Infant Pulmonary Function Tests (IPFT) in Children with Airway Anomalies
and Correlation with Bronchoscopy Findings
Abstract
Introduction: For the diagnosis of airway anomalies,
bronchoscopy is the gold standard. Infant pulmonary function testing is
an emerging modality to assess airways and its utility in diagnosis and
monitoring is unexplored in clinical studies. Objectives: To
evaluate infant Pulmonary Function Test [Tidal Breathing Flow Volume
Loop (TBFVL)] in children with airway anomalies and to correlate with
bronchoscopy findings. Methods: We performed a prospective
cohort study from July 2018 to April 2020 in children from 0-2 years
with physician suspected airway anomalies. We performed TBFVL (graphic
pattern and parameters) and bronchoscopy in these children and
correlated the results. The primary outcome measure was a graphic
pattern of TBFVL in children with laryngomalacia. Secondary outcome
measures were bronchoscopy diagnosis of various airway anomalies,
graphic pattern in children with airway anomalies other than
laryngomalacia, measurement of TBFVL parameters and measurement of
change in TBFVL graphic patterns and parameters at six months follow up.
We compared TBFVL parameters with controls without airway anomalies.
Results: We enrolled 53 children with both Infant Pulmonary
Function Tests and bronchoscopy data. Isolated laryngomalacia (28,
52.8%) was the most common airway anomaly, followed by
laryngo-tracheomalacia (7, 13.2%), laryngo-tracheo-bronchomalacia (6,
11.3%), and laryngomalacia with subglottic stenosis (4, 7.5%). Among
isolated laryngomalacia, pattern 3 (fluttering of inspiratory limb) was
most common in TBFVL, followed by pattern 4 (fluttering of inspiratory
limb and flattening of expiratory limb) in 13 (46.4) and 8 (28.6%)
cases, respectively. There was no strikingly predominant pattern in
other groups of bronchoscopy diagnoses. Among TBFVL parameters, the
ratio of Ti/Te was significantly high in children with isolated
laryngomalacia compared to controls. Compared to controls, the tPTEF/tE
was significantly higher in laryngomalacia plus sub-glottic stenosis. At
six months of follow-up, clinical symptoms improved significantly, TBFVL
pattern 1 (normal) became the most common pattern, and expiratory time
increased significantly among TBFVL parameters. Conclusion: A
particular type of airway anomaly may have a characteristic graphic
pattern in TBFVL. Further, the TBFVL pattern may indicate improvement in
the follow-up either spontaneously or after an intervention.