Posters / Paediatric Respiratory Reviews 12S1 (2011) S67S100

This retrospective study afrms the utility of exible bronchoscopy

with BAL in the evaluation of immunecompromised patients with
respiratory infections. The procedure is generally safe.
K5
Spirometric reference values of Thai Bangkok children
A. Preutthipan1 , C. Boonlarptaveechoke1 , S. Suwanpromma2 ,
U. Udomsubpayakul3 . 1 Ramathibodi Hospital, Pediatrics, Bangkok,
Thailand; 2 Lerdsin Hospital, Division of Pediatrics, Bangkok, Thailand;
3
Ramathibodi Hospital, Mahidol University Section for Clinical
Epidermiology&Biostatics, Bangkok, Thailand
Background: Spirometry is essential for pulmonologist to diagnose
and monitor treatment. Its reference values vary with ethnicity.
Objective: To establish an update predicted reference values, and
derive summary equations of spirometric parameters specically
for 618 years Thai children in Bangkok.
Materials and Methods: A cross sectional study of spirometry
measured with Jaeger spirometer (Jaeger, model: 97342 Hoechberg,
Germany) was carried out in 1,104 healthy non-smoker Bangkok
Thai children, aged 618 years (476 boys and 628 girls from
5 schools). Prior to pulmonary function testing the parents was
asked to complete the questionnaire for detailed medical history.
Various regression models treating two sexes separately were
applied to spirometric parameters including FVC, FEV1, FEF2575 and
PEF.
Results: 395 children were excluded due to presence of respiratory
illnesses within 4 weeks before testing (n = 156), inability to achieve
ATS criteria for reproducibility and acceptability (n = 199), chronic
illnesses (n = 39), Caucasians (n = 1). Results from the remaining 709
(292 boys and 417 girls) were analyzed. The correlation of FVC
and FEV1 were highest with height followed by weight and age in
both sexes. FEF2575 and PEF were also signicantly correlated with
height, weight and age respectively. Boys had greater FVC and FEV1
than girls in all separate height. Regression equations to predict
normal spirometry were derived for boys and girls in Bangkok.
Our measurements were similar to those reported for children in
Singapore and lower than those reported for Caucasians.
Conclusion: Our predicted values of spirometry can be used for
Thai Bangkok children aged 618 years. The results of the study
will improve clinical diagnosis, treatment outcomes monitoring
and future epidemiological research of respiratory diseases in Thai
children.
K6
Spirometry vs. resistance in children with asthma suspicion:
evaluating bronchodilation response
L.G. Gochicoa-Rangel, L. Torre-Bouscoulet, J.C. Vazquez-Garca,
C. Vargas-Domnguez. Instituto Nacional de Enfermedades
Respiratorias Fisiologa Pulmonar, Mexico D.F., Mexico
Introduction: Spirometry is the gold standard to evaluate airow
obstruction; however, other techniques are available such as the
interrupter technique (Rint) and the Impulse Oscillometry (IOS)
which evaluate airway resistance.
The aims of this study were (1) to explore the correlation between
forced expiratory ow in the rst second (FEV1) with the resistances
measured by Rint and IOS; (2) to analyze the agreement between
Rint and IOS; (3) to evaluate the effect of the forced maneuver
and bronchodilation over the resistance obtained by Rint and IOS
and (4) to compare the proportion of bronchodilation positive tests
among the methods.
Methods: We included children (<6 years old) with clinical asthma
suspicious. A written consent was obtained from the parents.
The following sequence of maneuvers were performed: RintIOS
SpirometryRintIOS. After 200 mcg of Albuterol the sequence was
repeated.
Results: 32 children were enrolled; 62.5% males, 4.31.2 years of
age (min 2.4 max 6.6). Rint maneuver was performed during

S89

expiration and it was completed in 81% of patients, 78% completed

the IOS; and 78% completed at least 1 acceptable spirometry
maneuver pre and postbronchodilator.
The Pearsons correlation coefcient between FEV1 vs. Rint was
0.57 (p = 0.004), FEV1 vs. IOS (R5Hz) was 0.53 (p = 0.008). The
agreement (intra-class correlation coefcient) between Rint and
IOS was 0.73, 95% CI 0.560.90, p < 0.0001.
After forced spirometry, the mean change in Rint was 0.06 kPa/L/s
(p = 0.08) whereas it was 2.5% in IOS (p = 0.13).
Bronchodilation response was positive in 48% patients measured by
Rint with a mean decreasing of 0.48kPa/L/s; while it was positive
in 57% when IOS was used with a mean decreasing of 27.5%.
Regarding spirometry, the bronchodilation test was positive only
in 2 patients (8%).
Conclusions: A good correlation between FEV1 vs. Rint and IOS was
observed as well as the agreement between Rint vs. IOS (R5Hz), even
though the agreement limits were width. Forced maneuver did not
signicantly modify the measurements obtained by Rint and IOS.
Rint and IOS (R5Hz) appear to be more sensitive methods than
spirometry to evaluate bronchodilation response in children with
asthma suspicious.
K7
Unilateral hyperlucent lung: the important role of pulmonary
ventilation and perfusion in the diagnosis of children
I-C. Chen, Y.-W. Chen, J.-H. Hsu, J.-R. Wu, Z.-K. Dai. Kaohsiung
Medical University Hospital, Kaohsiung, Taiwan
Unilateral hyperlucent lung on chest X-ray is uncommon in children.
It is often found incidentally and always refers to Swyer-James
syndrome, with decrease of pulmonary vascularity and air trapping
during expiration. However, it may occasionally mimic other serious
lung disease such as pulmonary hypoplasia/aplasia, defect of
pulmonary artery, and other primary pulmonary disorders.
In this study, we hypothesized that there would be characteristic
patterns in pulmonary ventilation-perfusion (V/Q) scan in children
with different etiologies accompanied with unilateral hyperlucency
on chest lm, which could play an important role in differential
diagnosis of this disease group explicitly. Except unilateral
hyperlucency noted on chest lm, all patients had a detailed clinical
examination and underwent echocardiography, chest computed
tomography, selective pulmonary angiogram, exible bronchoscopy
and pulmonary V/Q scan.
Totally, 10 cases were enrolled, including 2 cases of unilateral
pulmonary artery agenesis (UPAA), 3 cases of Swyer-James
syndrome (SJS), 2 cases of agenesis of the right lung, 1 case of
lobar emphysema, and 2 cases of Tetralogy of Fallot with left
pulmonary artery stenosis. Besides, an overview of children with
unilateral hyperlucent lung is provided, reviewing 9 studies (171
patients), including our clinical experience, and nally an algorithm
for diagnosis and management of SPM is proposed, based on the
characteristics of V/Q scan.

L. Therapeutic procedures
L1
A 4 years follow up in children with moderate/severe asthma
after discontinuation of 1 year treatment with omalizumab
C.E. Baena-Cagnani1 , A. Teijeiro1 , H. Badellino1 , M.E. Zernotti1 ,
G.W. Canonica2 , V.H. Croce1 , R. Baena-Cagnani1 . 1 CIMER Research
Center of Respiratory Medicine, Cordoba, Argentina; 2 Genoa University,
Allergy and Respiratory Medicine, Genoa, Italy
Background: Asthma guidelines include omalizumab in the step
up management in those patients with moderate/severe noncontrolled asthma despite the use of the highest dose recommended
treatment. This communication describes the 4 year follow up of