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Published on: April 13, 2010
Airway resistance and atopy in preschool children with wheeze and cough
S A McKenzie1, P D Bridge, M J Healy
1Queen Elizabeth Children's Service, Royal London Hospital, Whitechapel, UK.
Insights
Airway resistance measurements effectively distinguish preschool wheezers from healthy children and help classify persistent cough. This technique aids in monitoring respiratory symptoms and interventions in young children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Preschool wheeze and persistent cough are common respiratory issues in children.
- Accurate classification of these conditions is crucial for appropriate management and intervention.
- The interrupter technique for measuring airway resistance (Rint) has shown potential in assessing respiratory function.
Purpose of the Study:
- To evaluate the utility of airway resistance measurements using the interrupter technique (Rint) in differentiating preschool children with previous wheeze from asymptomatic controls.
- To assess the role of Rint in classifying children with persistent cough.
- To investigate the bronchodilator response (BDR) in these groups and its relation to atopy.
Main Methods:
- Airway resistance (Rint) was measured using the interrupter technique in 82 children with recurrent wheeze, 58 with isolated cough, and 48 asymptomatic controls (mean age 3.7 years).
- Measurements were taken before and after salbutamol administration to assess bronchodilator response (BDR).
- Statistical analyses compared Rint and BDR values across groups, and correlations with immunoglobulin E levels were examined.
Main Results:
- Median baseline Rint was significantly higher in wheezers compared to coughers and controls (p<0.0001).
- Coughers showed intermediate bronchodilator response (BDR) values, differing significantly from both wheezers and controls (p<0.01).
- A BDR ratio >1.22 demonstrated 80% specificity and 76% sensitivity for identifying wheeze; 28% of coughers met this criterion.
Conclusions:
- Airway resistance measurement by the interrupter technique is valuable for classifying preschool children with respiratory symptoms.
- The technique can aid in monitoring the effects of interventions for respiratory conditions.
- Coughers with a high BDR may represent a 'cough-variant' asthma phenotype, warranting further follow-up.
Abstract:
The extent to which the measurement of airways resistance by the interrupter technique (Rint) distinguishes preschool children with previous wheeze from those with no respiratory symptoms and helps to classify subjects with persistent cough, was investigated. Rint was measured before and after salbutamol treatment in 82 children with recurrent wheeze, 58 with isolated cough and 48 with no symptoms (control subjects). Their mean age (range) was 3.7 yrs (2-<5 yrs). Median baseline Rint was higher (p<0.0001) in wheezers than in either coughers or control subjects (1.16, 0.94 and 0.88 kPa x L(-1) x s(-1) respectively); coughers did not differ significantly from control subjects (p=0.14). The median ratios of baseline to post-salbutamol measurements (bronchodilator response (BDR)) in the groups differed significantly (1.40, 1.27 and 1.07, p< or =0.01 for all), suggesting that coughers occupy an intermediate position. A BDR ratio of >1.22 had a specificity and sensitivity for wheeze of 80% and 76% respectively. Twenty-eight coughers had a BDR ratio >1.22. Wheezers' immunoglobulin E was inversely related to baseline Rint. It is concluded that measurements of airway resistance by the interrupter technique are useful for classifying preschool children with respiratory symptoms and could be used to monitor the effect of interventions. The relation between atopy and airways resistance suggests that they have separate roles in preschool wheezing. Coughers with a high bronchodilator response could represent "cough-variant" asthma in children who have baseline airway resistance by the interrupter technique measurements similar to control subjects. Whether these children develop classical asthma will only be known at follow-up later in childhood.
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