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Bronchodilator responsiveness in wheezy infants and toddlers is not associated with asthma risk factors
Jason Debley1, Sanja Stanojevic, Amy G Filbrun
1Seattle Children's Hospital, University of Washington, Seattle, Washington, USA. jason.debley@seattlechildrens.org
Insights
Bronchodilator responsiveness (BDR) was present in about a quarter of young children with recurrent wheezing. However, this BDR was not linked to common asthma risk factors in infants and toddlers.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Limited data exist on bronchodilator responsiveness (BDR) in infants and toddlers with recurrent wheezing.
- Identifying factors associated with BDR in this age group is crucial for diagnosis and management.
Purpose of the Study:
- To assess the prevalence of BDR in infants and toddlers (≤36 months) experiencing recurrent wheezing.
- To identify clinical factors associated with BDR in this pediatric population.
Main Methods:
- A multicenter study measured forced expiratory flows before and after albuterol administration in 76 infants/toddlers with recurrent wheezing.
- Data on hospitalization, corticosteroid use, eczema treatment, environmental tobacco smoke, and family history were collected.
Main Results:
- 24% of the children exhibited BDR, defined by established normal limits for healthy infants.
- BDR was not associated with any clinical factors, including asthma risk factors, other than body size.
Conclusions:
- Approximately one-quarter of infants and toddlers with recurrent wheezing showed BDR at baseline.
- BDR in this wheezy pediatric group was not linked to known clinical asthma risk factors.
Background:
There are limited data assessing bronchodilator responsiveness (BDR) in infants and toddlers with recurrent wheezing, and factors associated with a positive response.
Objectives:
In a multicenter study of children ≤ 36 months old, we assessed the prevalence of and factors associated with BDR among infants/toddlers with recurrent episodes of wheezing.
Methods:
Forced expiratory flows and volumes using the raised-volume rapid thoracic compression method were measured in 76 infants/toddlers [mean (SD) age 16.8 (7.6) months] with recurrent wheezing before and after administration of albuterol. Prior history of hospitalization or emergency department treatment for wheezing, use of inhaled or systemic corticosteroids, physician treatment of eczema, environmental tobacco smoke exposure, and family history of asthma or allergic rhinitis were ascertained.
Results:
Using the published upper limit of normal for post bronchodilator change (FEV(0.5) ≥ 13% and/or FEF(25-75) ≥ 24%) in healthy infants, 24% (n = 18) of children in our study exhibited BDR. The BDR response was not associated with any clinical factor other than body size. Dichotomizing subjects into responders (defined by published limits of normal) or by quartile to identify children with the greatest change from baseline (4th quartile vs. other) did not identify any other factor associated with BDR.
Conclusions:
Approximately one quarter of infants/toddlers with recurrent wheezing exhibited BDR at their clinical baseline. However, BDR in wheezy infants/toddlers was not associated with established clinical asthma risk factors.
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