Kirkby, JC; (2012) Application and Interpretation of Paediatric Lung Function Tests in Health and Disease. Doctoral thesis , UCL (University College London).

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Abstract

Abstract Background: Lung function tests (LFT) provide valuable insights into respiratory physiology, and have been proven to be useful outcome measures in both clinical research and the clinical management of children with lung disease. Standardised methods and appropriate interpretation are, however, essential if these measurements are to be applied reliably. The aims of this thesis were to improve the application and interpretation of LFT’s in children and to determine the extent to which ethnic differences in lung function (LF) occurred between healthy Black and White children after adjusting for height, sex and age. Methods: A series of investigations using four commercially available LFT (Impulse oscillometry (IOS), specific airways resistance (sRaw), plethysmographic lung volumes, and spirometry) involving 400 healthy children (214 Black and 186 White) aged 4-12y were undertaken. Upon determining the most appropriate methods for interpreting LF in health, the LFT’s and a respiratory health questionnaire were applied to children with Sickle Cell Disease (SCD) to determine the extent to which each outcome measure identified LF abnormalities in these children. Results: Reference data for measurements of sRaw in children were developed as well as recommendations for interpreting spirometry and plethysmography in Black children. Despite the relatively high proportion of respiratory symptoms reported in SCD, the proportion of children with LF results falling outside the limits of normal was relatively small, and a pattern of restrictive lung disease was observed. Of the outcomes assessed in this thesis, spirometry appeared to be the most robust outcome measure for routine assessment of LF in SCD. Conclusions: Results from this thesis contribute to the literature that SCD is primarily associated with restrictive lung disease. Furthermore, the new interpretation strategies developed during the work for this thesis prevented significant misinterpretation of LF in Black children, and improved the standards for using these LFT’s in children.

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