Lung Function Test Via Tidal Breathing Arid Exhaled Nitric Oxide Changes Of Infants With Bronchiolitis Obliterans And Bronchiolitis

Bronchiolitis obliterans and bronchiolitis are both respiratory disease,which bothhave the main pathological change of small airway obstruction,and the main clinicalmanifestation of wheezing,three depressions sign and ecphysesis.Lung function testvia tidal breathing and Fraction of Exhaled Nitric Oxide(FeNO) is safe,effective,noninvasive and simple to operate.And become a way to solve the problem of infantof poor compliance. It also can acess the lung fuction and the degree of airwayinflammation.Bronchiolitis obliterans(BO) is a rare,chronic obstructive pulmonary diseasecharacterized by airflow limitation and can happen in any ages.The etiology of BO ismore,such as transplantation,infection,drugs,immunodeficiency.BO in infants is oftencaused by infection,especially adenovirus infection. The main pathological change ofBO is bronchiole narrow in different degree,even obstruction.Lung function test viatidal breathing can reflect small airway obstruction,and have an important role inclinical diagnoise and judgement of pathogenetic condition of BO.FeNO is a majorindex that can reflect the degree of airway inflammation and airwayhyperresponsiveness.The higher level of FeNO,the more sensitive to glucocorticoidtreatment.Due to the rate of BO diagnoised,the research on the relationship betweenBO and indexes of lung function test via tidal breathing and FeNO is limited.It is ofgreat significance for the treatment, treatment and management of BO to clarify thechanges of lung function via tidal breathing and FeNO in BO.The rate of bronchiolitis in infants is high,especially in winter and spring in theNorth.Most patients’ clinical course is mild,but some may wheeze repeated and develop into typical asthma in the futrue,and the incidence rate were68%and30%.Atpresent,there is no definite objective index to distinguish whether bronchiolitisevolved into typical asthma early.The main cause of bronchiolitis is respiratorysyncytial virus infection.Bronchial wall damage and inflammatory cause the differentdegree of terminal bronchioles obsruction.Lung function via tidal breathing canreflect the degree of airway flow limitation,especially the ratio of time to peak tidalexpiratory flow and expiratory time(tPTEF/tE) and the ratio of time to peak tidalexpiratory volume and expiratory volume(VPEF/VE) can reflect the ventilationfunction of small airway.FeNO as an objective index to reflect the degree ofinflammation of airway and the airway hyperresponsiveness,is simple to operate andhave no age limit.Studies have shown that,the high levels of FeNO may be related tothe wheezing and asthma in the future.FeNO play a role in the assessment of theprognosis of bronchiolitis.The purpose of this study is to investigate the role of lungfunction test via tidal and FeNO in bronchiolitis,and to predict the evolution of asthmarisk in the general cases to necessary intervention.So can reduce pain and burden offamily and society.The purpose of this study is to invesigate the changes of lung function via tidalbreathing and FeNO in obliterative bronchitis and bronchiolitis and whether there aredifferences in lung function via tidal breathing and FeNO between bronchiolitis withor not with atopic by retrospective analysis,to further analysis of the value of lungfunction and FeNO in the assessment of the severity of the disease and prognosis.Objective:To investigate the changs of Tidal breathing lung function andExhaled Nitric Oxide in obliterative bronchitis and bronchiolitis,and whether there aredifferences in Tidal breathing lung function and Exhaled Nitric Oxide betweenbronchiolitis with or not with atopic.Methods:We select clinical diagnosed bronchiolitis obliterans(0～36months)and bronchiolitis(0～24months) outpatients and inpatients who were treated inPediatric Respiratory Department of our hospital during2012January to2015Marchas the research object.In total,we collected30cases of bronchiolitis obliterans,60cases of bronchiolitis,according to the presence of atopic or not,we divided the bronchiolitis patients into atopic and non-atopic groups,each group has30cases.Wecollected the basic information of the patients including age,the results of lung fuctiontest via tidal breathing and FeNO.The main parameter are:tidal volume per kilogram（Tidal Volume/kg， TV/kg）， the ratio of inspiratory time to expiratorytime(TI/TE),the ratio of time to peak tidal expiratory flow and expiratorytime(tPTEF/tE),the ratio of time to peak tidal expiratory volume and expiratoryvolume(VPEF/VE), peak tidal expiratory flow(PF) and FeNO.Analysis of the variousparameters for statistics,the measurement data showed as mean±standarddeviation,comparison between groups used variance analysis,there were significantdifferrences in P<0.05.Results:1.TI/TE [(0.59±0.09)%]、 tPTEF/tE[(16.43±8.79)%]and VPEF/VE[(20.09±6.58)%]were significantly decreased, PF [(168.30±60.42)ml/s]increased inbronchiolitis obliterans.2.The FeNO[(31.83+16.03) ppb] increased in bronchiolitis obliterans.3. Atopic group compared with non-atopic groups of bronchiolitis,the atopicgroup tPTEF/tE[(16.85±4.69)%]、 VPEF/VE[(21.49±3.45)%] and the non-atopicgroup tPTEF/tE[(18.49±4.27)%、 VPEF/VE[(23.28±3.11)%] have no significantdifference, the atopic group PF[(131.37±42.64）ml/s] and the non-atopic group PF[(109.43±19.67）ml/s] have no significant difference too.（P>0.05）4. Atopic group compared with non-atopic groups of bronchiolitis,the FeNO ofatopic group[（35.00±12.12） ppb]was higher than the non-atopicgroup[(12.4±6.68)ppb].（P<0.05）Conclusion：1.Bronchiolitis obliterans has obstructive ventilation dysfunction particular insmall airway.2.The FeNO of bronchiolitis obliterans rised.3. Bronchiolitis has obstructive ventilation dysfunction particular in smallairway.The degree of airway obstruction has no significant difference betweenbronchiolitis wirh atopic and without atopic. 4. Not all of the level of FeNO of bronchiolitis is high. Bronchiolitis wirh atopichave a higher levels of FeNO than infants without atopic.Indirect evidence that, FeNOmay become a index to predict wheezing and asthma in the future.