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Diagnostic accuracy of bronchodilator responsiveness in wheezy children

I Dundas1, E Y Chan, P D Bridge

  • 1Department of Paediatric Respiratory Medicine, The Royal London Hospital, Barts and The London NHS Trust, London E1 1BB, UK. I.Dundas@qmul.ac.uk

Thorax
|December 25, 2004
PubMed

Insights

Bronchodilator responsiveness testing accurately diagnoses asthma in children. A 9% increase in predicted forced expiratory volume in 1 second (FEV1) effectively identifies wheezing, but its predictive value depends on wheeze prevalence.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Diagnostic Accuracy Studies

Background:

  • Asthma diagnosis in children aged 5-10 years requires accurate assessment.
  • Bronchodilator responsiveness is a key diagnostic indicator for asthma.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of bronchodilator responsiveness for asthma in children aged 5-10 years.
  • To determine the optimal threshold for bronchodilator response in pediatric asthma diagnosis.

Main Methods:

  • 142 children (58 with wheeze) underwent spirometry before and after inhaled salbutamol (400 µg).
  • Receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance.

Main Results:

  • A 9% increase in predicted forced expiratory volume in 1 second (FEV1) was identified as the optimal cutoff.
  • This threshold demonstrated 50% sensitivity and 86% specificity for detecting previous wheeze.
  • The positive likelihood ratio for wheeze was 3.6 (95% CI 2.0 to 6.3).

Conclusions:

  • The positive predictive value of a 9% FEV1 change varies significantly with wheeze prevalence (29% in community, 78% in clinic).
  • Bronchodilator responsiveness testing's utility is contingent upon the pretest probability of wheeze in the target population.
Abstract

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