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Published on: May 10, 2024
Adenosine bronchial provocation with computerized wheeze detection in young infants with prolonged cough: correlation
Lea Bentur1, Raphael Beck, Drora Berkowitz
1Pediatric Pulmonary Unit, Rambam Medical Center, PO Box 9602, Haifa, Israel 31096. l_bentur@rambam.health.gov.il
Insights
Computerized wheeze detection (CWD) offers earlier identification of bronchial hyperreactivity (BHR) in infants with chronic cough compared to traditional methods. Positive BPT results using CWD strongly correlated with later wheezing symptoms.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Diagnostic Technology
Background:
- Chronic cough in infants is often linked to bronchial hyperreactivity (BHR).
- Objective documentation of BHR in infants is challenging.
- Acoustic methods for bronchial provocation tests (BPTs) have been explored.
Purpose of the Study:
- To evaluate automatic computerized wheeze detection (CWD) for BHR assessment in infants.
- To correlate CWD findings with subsequent wheezing development.
Main Methods:
- Acoustic BPTs were performed on infants (<24 months) with prolonged cough.
- Responses were assessed by CWD and physician auscultation.
- Telephone follow-up was conducted for 3 years.
Main Results:
- 71.4% of infants showed BHR via positive acoustic BPT.
- CWD detected wheeze earlier than auscultation in most cases.
- Positive BPT results correlated with 3-year wheezing symptoms.
Conclusions:
- Acoustic BPT is a feasible method for detecting BHR in infants.
- CWD offers earlier wheeze detection than stethoscope auscultation.
- Positive acoustic BPTs predict future BHR-related symptoms.
Background:
Chronic cough in babies is often associated with bronchial hyperreactivity (BHR). The objective documentation of BHR in babies is difficult, and acoustic methods have been described (provocative concentration of a substance causing wheeze) for conducting bronchial provocation tests (BPTs). We conducted a study to evaluate automatic computerized wheeze detection (CWD) in determining BHR in young infants with prolonged cough, and its correlation with the subsequent development of wheezing.
Methods:
Infants aged < 24 months with prolonged cough (ie, > 2 months) underwent acoustic BPTs with the response determined by CWD and auscultation by a physician. Telephone interviews with parents were conducted after 1 month and yearly for the next 3 years.
Results:
A total of 28 infants who were 4 to 24 months old with prolonged cough were included in the study. Twenty of these infants (71.4%) had BHR as determined by a positive acoustic BPT result. In 11 of these 20 tests, the CWD occurred earlier, and in 9 tests it occurred at the same step as auscultation by a physician. Rhonchi or whistles often preceded wheezes. Seventeen of the 20 patients with BHR completed 3 years of follow-up. Of these, 14 had recurrent episodes of wheezing and shortness of breath, and 3 were well. Six of the eight adenosine-negative patients completed 3 years of follow-up and had no symptoms of BHR.
Conclusions:
Acoustic BPT is a technically feasible test for the detection of BHR in young infants. CWD provides an earlier detection of wheeze than stethoscope auscultation. In our group of infants, a positive acoustic BPT result had high correlation with symptoms compatible with BHR over the next 3 years.
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