Diagnostic de l'asthme chez l'enfant par la réversibilité de l'obstruction bronchique

Abstract : Shorter lung function testing methods are needed in young asthmatic children, requiring minimal cooperation, performed in spontaneous breathing, without anaesthesia. Such methods are measurement of respiratory impedance by forced oscillations technique, measurement of specific airway resistance by plethysmography or capnography, measurement of CO2 concentration in expired air. The main objective of this work was to improve pediatric asthma diagnosis by using clinical and experimental studies. A study including asthmatic and control children showed that the specificity of resistance was improved in expiration compared to inspiration due to the fact that the glottis closure during expiration was proportional to the degree of airway obstruction. Another clinical study demonstrated that asthma diagnosis was improved by computation of respiratory admittance response to a bronchodilator because this computation is not affected by upper airways artifact. A study showed that specific airway resistance measured during spontaneous breathing was overestimated compared to panting metthod. Capnography is a non invasive technique. The shape of the expired CO2 time course is altered by the non homogenous distribution of ventilation resulting from bronchoconstriction. But its clinical usefulness in young children may be limited by the relatively high respiratory rate. An experimental study was conducted in rabbits to validate capnogram shape indices at different rates of breathing during airway constriction by methacholine. The indices have detected the acute airway obstruction even at high frequencies, frequencies usually presented by infants during an acute bronchoconstriction
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Iulia-Cristina Balan Ioan. Diagnostic de l'asthme chez l'enfant par la réversibilité de l'obstruction bronchique. Médecine humaine et pathologie. Université de Lorraine, 2014. Français. ⟨NNT : 2014LORR0132⟩. ⟨tel-01750978⟩

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