Evaluation of the Double-Tracer Gas Single-Breath Washout Test in a Pediatric Field Study

Anne-Christianne Kentgens; Johanna M Kurz; Rebeca Mozun; Jakob Usemann; Eva S L Pedersen; Claudia E Kuehni; Philipp Latzin; Alexander Moeller; Florian Singer; LuftiBus In the School (LUIS) Study Group

doi:10.1016/j.chest.2023.09.006

Evaluation of the Double-Tracer Gas Single-Breath Washout Test in a Pediatric Field Study

Chest. 2024 Feb;165(2):396-404. doi: 10.1016/j.chest.2023.09.006. Epub 2023 Sep 15.

Authors

Anne-Christianne Kentgens¹, Johanna M Kurz¹, Rebeca Mozun², Jakob Usemann³, Eva S L Pedersen⁴, Claudia E Kuehni⁵, Philipp Latzin⁶, Alexander Moeller⁷, Florian Singer⁸; LuftiBus In the School (LUIS) Study Group

Collaborators

LuftiBus In the School (LUIS) Study Group:
Alexander Moeller, Jakob Usemann, Philipp Latzin, Florian Singer, Johanna Kurz, Claudia E Kuehni, Rebeca Mozun, Cristina Ardura-Garcia, Myrofora Goutaki, Eva S L Pedersen, Maria Christina Mallet, Kees de Hoogh

Affiliations

¹ Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
² Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Intensive Care and Neonatology and Children's Research Center, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland.
³ Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Respiratory Medicine, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland; University Children's Hospital Basel (UKBB), Basel, Switzerland.
⁴ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁵ Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁶ Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁷ Department of Respiratory Medicine, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁸ Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Respiratory Medicine, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland; Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria. Electronic address: [email protected].

Abstract

Background: The early life origins of chronic pulmonary diseases are thought to arise in peripheral small airways. Predictors of ventilation inhomogeneity, a proxy of peripheral airway function, are understudied in schoolchildren.

Research question: Is the double-tracer gas single-breath washout (DTG-SBW) measurement feasible in a pediatric field study setting? What are the predictors of the DTG-SBW-derived ventilation inhomogeneity estimate in unselected schoolchildren?

Study design and methods: In this prospective cross-sectional field study, a mobile lung function testing unit visited participating schools in Switzerland. We applied DTG-SBW, fraction of exhaled nitric oxide (Feno), and spirometry measurements. The DTG-SBW is based on tidal inhalation of helium and sulfur-hexafluoride, and the phase III slope (SIII_He-SF6) is derived. We assessed feasibility, repeatability, and associations of SIII_He-SF6 with the potential predictors of anthropometrics, presence of wheeze (ie, parental report of one or more episode of wheeze in the prior year), Feno, FEV₁, and FEV₁/FVC.

Results: In 1,782 children, 5,223 DTG-SBW trials were obtained. The DTG-SBW was acceptable in 1,449 children (81.3%); the coefficient of variation was 39.8%. SIII_He-SF6 was independently but weakly positively associated with age and BMI. In 276 children (21.2%), wheeze was reported. SIII_He-SF6 was higher by 0.049 g.mol.L^-1 in children with wheeze compared with those without and remained associated with wheeze after adjusting for age and BMI in a multivariable linear regression model. SIII_He-SF6 was not associated with Feno, FEV₁, and FEV₁/FVC.

Interpretation: The DTG-SBW is feasible in a pediatric field study setting. On the population level, age, body composition, and wheeze are independent predictors of peripheral airway function in unselected schoolchildren. The variation of the DTG-SBW possibly constrains its current applicability on the individual level.

Trial registration: ClinicalTrials.gov; No.: NCT03659838; URL: www.

Clinicaltrials: gov.

Keywords: adolescent; child; helium; lung function tests; small airway remodeling; sulfur hexafluoride; ventilation tests; wheezing.

MeSH terms

Breath Tests
Child
Cross-Sectional Studies
Gases*
Humans
Prospective Studies
Respiration*
Sulfur Hexafluoride

Substances

Gases
Sulfur Hexafluoride

Associated data

ClinicalTrials.gov/NCT03659838