Pulmonary Function Testing in Healthy Infants in Rural Bangladesh: Feasibility Study

Charl Verwey; Hm Golam Kibria Sojib; Md Shafiqul Islam; Arunangshu Dutta Roy; Md Asmd Ashraful Islam; Nabidul H Chowdhury; Dorottya Czovek; Gergely Makan; Salahuddin Ahmed; Abdullah H Baqui; Zoltan Hantos; Eric D McCollum

doi:10.1002/ppul.27461

Pulmonary Function Testing in Healthy Infants in Rural Bangladesh: Feasibility Study

Pediatr Pulmonol. 2025 Jan;60(1):e27461. doi: 10.1002/ppul.27461.

Authors

Affiliations

¹ Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
² South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa.
³ Projahmo Research Foundation, Dhaka, Bangladesh.
⁴ Department of Paediatrics, Semmelweis University, Budapest, Hungary.
⁵ Department of Technical Informatics, University of Szeged, Szeged, Hungary.
⁶ Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁷ Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
⁸ Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatrics, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.

Abstract

Background: Infant pulmonary function testing (iPFT) in low- and middle-income countries is limited. We evaluated the early feasibility of iPFT in rural Bangladesh.

Methods: Experts established an iPFT laboratory at Zakiganj Upazila Health Complex in Sylhet, Bangladesh and trained staff. Infants ≤ 6 months old participating in a cohort study between 2021 and 2022 were eligible for respiratory oscillometry (Osc), tidal breath flow-volume loops (TBFVL), and sulphur hexaflouride multiple breath washout (MBW) during natural sleep. Participants with a respiratory infection within 4 weeks were not tested. Among the first 25 infants with attempted Osc, TBFVL, or MBW measurements, we report the test proportions meeting international quality standards, measurement averages, and the mean measurement differences between laboratory staff and experts.

Results: Among the first 25 eligible infants with attempted measurements, acceptable Osc measurements were achieved in 88% (22/25), TBFVL in 96% (24/25), and MBW in 88% (22/25). Infants tested by Osc at 2 months were a median (IQR) of 81 days old (73, 85) and tested at 6 months were a median of 194 days old (193, 202); TBFVL/MBW tested infants were a mean 83 days (79, 87). Mean (SD) Osc resistance at 7 Hz was 66.3 (25.2) and 64.0 (22.4) hPa.s.L^-1 at 2 and 6 months. At 2 months, TBFVL mean tidal volume/body weight was 7.4 (1.4) mL/kg and MBW mean (SD) lung clearance index was 7.2 (1.0) turnovers. iPFT staff and expert interpretation differences were minimal.

Conclusions: Establishing an iPFT laboratory and performing quality measurements and expert-level interpretations in rural Bangladesh is feasible.

MeSH terms

Bangladesh
Cohort Studies
Feasibility Studies*
Female
Humans
Infant
Infant, Newborn
Male
Respiratory Function Tests* / methods
Rural Population*

Grants and funding

This work was funded by the United States National Institute of Environmental Health Sciences (R21ES029330 to E.D.M.) and Hungarian Scientific Research Fund (K105403, FK 129237 and K128701 to D.C. and Z.H.).