent wheezing. [ABSTRACT FROM AUTHOR]