PDF(Pubmed)
Abstract：
OBJECTIVE: To determine the diagnostic utility of spirometry in distinguishing children with Induced Laryngeal Obstruction (ILO) or chronic non-specific cough (a.k.a. tic cough) from those with mild or moderate to severe asthma.
METHODS: Retrospective cross sectional design. Children diagnosed with ILO (N = 70), chronic non-specific cough (N = 70), mild asthma (N = 60), or moderate to severe asthma (N = 60) were identified from the electronic medical record of a large children\'s hospital. Spirometry was completed before ILO, non-specific cough, or asthma diagnoses were made by pediatric laryngologists or pulmonologists. Spirometry was performed following American Thoracic Society guidelines and was interpreted by a pediatric pulmonologist. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1), FEV1/FVC Ratio (FEV1/FVC), Forced Mid-Expiratory Flow 25--75 % (FEF25-75%), pulmonologist interpretation of flow volume loops, and overall exam findings were extracted from the medical record.
RESULTS: Ninety seven percent of children with ILO or chronic non-specific cough presented with spirometry values within normative range. Patients with ILO, non-specific cough, and mild asthma presented with FVC, FEV1, FEV1/FVC, and FEF25-75% values in statistically similar range. Children with moderate to severe asthma presented with significantly reduced FVC (p < .001), FEV1 (p < .001), FEV1/FVC (p < .001), and FEF25-75% (p < .001) values when compared with patients in the other groups. Flow volume loops were predominantly normal for children with ILO and non-specific cough.
CONCLUSIONS: Findings indicate that ILO and chronic non-specific cough can neither be diagnosed nor differentiated from mild asthma using spirometry alone. Spirometry should therefore be used judiciously with this population, bearing in mind the limitations of the procedure. Future research should determine the most effective and efficient ways of delineating ILO and non-specific cough from other respiratory conditions in children.
METHODS: Retrospective cross sectional design. Children diagnosed with ILO (N = 70), chronic non-specific cough (N = 70), mild asthma (N = 60), or moderate to severe asthma (N = 60) were identified from the electronic medical record of a large children\'s hospital. Spirometry was completed before ILO, non-specific cough, or asthma diagnoses were made by pediatric laryngologists or pulmonologists. Spirometry was performed following American Thoracic Society guidelines and was interpreted by a pediatric pulmonologist. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1), FEV1/FVC Ratio (FEV1/FVC), Forced Mid-Expiratory Flow 25--75 % (FEF25-75%), pulmonologist interpretation of flow volume loops, and overall exam findings were extracted from the medical record.
RESULTS: Ninety seven percent of children with ILO or chronic non-specific cough presented with spirometry values within normative range. Patients with ILO, non-specific cough, and mild asthma presented with FVC, FEV1, FEV1/FVC, and FEF25-75% values in statistically similar range. Children with moderate to severe asthma presented with significantly reduced FVC (p < .001), FEV1 (p < .001), FEV1/FVC (p < .001), and FEF25-75% (p < .001) values when compared with patients in the other groups. Flow volume loops were predominantly normal for children with ILO and non-specific cough.
CONCLUSIONS: Findings indicate that ILO and chronic non-specific cough can neither be diagnosed nor differentiated from mild asthma using spirometry alone. Spirometry should therefore be used judiciously with this population, bearing in mind the limitations of the procedure. Future research should determine the most effective and efficient ways of delineating ILO and non-specific cough from other respiratory conditions in children.
摘要：
目的：确定肺活量测定法在区分患有诱导性喉梗阻（ILO）或慢性非特异性咳嗽（也称抽搐咳嗽）的儿童与轻度或中度至重度哮喘患儿中的诊断价值。
方法：回顾性横断面设计。诊断为国际劳工组织（N=70）的儿童，慢性非特异性咳嗽（N=70），轻度哮喘（N=60），从一家大型儿童医院的电子病历中发现中度至重度哮喘(N=60).肺活量测定在国际劳工组织之前完成，非特异性咳嗽,或哮喘的诊断是由小儿喉科医师或肺科医师做出的。肺活量测定是按照美国胸科学会的指南进行的，并由儿科肺科医师解释。强制肺活量（FVC），1秒内用力呼气量（FEV1），FEV1/FVC比值(FEV1/FVC),用力呼气中流量25-75%（FEF25-75%），肺科医师对流量回路的解释，并从病历中提取总体检查结果。
结果：97%的ILO或慢性非特异性咳嗽患儿肺活量测定值在标准范围内。国际劳工组织的患者，非特异性咳嗽,轻度哮喘表现为FVC，FEV1,FEV1/FVC,和FEF25-75%的值在统计学上相似的范围内。中度至重度哮喘患儿FVC显著降低（p<.001），FEV1（p<.001），FEV1/FVC（p<.001），与其他组患者相比，FEF25-75%(p<.001)值。对于患有ILO和非特异性咳嗽的儿童，流量回路主要是正常的。
结论：研究结果表明，仅使用肺活量测定法既不能诊断ILO和慢性非特异性咳嗽，也不能与轻度哮喘区分开来。因此，应明智地对该人群使用肺活量测定，考虑到程序的局限性。未来的研究应该确定最有效和最有效的方法来描述ILO和非特异性咳嗽与其他儿童呼吸系统疾病。
方法：回顾性横断面设计。诊断为国际劳工组织（N=70）的儿童，慢性非特异性咳嗽（N=70），轻度哮喘（N=60），从一家大型儿童医院的电子病历中发现中度至重度哮喘(N=60).肺活量测定在国际劳工组织之前完成，非特异性咳嗽,或哮喘的诊断是由小儿喉科医师或肺科医师做出的。肺活量测定是按照美国胸科学会的指南进行的，并由儿科肺科医师解释。强制肺活量（FVC），1秒内用力呼气量（FEV1），FEV1/FVC比值(FEV1/FVC),用力呼气中流量25-75%（FEF25-75%），肺科医师对流量回路的解释，并从病历中提取总体检查结果。
结果：97%的ILO或慢性非特异性咳嗽患儿肺活量测定值在标准范围内。国际劳工组织的患者，非特异性咳嗽,轻度哮喘表现为FVC，FEV1,FEV1/FVC,和FEF25-75%的值在统计学上相似的范围内。中度至重度哮喘患儿FVC显著降低（p<.001），FEV1（p<.001），FEV1/FVC（p<.001），与其他组患者相比，FEF25-75%(p<.001)值。对于患有ILO和非特异性咳嗽的儿童，流量回路主要是正常的。
结论：研究结果表明，仅使用肺活量测定法既不能诊断ILO和慢性非特异性咳嗽，也不能与轻度哮喘区分开来。因此，应明智地对该人群使用肺活量测定，考虑到程序的局限性。未来的研究应该确定最有效和最有效的方法来描述ILO和非特异性咳嗽与其他儿童呼吸系统疾病。
