With the advent of ventilatory care for newborn in India, the practicing pediatrician is likely to see the "intensive care nursery survivors" who are likely to manifest an abnormal pulmonary outcome during infancy. These include: sudden death, bronchopulmonary dysplasia (with chronic lung disease and even core pulmonale), reactive airway disease, an increased propensity for respiratory infections and anatomical complications as subglottic stenosis, tracheobronchomalacia or palatal grooves. These not only have effects on respiratory compromise but also impact on feeding, growth and development.

Child↗

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Pulmonary function tests.

Spirometry is indicated in all the children with clinical diagnosis of asthma, chronic/recurrent cough or wheeze, exercise induced cough or breathlessness and with recurrent respiratory manifestations. Mid expiratory How 25-75% (MEF 25-75) is an important diagnostic parameters in children due to its effort independence, high sensitivity in bronchodilator reversibility test and also because it represents smaller airways and is likely to be affected in mildest obstruction. The base line spirometry, bronchodilator reversibility and histamine challenge are diagnostic of hyper reactive airway with 98% sensitivity. Flow volume loops hardly add to the diagnosis and also need more co-operation from the subject. Therefore it is not useful in children. PEFR monitoring constitutes an important part of the followup care of asthma patients.

Adolescent↗