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Airwave oscillometry to measure lung function in children with Down syndrome

Abstract

Background

Children with Down syndrome are at risk for significant pulmonary co-morbidities, including recurrent respiratory infections, dysphagia, obstructive sleep apnea, and pulmonary vascular disease. Because the gold standard metric of lung function, spirometry, may not be feasible in children with intellectual disabilities, we sought to assess the feasibility of both airwave oscillometry and spirometry in children with Down syndrome.

Methods

Thirty-four children with Down syndrome aged 5–17 years were recruited. Participants performed airwave oscillometry and spirometry before and 10 min after albuterol. Outcomes include success rates, airway resistance and reactance pre- and post-bronchodilator, and bronchodilator response.

Results

Participants were median age 9.2 years (interquartile range 7.2, 12.0) and 47% male. Airwave oscillometry was successful in 26 participants (76.5%) and 4 (11.8%) were successful with spirometry. No abnormalities in airway resistance were detected, and 16/26 (61.5%) had decreased reactance. A positive bronchodilator response by oscillometry was observed in 5/23 (21.7%) of those with successful pre- and post-bronchodilator testing.

Conclusions

Measures of pulmonary function were successfully obtained using airwave oscillometry in children with Down syndrome, which supports its use in this high-risk population.

Impact

  • Children with Down syndrome are at risk for significant pulmonary co-morbidities, but the gold standard metric of lung function, spirometry, may not be feasible in children with intellectual disabilities. This may limit the population’s enrollment in clinical trials and in standardized clinical care.

  • In this prospective study of lung function in children with Down syndrome, airwave oscillometry was successful in 76% of participants but spirometry was successful in only 12%.

  • This study reinforces that measures of pulmonary function can be obtained successfully using airwave oscillometry in children with Down syndrome, which supports its use in this high-risk population.

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Fig. 1: A participant demonstrating acceptable technique for airwave oscillometry by wearing nose clips, supporting the cheeks to minimize upper airway vibrations, and maintaining a seal around the mouthpiece.
Fig. 2: The absolute difference between the expiratory and inspiratory reactance values (X5Ex–In) is shown for those with abnormal or normal reactance at baseline.

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Acknowledgements

This publication is supported by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535, allowing the use of REDCap for data storage and R21 HL151261-01 (to E.D.B.). Contents are the authors’ sole responsibility and do not necessarily represent official NIH views. We would also like to thank the Global Down Syndrome Foundation and the Anna and John J. Sie Foundation for their financial support of research conducted at the Sie Center for Down Syndrome at Children’s Hospital Colorado.

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Correspondence to Emily M. DeBoer.

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Competing interests

E.D.B. is a consultant of EvoEndoscopy (formerly TripleEndoscopy Inc.) and is listed as a co-inventor on patents related to endoscopy. E.D.B. also receives funding from the Cystic Fibrosis Foundation and NIH, and is a consultant for Boehringer Ingelheim, not related to this project. The remaining authors declare no competing interests.

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Informed consent was obtained from the parent or legal guardian before study procedures and assent was obtained from children aged 7 years or older, if developmentally able.

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Vielkind, M.L., Hamlington, K.L., Wolter-Warmerdam, K. et al. Airwave oscillometry to measure lung function in children with Down syndrome. Pediatr Res (2021). https://doi.org/10.1038/s41390-021-01664-7

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