The Application Of Combing Tidal Breathing Lung Function With Exhaled NO Level In The Standardized Treatment Of Children Asthma Aged 1 To 4 Years

Objective:The incidence rate of infant asthma has been a progressive increase year by year,but not all of these asthmatic patients are asthma.It is important to diagnosis infant asthma early from many asthmatic infant patients and give long-term standard treatment,though diagnosing infant asthma is difficult.Due to the children's incoordination,it could not diagnosis asthma with the commonly inspection equipment,which bothers pediatrician a lot.So it is pivotal to apply many special methods besides the clinical symptoms.In this study,the asthma detection tools including the tidal breathing lung function,tidal breathing and exhaled NO examination were used to observe the clinical efficacy of standardized diagnosis and treatment in 1 to 4 years asthma children with combing tidal breathing lung function and exhaled NO level detection,whether the children were coordinated or not.Methods This study included a series of 60 asthmatic children aged 1 to 4 years from asthma outpatients in the Affiliated Hospital of Yangzhou University between September 2015 and September 2017.Thirty patients with repeated wheezing more than four times per year and positive asthma prediction index(API)were included in API positive group,and 30 patients were included in API negative group.Thirty patients who had no cardiopulmonary diseases were included in the control group.The exhaled NO level and tidal breathing lung function detection,describing the tidal breathing flow volume(TBFV)curve were examined.The main indicators for the tidal breathing lung level function including time to peak ratio,volume to peak ratio(TPTEF/TE,VPEF/VE)and fractional exhaled nitric oxide(FeNO)were compared between these groups.Diastolic test was performed on all asthmatic children after the first pulmonary function examination,when the improvement of TPEF/TE and VPEF/VE were more than 15%as positive.At last we gave the standardized treatment in the asthma children with one year follow up.It was classified with uncontrolled,partial controlled,good controlled due to the controlling levels of asthma in children under 6 years,comparing the tidal lung functi on and the level of fractional exhaled nitric oxide.Results(1)The variances of TPEF/TE,VPEF/VE and FeNO were analyzed,which demonstrated significant difference(P<0.05)between API positive group,API negative group and controlled group.The variables of TPEF/TE and VPEF/VE were significantly lower in API positive and negative group compared it in controlled group.But the level of FeNO was higher in API positive group compared it in API negative group and controlled group(P<0.05).(2)The tidal breathing flow volume(TBFV)curve with obstructive ventilation function images reached up to 82%,obviously concaving to the X axis in API positive and negative group during the expiratory decreasing phase,as it was with normal ellipse(normal ventilation function images)up to 100%in controlled group.Additionally there were significant differences between these 3 groups(P<0.05).(3)The positive rate of bronchial diastolic test in API positive group was higher than it in API negative group(P<0.05).(4)In API positive group the FeNO level,the TPEF/TE and VPEF/VE had already reached up to 63%abnormally,which was higher than it in controlled group(0)and API negative group(6.7%)(P<0.05).(5)The ratio of TPTEF/TE,VPEF/VE for children with uncontrolled asthma was still lower than that for partial controlled and good controlled asthmatic children(P<0.05).Additionally it was also lower in partial controlled asthmatic children compared in good controlled asthmatic children(P<0.05).The tidal breathing flow-volume curve demonstrated the obstructive ventilation function disturbance,whose proportion was 90%with uncontrolled asthma children,and 67%with partly controlled asthma children,as well as 0 with good controlled asthma children.There had statistical difference between them(P<0.05)which elucidated that the ventilation function was significantly improved by the controlling of asthma.(6)The FeNO level of uncontrolled asthmatic children was significantly higher than that of partial and good controlled asthmatic children,while it was still significantly higher than that of good controlled asthmatic children(P<0.05).It demonstrated that the airway inflammation reduced graduallyConclusions The pediatric tidal breathing lung function testing method which were suitable for children aged 1 to 4 years was simple,without children's cooperation completely.Its index TPTEF/TE and VPEF/VE could better reflect children's airway obstruction especially the small airway function.Additionally the concentration of FeNO reflecting airway inflammation could be measured by offline test without the children's active cooperation.These indicators could be used for the diagnosis of asthma in children aged 1 to 4 years and evaluate the improvement of ventilation function.Therefore the combination of the two methods could be well applied in the standardized diagnosis and treatment of asthma children aged 1 to 4 years.