Volumetric capnography <i>versus</i> spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma

Almeida-Junior, Armando; Marson, Fernando Augusto Lima; Almeida, Celize Cruz Bresciani; Ribeiro, Maria Ângela Gonçalves Oliveira; Paschoal, Ilma Aparecida; Moreira, Marcos Mello; Ribeiro, José Dirceu

doi:10.1016/j.jped.2018.10.008

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Original articles • J. Pediatr. (Rio J.) 96 (2) • Mar-Apr 2020 • https://doi.org/10.1016/j.jped.2018.10.008 copy

Volumetric capnography versus spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma^☆ ☆ Please cite this article as: Almeida-Junior A, Marson FA, Almeida CC, Ribeiro MÂ, Paschoal IA, Moreira MM, et al. Volumetric capnography versus spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma. J Pediatr (Rio J). 2020;96:255-63. , ^☆☆ ☆☆ The study was performed at the Laboratório de Fisiologia Pulmonar (Lafip), Centro de Investigação em Pediatria (Ciped), Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To compare the values of the markers for volumetric capnography and spirometry and their ability to classify children and adolescents with asthma, cystic fibrosis (CF), and healthy controls.

Methods:

This was a cross-sectional study that included 103 patients with controlled persistent allergic asthma, 53 with CF and a healthy control group with 40 volunteers (aged 6 to 15 years), of both sexes. The individuals underwent volumetric capnography and spirometry.

Results:

Phase III slope (SIII), SIII standardized by exhaled tidal volume (SIII/TV) and capnographic index (SIII/SII) × 100 (KPIv) were different among the three groups assessed, with highest values for CF. The relation between the forced expiratory volume in one second and the forced vital capacity (FEV₁/FVC) was the only spirometric marker that presented difference on the three groups. On individuals with normal spirometry, KPIv and FEV₁/FVC were different among the three groups. The ROC curve identified the individuals with asthma or CF from the control group, both through volumetric capnography (better to identify CF in relation to the control using KPIv) and through spirometry (better to identify asthma in relation to the control). KPIv was the best parameter to distinguish asthma from CF, even in individuals with normal spirometry.

Conclusion:

Volumetric capnography and spirometry identified different alterations in lung function on asthma, CF, and healthy controls, allowing the three groups to be distinguished.

KEYWORDS
Asthma; Cystic fibrosis; Pulmonary function; Spirometry; Volumetric capnography

Markers	HCG (n = 40)	AAG (n = 103)	CFG (n = 53)	HCG versus AAG (p-value)	HCG versus CFG (p-value)	AAG versus CFG (p-value)
Age (years)	10.51 (6.52 to 15.01)	10.91 (6.21 to 15.56)	10.29 (6.02 to 15.79)	0.167	0.647	0.071
Weight (kg)	39.55 (18.60 to 89.30)	36.5 (15.80 to 65.50)	28.60 (16.90 to 62)	0.096	0.001	0.001
Height (cm)	147 (110 to 168.40)	143.50 (110 to 175)	135 (108 to 181)	0.613	0.021	0.007
SII (mmHg/L)	461.59 (255.60 to 857.30)	506.60 (267 to 1051.10)	467.15 (236.60 to 1179.30)	0.101	0.798	0.23
SIII (mmHg/L)	12.31 (4.50 to 27.70)	17.55 (5.60 to 51.90)	27.86 (6.50 to 69.80)	<0.001	<0.001	<0.001
SII/TV	1.17 (0.35 to 3.42)	1.44 (0.21 to 4.82)	1.41 (0.32 to 5.44)	0.043	0.203	0.688
SIII/TV	0.03 (0.004 to 0.12)	0.05 (0.004 to 0.25)	0.08 (0.012 to 0.37)	<0.001	<0.001	0.001
KPIv	2.53 (1.25 to 4.09)	3.41 (1.79 to 10.78)	4.96 (1.63 to 16.94)	<0.001	<0.001	<0.001
FEV₁ (predicted %)	101.27 (74.64 to 126.70)	81.71 (26.32 to 121.90)	82.01 (35.42 to 113.56)	<0.001	<0.001	0.741
FEV₁ (Z-score)	0.11 (-2.12 to 2.34)	-1.57 (-5.79 to 1.77)	-1.47 (-5.27 to 1.14)	<0.001	<0.001	0.789
FVC (predicted %)	97.15 (82.48 to 118.77)	90.42 (51.63 to 148.01)	86.40 (53.05 to 116.77)	0.001	<0.001	0.051
FVC (Z-score)	-0.24 (-1.51 to 1.56)	-0.82 (-4.27 to 3.82)	-1.17 (-4.16 to 1.33)	0.001	<0.001	0.062
FEV₁/FVC (predicted %)	104.19 (89.26 to 112.26)	90.43 (50.52 to 112.63)	95.79 (67.06 to 109.03)	<0.001	<0.001	0.011
FEV₁/FVC (Z-score)	0.75 (-1.49 to 2.48)	-1.31 (-4.44 to 2.12)	-0.60 (-3.55 to 1.46)	<0.001	<0.001	0.013
FEF_25-75% (predicted %)	107.59 (35.48 to 142.48)	62.79 (8.75 to 137.55)	67.79 (12.23 to 129.85)	<0.001	<0.001	0.294
FEF_25-75% (Z-score)	0.34 (-3.31 to 1.85)	-1.79 (-6.28 to 1.59)	-1.60 (-5.83 to 1.24)	<0.001	<0.001	0.203
Individuals with normal spirometry values
Markers	HCG (n = 39)	AAG (n = 57)	CFG (n = 28)	HCG versus AAG (p-value)	HCG versus CFG (p-value)	AAG versus CFG (p-value)
SIII (mmHg/L)	12.31 (4.53 to 27.73)	16.88 (6.78 to 37.85)	21.77 (6.46 to 56.82)	<0.001	<0.001	0.065
SIII/TV	0.03 (0.004 to 0.13)	0.05 (0.01 to 0.18)	0.08 (0.01 to 0.32)	<0.001	0.001	0.350
KPIv	2.55 (1.25 to 4.09)	3.14 (1.79 to 10.78)	4.47 (1.63 to 14.33)	0.002	<0.001	0.003
FEV₁ (predicted %)	101.41 (84.27 to 126.70)	90.93 (80.23 to 121.90)	92.78 (80.65 to 113.56)	<0.001	0.003	0.779
FEV₁ (Z-score)	0.13 (-1.30 to 2.34)	-0.75 (-1.67 to 1.77)	-0.61 (-1.67 to 1.14)	<0.001	0.003	0.793
FVC (predicted %)	97.25 (82.48 to 118.77)	95.79 (80.14 to 148.01)	92.15 (81.70 to 112.46)	0.389	0.069	0.266
FVC (Z-score)	-0.23 (-1.51 to 1.56)	-0.37 (-1.65 to 3.82)	-0.67 (-1.57 to 1)	0.389	0.071	0.282
FEV₁/FVC (predicted %)	104.31 (90.67 to 112.26)	95.23 (80.58 to 112.63)	99.67 (90.30 to 109.03)	<0.001	0.005	0.006
FEV₁/FVC (Z-score)	0.77 (-1.27 to 2.48)	-0.69 (-2.32 to 2.12)	-0.06 (-1.37 to 1.46)	<0.001	0.005	0.007
FEF_25-75% (predicted %)	108.20 (63.49 to 142.48)	82.61 (63.28 to 135.56)	90.56 (72.94 to 129.85)	<0.001	0.221	0.081
FEF_25-75% (Z-score)	0.35 (-1.64 to 1.85)	-0.78 (-1.64 to 1.59)	-0.42 (-1.19 to 1.24)	<0.001	0.204	0.069
Area under the curve for volumetric capnography and spirometry between control group (HCG; n = 40), group of patients with asthma (AAG; n = 103) and group of patients with cystic fibrosis (CFG; n = 53)
Markers	HCG versus CFG	HCG versus CFG	AAG versus CFG	HCG versus AAG (p-value)	HCG versus CFG (p-value)	AAG versus CFG (p-value)
SIII (mmHg/L)	0.782^a a A smaller result indicates a positive test.	0.899^a a A smaller result indicates a positive test.	0.722^a a A smaller result indicates a positive test.	<0.001	<0.001	<0.001
SIII/TV	0.732^a a A smaller result indicates a positive test.	0.831^a a A smaller result indicates a positive test.	0.660^a a A smaller result indicates a positive test.	<0.001	<0.001	0.001
KPIv	0.737^a a A smaller result indicates a positive test.	0.927^a a A smaller result indicates a positive test.	0.763^a a A smaller result indicates a positive test.	<0.001	<0.001	<0.001
FEV₁ (predicted %)	0.836^b b A higher result indicates a positive test.	0.836^b b A higher result indicates a positive test.	0.516^b b A higher result indicates a positive test.	<0.001	<0.001	0.741
FEV₁ (Z-score)	0.839^b b A higher result indicates a positive test.	0.838^b b A higher result indicates a positive test.	0.513^b b A higher result indicates a positive test.	<0.001	<0.001	0.789
FVC (predicted %)	0.685^b b A higher result indicates a positive test.	0.756^b b A higher result indicates a positive test.	0.596^b b A higher result indicates a positive test.	0.001	<0.001	0.051
FVC (Z-score)	0.686^b b A higher result indicates a positive test.	0.754^b b A higher result indicates a positive test.	0.591^b b A higher result indicates a positive test.	0.001	<0.001	0.062
FEV₁/FVC (predicted %)	0.863^b b A higher result indicates a positive test.	0.799^b b A higher result indicates a positive test.	0.624^a a A smaller result indicates a positive test.	<0.001	<0.001	0.011
FEV₁/FVC (Z-score)	0.864^b b A higher result indicates a positive test.	0.800^b b A higher result indicates a positive test.	0.622^a a A smaller result indicates a positive test.	<0.001	<0.001	0.013
FEF_25-75% (predicted %)	0.839^b b A higher result indicates a positive test.	0.778^b b A higher result indicates a positive test.	0.551^a a A smaller result indicates a positive test.	<0.001	<0.001	0.294
FEF_25-75% (Z-score)	0.843^b b A higher result indicates a positive test.	0.780^b b A higher result indicates a positive test.	0.562^a a A smaller result indicates a positive test.	<0.001	<0.001	0.203
Patients with normal spirometry. HCG (n = 39), AAG (n = 57) and CFG (n = 28)
Markers	HCG versus CFG	HCG versus CFG	AAG versus CFG	HCG versus AAG (p-value)	HCG versus CFG (p-value)	AAG versus CFG (p-value)
SIII (mmHg/L)	0.768^a a A smaller result indicates a positive test.	0.822^a a A smaller result indicates a positive test.	0.623^a a A smaller result indicates a positive test.	<0.001	<0.001	0.065
SIII/TV	0.730^a a A smaller result indicates a positive test.	0.742^a a A smaller result indicates a positive test.	0.563^a a A smaller result indicates a positive test.	<0.001	0.001	0.350
KPIv	0.686^a a A smaller result indicates a positive test.	0.866^a a A smaller result indicates a positive test.	0.702^a a A smaller result indicates a positive test.	0.002	<0.001	0.003
FEV₁ (predicted %)	0.726^b b A higher result indicates a positive test.	0.712^b b A higher result indicates a positive test.	0.519^b b A higher result indicates a positive test.	<0.001	0.003	0.779
FEV₁ (Z-score)	0.732^b b A higher result indicates a positive test.	0.717^b b A higher result indicates a positive test.	0.518^b b A higher result indicates a positive test.	<0.001	0.003	0.793
FVC (predicted %)	0.552^b b A higher result indicates a positive test.	0.631^b b A higher result indicates a positive test.	0.575^b b A higher result indicates a positive test.	0.389	0.069	0.266
FVC (Z-score)	0.552^b b A higher result indicates a positive test.	0.630^b b A higher result indicates a positive test.	0.572^b b A higher result indicates a positive test.	0.389	0.071	0.282
FEV₁/FVC (predicted %)	0.814^b b A higher result indicates a positive test.	0.702^b b A higher result indicates a positive test.	0.683^a a A smaller result indicates a positive test.	<0.001	0.005	0.006
FEV₁/FVC (Z-score)	0.815^b b A higher result indicates a positive test.	0.701^b b A higher result indicates a positive test.	0.681^a a A smaller result indicates a positive test.	<0.001	0.005	0.007
FEF_25a75% (predicted %)	0.740^b b A higher result indicates a positive test.	0.596^b b A higher result indicates a positive test.	0.634^a a A smaller result indicates a positive test.	<0.001	0.221	0.081
FEF_25a75% (Z-score)	0.745^b b A higher result indicates a positive test.	0.600^b b A higher result indicates a positive test.	0.640^a a A smaller result indicates a positive test.	<0.001	0.204	0.069

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[1] * Corresponding authors. E-mails:fernandolimamarson@hotmail.com (F.A. Marson), jdirceuribeiro@gmail.com (J.D. Ribeiro).