Tidal breathing flow measurement in awake young children by using impedance pneumography

Characteristics of tidal breathing (TB) relate to lung function and may be assessed even in young children. Thus far, the accuracy of impedance pneumography (IP) in recording TB flows in young children with or without bronchial obstruction has not been evaluated. The aim of this study was to evaluate the agreement between IP and direct flow measurement with pneumotachograph (PNT) in assessing TB flow and flow-derived indices relating to airway obstruction in young children. Tidal flow was recorded for 1 min simultaneously with IP and PNT during different phases of a bronchial challenge test with methacholine in 21 wheezy children aged 3 to 7 years. The agreement of IP with PNT was found to be excellent in direct flow signal comparison, the mean deviation from linearity ranging from 2.4 to 3.1% of tidal peak inspiratory flow. Methacholine-induced bronchoconstriction or consecutive bronchodilation induced only minor changes in the agreement. Between IP and PNT, the obstruction-related tidal flow indices were equally repeatable, and agreement was found to be high, with intraclass correlation coefficients for T-PTEF/T-E, V-PTEF/V-E, and parameter S being 0.94, 0.91, and 0.68, respectively. Methacholine-induced changes in tidal flow indices showed significant associations with changes in mechanical impedance of the respiratory system assessed by the oscillometric technique, with the highest correlation found in V-PTEF/V-E (r = -0.54; P < 0.005 and r = -0.55; P < 0.005 by using IP or PNT, respectively). The results indicate that IP can be considered as a valid method for recording tidal airflow profiles in young children with wheezing disorders.