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Validation of a single concentration methacholine inhalation provocation test (SCIPT) in children
Wanda Hagmolen of ten Have1, N J van den Berg, J van der Palen
1Department of Pediatrics, Flevohospital, Almere, The Netherlands. whagmolen@flevoziekenhuis.nl
Insights
The single concentration methacholine inhalation provocation test (SCIPT) is a reproducible method for assessing bronchial hyperresponsiveness in children. It shows good agreement with standard dosimeter methods, making it reliable for pediatric asthma evaluation.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
Background:
- Bronchial hyperresponsiveness (BHR) assessment in children differs from adults due to airway geometry.
- Existing BHR tests validated in adults may not be directly applicable to pediatric populations.
Purpose of the Study:
- To validate the single concentration methacholine inhalation provocation test (SCIPT) for assessing BHR in children.
- To evaluate the reproducibility and agreement of the SCIPT with a standard dosimeter method (SDM) in pediatric subjects.
Main Methods:
- Twenty-two children underwent three methacholine inhalation challenge tests in random order.
- Two challenges utilized the SCIPT with doubling doses (0.03-1.8 mg) via an Aerosol Provocation System.
- One challenge employed the SDM with doubling doses (0.002-1.8 mg) using a DeVillbiss 646 nebulizer.
Main Results:
- High intraclass correlation (0.91) was found between SCIPT tests, indicating excellent reproducibility.
- Good agreement (intraclass correlation 0.80) was observed between the SCIPT and SDM.
- Bland and Altman analysis confirmed good agreement between the two challenge methods.
Conclusions:
- The single concentration inhalation provocation test is a reproducible method for evaluating bronchial responsiveness in children.
- The SCIPT demonstrates good agreement with standard dosimeter methods, supporting its use in pediatric BHR assessment.
Abstract:
A new method to assess bronchial hyperresponsiveness (BHR) using a single concentration methacholine has already been validated in adults with asthma. Because the geometrical dimensions of the airways in children are different, the results from studies in adults cannot be extrapolated to children. In this study, we validated the single concentration methacholine inhalation provocation test (SCIPT) in children. Twenty-two children performed three methacholine inhalation challenge tests in random order. Two challenges were performed according to the SCIPT: doubling doses (0.03-1.8 mg; maximal cumulated dose 3.6 mg) were administered with an Aerosol Provocation System (Masterscope, Jaeger). The third challenge was performed according to a standard dosimeter method (SDM): doubling doses (0.002-1.8 mg; maximal cumulative dose 3.5 mg) were administered with a DeVillbiss 646 nebulizer. The degree of BHR is expressed as a PD20. A difference of < 1.5 dose step was assumed to be due to intraindividual variation. We found an intraclass correlation of 0.91 between both tests according to the SCIPT and of 0.80 between the SCIPT and SDM. We found, according to the method of Bland and Altman, good agreement when comparing these two challenge tests. The single concentration inhalation provocation test is reproducible and shows good agreement with a standard dosimeter method to test bronchial responsiveness in children.
