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The relationship of the bronchodilator response phenotype to poor asthma control in children with normal spirometry

Stanley P Galant1, Tricia Morphew, Robert L Newcomb

  • 1Children's Hospital of Orange County(CHOC), Orange, CA, USA. spg1505@aol.com

The Journal of Pediatrics
|January 15, 2011
PubMed

Insights

A bronchodilator response (BDR) of 10% or higher is linked to poor asthma control in children. This finding offers an objective measure for assessing asthma control, especially in those not yet on medication and with normal spirometry.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Asthma Research

Background:

  • Poorly controlled asthma in children presents diagnostic challenges, particularly with normal baseline spirometry.
  • Identifying objective markers for asthma control is crucial for timely intervention.

Purpose of the Study:

  • To investigate the association between clinical indicators of poor asthma control and bronchodilator response (BDR) phenotypes in children.
  • To evaluate the utility of BDR as an objective measure in children with normal spirometry.

Main Methods:

  • Assessed clinical indices of poorly controlled asthma in children with asthma.
  • Performed pre- and post-bronchodilator spirometry to determine BDR percentage.
  • Utilized multivariate logistic regression to analyze relationships between clinical indices and BDR thresholds (≥ 8%, ≥ 10%, ≥ 12%).

Main Results:

  • In controller-naïve children, significant associations were found between poor asthma control indicators and BDR phenotypes ≥ 10% and ≥ 12%.
  • Factors linked to positive BDR included younger age, atopy, nocturnal symptoms (females), beta-agonist use, and exercise limitation.
  • These relationships were particularly evident in the controller-naïve population.

Conclusions:

  • A bronchodilator response (BDR) phenotype of ≥ 10% is significantly associated with poor asthma control.
  • This BDR phenotype serves as a potentially valuable objective tool for assessing asthma control in controller-naïve children, even with normal pre-bronchodilator spirometry.
Abstract

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