Analysis of expiratory pattern for monitoring bronchial obstruction in school-age children.

This study was designed to assess the validity of the percent of volume expired at tidal peak flow (dV/Vt) as an indicator of bronchial obstruction in school-age children. We analyzed 126 dV/Vt ratios and compared them with spirometric and plethysmographic results measured in 24 healthy (14 males) and 60 asthmatic (41 males) children; 42 of them underwent measurements before and after bronchial challenge with histamine. The two groups differed in resistance, forced expiratory volume in 1 sec (FEV1), and forced expiratory flows, as percents of predicted (FEV1: 94.6 +/- 2.4% in controls vs 86.7 +/- 1.6% in asthmatics; P less than 0.001). They did not differ in peak expiratory flow (PEF), forced vital capacity, functional residual capacity, measured by body plethysmography, and in dV/Vt. The dV/Vt was found to correlate with FEV1 (r = 0.58, P less than 0.001), PEF (r = 0.57, P less than 0.001), and other lung function parameters. Forty-two of the asthmatic children performed a bronchoprovocation histamine test. The fall of dV/Vt after histamine was significantly correlated (r = 0.61, P less than 0.001) with the variation in FEV1 and other lung function parameters. We conclude that dV/Vt is a good indicator of bronchial obstruction, as useful in school-age children as in adults and infants, with no need for the subject's cooperation.