Am. J. Respir. Crit. Care Med., Volume 159, Number 1, January 1999, 107-111

Sniff Nasal Inspiratory Pressure
Reference Values in Caucasian Children

DANIELA STEFANUT TI and JEAN-WILLIAM FIT TING

Division de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Like in adults, normal values of maximal inspiratory pressure (PI_max) and maximal expiratory pressure (PE_max) span a large range in children, making interpretation of low values difficult. Recently, sniff nasal inspiratory pressure (Pn_sn) was developed as a new noninvasive test of inspiratory muscle strength. In healthy adults, Pn_sn is most often higher than PI_max. The aim of this study was to establish reference values of Pn_sn in children and to compare them with PI_max. A group of 180 unselected healthy children age 6 to 17 yr was studied in a school setting. All had a forced vital capacity (FVC) > 80% of predicted and a ratio of forced expiratory volume in one second/forced vital capacity (FEV₁/ FVC) > 85% of predicted. All maneuvers were performed in the sitting position. The Pn_sn was measured using a catheter occluding one nostril during maximal sniffs performed through the contralateral nostril from FRC. The PI_max was measured from FRC and residual volume, and PE_max from FRC and total lung capacity. All children were able to perform the Pn_sn maneuver easily. Pn_sn was 104 ± 26 cm H₂O in boys and 93 ± 23 cm H₂O in girls (p < 0.005). These values were similar to those previously measured in healthy adults. Pn_sn correlated with age, weight, and height in boys, but not in girls. In both sexes, Pn_sn was higher than PI_max measured at the same lung volume (FRC) (p < 0.0001). Pn_sn was  PI_maxFRC in 73 of 93 boys and 79 of 87 girls. We conclude that Pn_sn can be easily used to assess inspiratory muscle strength in children age 6 yr or more, providing values higher than PI_max. Normal values are independent of age in girls, and can be predicted from age by a first-degree equation in boys. Being easy and noninvasive, Pn_sn may prove useful to assess inspiratory muscle strength in children with neuromuscular disorders.

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