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Age and height dependence of lung clearance index and functional residual capacity

Sooky Lum, Janet Stocks, Sanja Stanojevic, Angie Wade, Paul Robinson, Per Gustafsson, Meghan Brown, Paul Aurora, Padmaja Subbarao, Ah-fong Hoo, Samatha Sonnappa
European Respiratory Journal 2013 41: 1371-1377; DOI: 10.1183/09031936.00005512
Sooky Lum
Portex Respiratory Unit, UCL Institute of Child Health, London
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  • For correspondence: s.lum@ich.ucl.ac.uk
Janet Stocks
Portex Respiratory Unit, UCL Institute of Child Health, London
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Sanja Stanojevic
Portex Respiratory Unit, UCL Institute of Child Health, LondonHospital for Sick Children, Toronto, Canada
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Angie Wade
Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London
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Paul Robinson
Portex Respiratory Unit, UCL Institute of Child Health, LondonDept of Paediatric Respiratory Medicine, The Children’s Hospital, Westmead, Sydney, Australia
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Per Gustafsson
Dept of Paediatrics, Central Hospital, Skövde, Sweden
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Meghan Brown
Hospital for Sick Children, Toronto, Canada
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Paul Aurora
Portex Respiratory Unit, UCL Institute of Child Health, LondonDept of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Padmaja Subbarao
Hospital for Sick Children, Toronto, Canada
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Ah-fong Hoo
Dept of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Samatha Sonnappa
Portex Respiratory Unit, UCL Institute of Child Health, LondonDept of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Abstract

The lung clearance index (LCI) is more sensitive than spirometry in detecting abnormal lung function in children with cystic fibrosis. LCI is thought to be independent of age, but recent evidence suggests that the upper limit of normal is higher in infants and preschool children than in older subjects. This study examines whether LCI remains independent of body size throughout childhood.

Multiple-breath washout data from healthy children and adolescents were collated from three centres using the mass spectrometer system and the inert gas sulfur hexafluoride. Reference equations for LCI and functional residual capacity (FRC) were constructed using the LMS (lambda–mu–sigma) method.

Data were available from 497 subjects (2 weeks to 19 years of age) tested on 659 occasions. LCI was dependent on body size, decreasing in a nonlinear pattern as height increased. Changes were particularly marked in the first 5 years of life. Height, age and sex were all independent predictors of FRC. Minimal between-centre differences allowed unified reference equations to be developed.

LCI is not independent of body size. Although a constant upper normal limit would suffice for cross-sectional clinical assessments from 6 years of age, appropriate reference equations are essential for accurate interpretation of results during early childhood.

  • Children
  • functional residual capacity
  • lung clearance index
  • reference values
  • ventilation inhomogeneity

Footnotes

  • This article has supplementary material available from www.erj.ersjournals.com

  • Support Statement

    This study was supported by the UK Medical Research Council (grant G0401525), the Cystic Fibrosis Trust (PJ550), a Wellcome Trust Value in People award (to S. Lum), the British Lung Foundation (P06/7 and P99/16), Asthma UK (06/037 and 10/013) and Smiths Medical PLC; research at the Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust (London, UK) benefits from research and development funding from the NHS Executive, the Canadian Institute of Health Research (AEC-85761) and AllerGEN NCE (09A7).

  • Statement of Interest

    None declared.

  • Received January 10, 2012.
  • Accepted September 4, 2012.
  • ©ERS 2013
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Age and height dependence of lung clearance index and functional residual capacity
Sooky Lum, Janet Stocks, Sanja Stanojevic, Angie Wade, Paul Robinson, Per Gustafsson, Meghan Brown, Paul Aurora, Padmaja Subbarao, Ah-fong Hoo, Samatha Sonnappa
European Respiratory Journal Jun 2013, 41 (6) 1371-1377; DOI: 10.1183/09031936.00005512

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Age and height dependence of lung clearance index and functional residual capacity
Sooky Lum, Janet Stocks, Sanja Stanojevic, Angie Wade, Paul Robinson, Per Gustafsson, Meghan Brown, Paul Aurora, Padmaja Subbarao, Ah-fong Hoo, Samatha Sonnappa
European Respiratory Journal Jun 2013, 41 (6) 1371-1377; DOI: 10.1183/09031936.00005512
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