Lung clearance index predicts persistence of preschool wheeze

Shahideh Safavi; Ruixue Dai; Vanessa L Breton; Melanie N Emmerson; Krzysztof Kowalik; Zihang Lu; Wendy Lou; Aimée Dubeau; Stephanie DeLorenzo; Meghan B Azad; Allan B Becker; Piush J Mandhane; Stuart E Turvey; Per Gustafsson; Diana L Lefebvre; Malcolm R Sears; Theo J Moraes; Padmaja Subbarao

doi:10.1111/pai.13713

Lung clearance index predicts persistence of preschool wheeze

Pediatr Allergy Immunol. 2022 Jan;33(1):e13713. doi: 10.1111/pai.13713. Epub 2021 Dec 14.

Authors

Shahideh Safavi¹, Ruixue Dai¹, Vanessa L Breton¹, Melanie N Emmerson¹, Krzysztof Kowalik^{1

2}, Zihang Lu³, Wendy Lou⁴, Aimée Dubeau¹, Stephanie DeLorenzo¹, Meghan B Azad⁵, Allan B Becker⁵, Piush J Mandhane⁶, Stuart E Turvey⁷, Per Gustafsson⁸, Diana L Lefebvre⁹, Malcolm R Sears⁹, Theo J Moraes¹, Padmaja Subbarao^{1

2

4

9}

Affiliations

¹ Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada.
² Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
³ Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
⁷ Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
⁸ Department of Pediatrics, Central Hospital, Skövde, Sweden.
⁹ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

PMID: 34875116
DOI: 10.1111/pai.13713

Abstract

Background: The lung clearance index (LCI) is a measure of pulmonary function. Variable feasibility (50->80%) in preschool children has been reported. There are limited studies exploring its relationship to respiratory symptoms and how it predicts persistent wheeze. We aimed to assess the association with respiratory symptoms in preschool-aged children with LCI and determine its utility in predicting persistent wheeze.

Methods: LCI was measured in a subcohort of the CHILD Cohort Study at age 3 years using SF₆ multiple breath washout test mass spectrometry. Respiratory symptom phenotypes at age 3 were derived from children's respiratory symptoms reported by their parents. Responses were used to categorize children into 4 symptom groups: recurrent wheeze (3RW), recurrent cough (3RC), infrequent symptoms (IS), and no current symptoms (NCS). At age 5 years, these children were seen by a specialist clinician and assessed for persistent wheeze (PW).

Results: At age 3 years, 69% (234/340) had feasible LCI. Excluding two children with missing data, 232 participants were categorized as follows: 33 (14%) 3RW; 28 (12%) 3RC; 17 (7%) IS; and 154 (66%) NCS. LCI z-score at age 3 years was highest in children with 3RW compared to 3RC (mean (SD): 1.14 (1.56) vs. 0.09 (0.95), p < .01), IS (mean (SD): -0.14 (0.59), p < .01), and NCS (mean (SD): -0.08 (1.06), p < .01). LCI z-score at age 3 was predictive of persistent wheeze at age 5 (PW) (AUROC: 0.87).

Conclusions: LCI at age 3 was strongly associated with recurrent wheeze at age 3, and predictive of its persistence to age 5.

Keywords: asthma; lung clearance index; multiple breath washout; preschool; pulmonary function test; ventilation inhomogeneity; wheeze phenotypes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child, Preschool
Cohort Studies
Humans
Lung*
Phenotype
Respiratory Function Tests / methods
Respiratory Sounds*

Grants and funding

CIHR/Canada