Tidal breathing parameters measured by structured light plethysmography in children aged 2-12 years recovering from acute asthma/wheeze compared with healthy children

Hamzah Hmeidi, Shayan Motamedi-Fakhr, Edward K Chadwick, Francis J Gilchrist, Warren Lenney, Richard Iles, Rachel C Wilson, John Alexander, Hamzah Hmeidi, Shayan Motamedi-Fakhr, Edward K Chadwick, Francis J Gilchrist, Warren Lenney, Richard Iles, Rachel C Wilson, John Alexander

Abstract

Measurement of lung function can be difficult in young children. Structured light plethysmography (SLP) is a novel, noncontact method of measuring tidal breathing that monitors displacement of the thoraco-abdominal wall. SLP was used to compare breathing in children recovering from an acute exacerbation of asthma/wheeze and an age-matched cohort of controls. Children aged 2-12 years with acute asthma/wheeze (n = 39) underwent two 5-min SLP assessments, one before bronchodilator treatment and one after. SLP was performed once in controls (n = 54). Nonparametric comparisons of patients to healthy children and of pre-bronchodilator to post-bronchodilator were made for all children, and also stratified by age group (2-5 vs. 6-12 years old). In the asthma/wheeze group, IE50SLP (inspiratory to expiratory flow ratio) was higher (median 1.47 vs. 1.31; P = 0.002), thoraco-abdominal asynchrony (TAA) and left-right asynchrony were greater (both P < 0.001), and respiratory rate was faster (P < 0.001) than in controls. All other timing indices were shorter and displayed reduced variability (all P < 0.001). Variability in time to peak inspiratory flow was also reduced (P < 0.001). Younger children showed a greater effect than older children for TAA (interaction P < 0.05). After bronchodilator treatment, the overall cohort showed a reduction in within-subject variability in time to peak expiratory flow only (P < 0.001). Younger children exhibited a reduction in relative contribution of the thorax, TAA, and variability in TAA (interaction P < 0.05). SLP can be successfully performed in young children. The potential of SLP to monitor diseases such as asthma in children is worthy of further investigation. ClinicalTrials.gov identifier: NCT02543333.

Keywords: Acute asthma; bronchodilator; children; structured light plethysmography.

© 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Figures

Figure 1
Figure 1
Principles of structured light plethysmography. A grid of light is projected onto the thoraco–abdominal (TA) wall of a participant. The changes in the grid pattern that occur during breathing are recorded by two cameras, which are located in the scanning head. These changes are translated into a virtual surface that corresponds to the shape of the subject's TA wall. Tidal breathing timing indices are then calculated using the one‐dimensional movement over time trace generated from the average axial displacement of the grid. The subject in the photo was a volunteer and not a study participant.
Figure 2
Figure 2
Age distribution of the participants in the (A) healthy and (B) acute asthma/wheeze groups.
Figure 3
Figure 3
Two of the nine timing‐based parameters (mtI [A], vtI [B]), and three flow‐based parameters (vtPTEFSLP/tE [C], vtPTIFSLP/tI [D], and mIE50SLP [E]) differed between healthy children (n = 54) and those with asthma/wheeze (n = 39) both pre‐ and post‐bronchodilator administration. The reduction in vtPTEFSLP/tE in the children with asthma following bronchodilator administration is also illustrated (C). The gray line indicates the median value, the rectangle spans the interquartile range, and the black whiskers indicate the minimum and maximum values (excluding the outliers indicated by the black circles). BD, bronchodilator; IE50SLP,SLP‐derived tidal inspiratory flow at 50% of inspiratory volume divided by tidal expiratory flow at 50% of expiratory volume; m, median; SLP, structured light plethysmography; tE, expiratory time; tI, inspiratory time; tPTEFSLP, SLP‐derived time to reach peak tidal expiratory flow; tPTIFSLP, SLP‐derived time to reach peak tidal inspiratory flow; v, within‐subject variability.
Figure 4
Figure 4
The asynchrony‐based parameters mTAA (A), vTAA (B), mHTA (C), and vHTA (D) differed in healthy children (n = 54) compared with those with asthma/wheeze (n = 39) and remained so after bronchodilator administration. The gray line indicates the median value, the rectangle spans the interquartile range, and the black whiskers indicate the minimum and maximum values (excluding the outliers indicated by the black circles). BD, bronchodilator; HTA, left–right hemi‐thoracic asynchrony; m, median; SLP, structured light plethysmography; TAA, thoraco–abdominal asynchrony; v, within‐subject variability.
Figure 5
Figure 5
mTAA in healthy children and those with asthma/wheeze, stratified by age group. Error bars indicate the 25th and 75th quartiles. m, median; TAA, thoraco–abdominal asynchrony.
Figure 6
Figure 6
Change in (A) mrCT, (B) mTAA, and (C) vTAA after treatment with bronchodilator in children with asthma/wheeze, stratified by age group. Error bars indicate the 25th and 75th quartiles. m, median; rCT, relative contribution of the thorax; TAA, thoraco–abdominal asynchrony; v, within‐subject variability.

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