Dundas, Isobel; (2000) Simpler methods of assessing respiratory function and their application in infancy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The need to develop and evaluate simple non-invasive tests to measure respiratory function in wheezy infants, in order to investigate the physiological basis of lung disease and move towards a more rational basis for the treatment of airway disease in infancy was well recognised at the inception of this work. The main aims of this thesis were: to evaluate simpler methods of assessment of lung function such as the tidal breathing parameter tPTEF:tE, passive respiratory mechanics using the Single Breath technique and the rapid thoraco-abdominal compression technique (RTC) by comparison with established "gold standard" techniques, and: to address applications of such assessments, when comparing respiratory function in survivors of each limb of the Collaborative ECMO trial. tPTEF:tE and specific airway conductance were measured in healthy infants and those with recurrent wheezing and it was found that both parameters were significantly lower in the wheezy compared to the healthy group. There was a significant although weak association between these variables in infants, irrespective of prior wheezing status, which was also confirmed in the ECMO Respiratory Follow-up population. Although a variable relationship between respiratory and airway resistance was found, both were significantly higher in infants with prior wheeze. Measurements obtained using the Single Breath technique had a relatively high failure rate. Inter observer variability was compared within and between two specialised infant lung function testing centres and a strategy developed for performing and analysing infant respiratory function tests to facilitate future similar trials. A collaborative approach to trials with infant respiratory function as an outcome measure appears feasible, providing close attention is paid to study design. Airway function was compared in survivors of the Collaborative ECMO trial. Respiratory function outcomes in those managed conventionally suggested that the larger proportion of these infants receiving respiratory medication and reporting respiratory symptoms may be attributed to subtle impairment of small airway function, relative to those assigned to ECMO. These findings probably reflected differences in neonatal management, since initial disease severity and background characteristics were similar in both groups.

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