• Paul D Robinson, Philipp Latzin, Kathryn A Ramsey, Sanja Stanojevic, Paul Aurora, Stephanie D Davis, Monika Gappa, Graham L Hall, Alex Horsley, Renee Jensen, Sooky Lum, Carlos Milla, Kim G Nielsen, Jessica E Pittman, Margaret Rosenfeld, Florian Singer, Padmaja Subbarao, Per M Gustafsson, Felix Ratjen, and ATS Assembly on Pediatrics.
• Am. J. Respir. Crit. Care Med. 2018 Mar 1; 197 (5): e1-e19.

BackgroundObstructive airway disease is nonuniformly distributed throughout the bronchial tree, although the extent to which this occurs can vary among conditions. The multiple-breath washout (MBW) test offers important insights into pediatric lung disease, not available through spirometry or resistance measurements. The European Respiratory Society/American Thoracic Society inert gas washout consensus statement led to the emergence of validated commercial equipment for the age group 6 years and above; specific recommendations for preschool children were beyond the scope of the document. Subsequently, the focus has shifted to MBW applications within preschool subjects (aged 2-6 yr), where a "window of opportunity" exists for early diagnosis of obstructive lung disease and intervention.MethodsThis preschool-specific technical standards document was developed by an international group of experts, with expertise in both custom-built and commercial MBW equipment. A comprehensive review of published evidence was performed.ResultsRecommendations were devised across areas that place specific age-related demands on MBW systems. Citing evidence where available in the literature, recommendations are made regarding procedures that should be used to achieve robust MBW results in the preschool age range. The present work also highlights the important unanswered questions that need to be addressed in future work.ConclusionsConsensus recommendations are outlined to direct interested groups of manufacturers, researchers, and clinicians in preschool device design, test performance, and data analysis for the MBW technique.

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