The Journal of Asthma Research. Vol. 4, No. 3, March, 1967

Pulmonary Function in Asthmatic Children

NATHAN E. SILBERT, M.D."

This presentation concerns the laboratory studies performed as an office pro- cedure in a group of asthmatic children who have been under allergic manage- ment. Total lung function studies have been done and the tracings and results are presented.

It is interesting to observe that the majority of reports in the field of pul- monary function in children concern themselves with values associated with, principally, vital capacities and forced expiratory volumes in a given measured unit of time. This presentation, however, concerns itself with total lung func- tion studies with particular reference to lung volumes, ventilation studies, and studies observed on the mechanics of breathing. In some selected cases the study has been extended to acid-base nomograms. It is the purpose of the paper to show that although such studies are time-consuming, they can be done as an office procedure and are a most rewarding adjunct in following the prog- ress of children in whom a diagnosis of bronchial asthma or emphysema has been established. The actual studies which are done as part of office procedure in this office are observed in Chart 1.

* Chief, Department of Allergy, St. Joseph's Hospital, Lowell, Massachusetts. Presented a t the First International Symposium on Pediatric Allergy. Tokyo, Japan.

November 5th and 6th, 1965.

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CHART 1 Case No. ___ Date -

Name Age- Height Weight.-_- - _--_ A . Lung Volumes

Pulmonet Expirograpb Observed Observed Predicted

Inspiratory Capacity ( I C ) . . . . . . . . . . . . . . ___ ___ 250&3600 cc. Expiratory Reserve Volume (ERV) . . . . . ___ ~ 1000-1500 cc. lnspiratory Reserve Volume (IRV) . . . . . ___ ___ 2000-3000 cc. Residiial Volurne (RV) . . . . . . . . . . . . . . . . . ___ ____ 1000-1500 cc. Functional Residiial Capacit,y (FRC) . . . ___ ___ 200&3000 cc. Total Lung Capacity (TLC) . . . . . . . . . . . . ___ ____ 4500-6500 c c . RV/TLC.. . . . . . . . . . . . . . . . . . . . . . . . . . . ___ ___ 2&30%

Tidal Volume (TV). . . . . . . . . . . . . . . . . . . . . ___ _ ~ - 600-800 cc. Freqriency/minnt,e (F/M) . . . . . . . . . . . . . . . ~ _ _ ___ 11-14 min. Minut,e Volume (MV).. . . . . . . . . . . . . . . . . . I__ - ~ _ 8-12 L/min. Helium Washout ( H e w ) . . . . . . . . . . . . . . . . ____ ___ 2-4 min. Note: Each value corrected for body t a n -

peratiire, pressiire and saturation with water vapor.

B . Ventilation. Studies

C. Mechanics of Breathing Maximal Breathing Capacity (MBC) or

(MVV) (a) Pat’ient’s observed value. . . . . . . . . . ~ _ _ ~ Liters (b) Patient,’s predicted value. . . . . . . . . ___ ___ Y&170 L. (c) Fractional Proportion. . . . . . . . . . . . . ____ _~ 100%

Forced Expiratory Volume (FEV) (recumbent.-) (stand--)

(sit,-) (a) Patient’s observed value. . . . . . . . . . ___ ~- Liters (b) Patient’s predicted value. . . . . . . . . ___ ___ 3.5-5.0 L.

. . . . . . . . . . . . (c) Fractional proportion. ___ ___ 100%

Observed MBC 70/Observed FEV % . . __- ~ 100% Air Velocity Index (AVI) :

Forced Expiratory Volume (FEV1). . . . . . ___ ___ 7583% Maximal Midexpiratory Flow (MMF) or

(FEF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ___ -__ Maximal Midexpiratory Time (MMT) ___ ___

D. Acid Rase Nomogmm (Radiometer Astricp Methwd) Observed Predicted

Actual p H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ___ 7.40 Actiial P C 0 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ___ 40 mm. Hg. Base Excess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 0 Biiffer B a s e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~

Standard Bicarbor1at.e. . . . . . . . . . . . . . . . . . . . . . . . . . . . ___ 24 meq/I,. Actual Bicarbon:tt,e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -~ 24 meq/L. Total C o g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ ~ _ 25.2 meq/L. PCOz concentration (Rsvin and St’ein). . . . . . . . . . . . . . ____ 5.3% or 40 mrn. Tlg

Patient Response to tests: Remarks and Findings:

Technician’s signature.

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