Hyperinflation is Associated with Increased Respiratory Rate and is a
More Sensitive Measure of Cystic Fibrosis Lung Disease During Infancy
Compared to Forced Expiratory Measures
Abstract
ABSTRACT Background: The goal of this study was to identify clinical
features associated with abnormal infant pulmonary function tests
(iPFTs), specifically functional residual capacity (FRC), in infants
with cystic fibrosis (CF) diagnosed via newborn screen (NBS). We
hypothesized that poor nutritional status in the first 6-12 months would
be associated with increased FRC at 12-24 months. Methods: This study
utilized a combination of retrospectively and prospectively collected
data from ongoing research studies and iPFTs performed for clinical
indications. Demographic and clinical features were obtained from the
electronic medical record. Forced expiratory flows and volumes were
obtained using the raised volume rapid thoracoabdominal technique
(RVRTC) and FRC was measured via plethysmography. Results: A total of 45
CF NBS infants had iPFTs performed between 12-24 months. Mean forced
vital capacity, forced expiratory volume in 0.5 second, and forced
expiratory flows were all within normal limits. In contrast, the mean
FRC z-score was 2.18 (95%CI=1.48, 2.88) and the mean respiratory rate
(RR) z-score was 1.42 (95%CI=0.95, 1.89). There was no significant
association between poor nutritional status and abnormal lung function.
However, there was a significant association between higher RR and
increased FRC, and a RR cutoff of 36 breaths/min resulted in 92%
sensitivity to detect hyperinflation with 32% specificity. Conclusions:
These results suggest that FRC is a more sensitive measure of early CF
lung disease than RVRTC measurements and that RR may be a simple,
non-invasive clinical marker to identify CF NBS infants with
hyperinflation.