Breathing Easier
Dr. Jason Debley is developing simple, noninvasive tests to collect and analyze the biochemicals in the exhaled breath of young children to diagnose asthma more accurately.
Parents of a 2-year-old boy rush him to the emergency room after a walk in the park sparks an episode of uncontrollable coughing and wheezing. It’s a common scenario that leaves pediatric specialists guessing whether the young child’s symptoms are truly asthma or merely asthma-like. Currently, there is no objective, noninvasive, widely available test that confirms the suspicion of asthma for children under 3.
“We tend to take a wait-and-see approach,” says Dr. Jason Debley of Seattle Children’s. “If the symptoms appear serious enough, we prescribe medications. But without a definitive way of diagnosing asthma in infants and toddlers, we run the risk of overtreating children who don’t have asthma and undertreating some who do.”
Though specialized equipment to test the lung function of infants is available at a few medical centers around the country (including Seattle Children’s), it requires sedating the patient, making it impractical. So Debley, a pediatric pulmonologist, is developing simple, noninvasive tests that analyze the biochemicals in the exhaled breath of infants, toddlers and preschoolers. The tests are based on the link between elevated levels of certain biochemicals — particularly nitric oxide — and the degree of inflammation in a patient’s airways.
“Although not widely used, measurement of nitric oxide in exhaled breath is FDA-approved as a way to monitor airway inflammation in older children and adults with asthma,” explains Debley. “That’s a really exciting measure of airway inflammation that is potentially ideal for younger children.” It’s an underutilized but logical approach. By collecting and analyzing exhaled breath in patients admitted to Children’s for asthma, Debley and his team — including Kelly Worrell, RN, and laboratory technician Arpy Ohanian — are establishing specific “profiles” of airway inflammation that correspond to various levels of asthma activity. The profiles will then be used to guide diagnosis and treatment through simple breathing tests.
“If we can identify a profile of inflammation that is similar to older kids with asthma, we might have a simple diagnostic test that can be performed virtually anywhere, improve our ability to treat asthma earlier and identify who responds to asthma medicines and who does not,” says Debley. Part of this work includes perfecting a new technique to capture breath samples from children younger than 4 who are unable to use the equipment used by older children because it requires them to exhale on cue into mouthpieces attached to special tubes. Debley’s simple machine collects samples through a facemask that children can use while sitting in their parents’ laps — a technique that will eventually yield data that will help them breathe easier.
Learn more about the Pulmonary Clinic at Children's.