Improved detection of abnormal respiratory function using forced expiration from raised lung volume in infants with cystic fibrosis

The raised volume rapid thoracic compression (RVRTC) technique is a recently developed method of measuring lung function in infants. The measurements of forced expiratory volume-time (FEVt) parameters from raised lung volumes have been shown to be less variable than maximal flow at functional residual capacity (VmaxFRC), obtained from the conventional rapid thoracic compression (RTC) technique. Measurements of VmaxFRC are highly variable, and may not be sensitive enough to detect a difference between normal infants and infants with cystic fibrosis (CF). The aim of this study was to determine whether the raised volume rapid thoracic compression technique could detect abnormal lung function in a group of CF infants with no current respiratory symptoms. Twelve CF infants were studied (median age 10.5 months, range 3-18 months), and compared to normative data collected previously on 26 healthy infants (median age 14 months, range 3-23 months). We found that VmaxFRC failed to detect any difference between the two groups. CF infants had significantly smaller FEV0.5 and FEV0.75 measurements at a lung volume set by 17.5 cmH2O predetermined inflation pressure (PP) both as raw values and when expressed as percentage predicted. We conclude that the raised volume rapid thoracic compression technique is a sensitive tool, able to detect abnormal lung function in infants with cystic fibrosis. This abnormality was not demonstrated by measurements derived from the conventional rapid thoracic compression technique in the tidal volume range.

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