P.J.F.M. Merkus*, U.
*Dept of Paediatrics, Division of Respiratory Medicine, Children’s Hospital, Radboud University Nijmegen
Medical Centre, The Netherlands, and
Division of Paediatric Respiratory Medicine, Dept of Paediatrics,
University Hospital of Bern, Inselspital, Bern, Switzerland.
Correspondence: P.J.F.M. Merkus, Dept of Paediatrics, Division of Respiratory Medicine, Room 4.164,
Route 842 Post 833, Children’s Hospital, Radboud University Medical Centre, P.O. Box 9101, 6500 HB
Nijmegen, The Netherlands. E-mail:
Paediatric lung function testing is an expanding field. Traditionally, tests developed
for adults were adapted for use in primary schoolchildren; nowadays, we consider it
relatively normal that efforts are made to assess lung function in sedated or unsedated
(premature) infants, in toddlers who do not cooperate actively, and preschool children
who may perform active manoeuvres when rewarded with the right incentive.
The technical developments of the last decades are the major reason why it has been
possible to improve equipment, enhance data sampling and refine data analyses. Especially
in the children with the lowest ‘‘respiratory signals’’, it was crucial to reduce factors such as
technical noise and equipment deadspace as much as possible. Although infant lung
function testing is usually not a realistic option for diagnostic purposes in clinical care,
further understanding of lung growth in health and disease, and of the relationships between
structure and function, has been partly the result of studies in this field. This was and is
especially the case when observations from infant lung function testing are combined with
those of additional studies of structure (imaging, histology), inflammation and therapeutic
interventions in young children, or from animal experiments.
The main progress in clinical research of functioning of the paediatric lung has been
made through global collaboration of a large number of researchers and clinicians, many
of whom also contributed to this European Respiratory Monograph (ERM). Most of them
were somehow related to or members of the scientific group Paediatric Respiratory
Physiology (group 7.01) within the European Respiratory Society. They worked in teams,
who have been creative, and were willing to spend a lot of time and effort upon details of
the procedures and equipment, to improve their sensitivity and validity, and to reduce
variability of these techniques between and within centres. Furthermore, much work has
also been done in international standardisation and development of reliable reference
ranges in healthy controls. More recently, studies and mathematical techniques have been
employed to study biological variance in health and disease. This is a new way of looking
at respiratory physiology as a complex and dynamic system that has an intrinsic tendency
to vary, where the ability to alter rhythm and dimensions can be regarded as a way to
adapt adequately to changes in the environment or as a manner to meet the changes in
metabolic needs of the body in health and disease.
We think this ERM is a unique collection of reviews on paediatric lung function
testing, providing an overview and update of a very active field within paediatric
pulmonology. In general, the chapters have been limited in size because of the
constraints of this ERM issue. If, however, you want to ask the authors for more
background information, you are welcome to do so, and for that you can use the address
information listed in each chapter of this volume. Additionally, if you have suggestions
for future improvement of the ERM, on paediatric pulmonology in particular, please
feel free to contact the editors. We hope this issue will contribute to enhanced knowledge
and better treatment of children with respiratory disorders.
Eur Respir Mon, 2010, 47, ix. Printed in UK - all rights reserved. Copyright ERS Journals Ltd 2010; European Respiratory Monograph;
ISSN 1025-448x.
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