Bronchodilator responsiveness using spirometry in healthy and asthmatic preschool children
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Published on: February 9, 2022
Luis Miguel Borrego1, Janet Stocks, Isabel Almeida
1Departamento de Imunologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 123, Lisboa 1150-227, Portugal. borregolm@gmail.com
Insights
Spirometry is repeatable and reproducible in preschool children with asthma. Bronchodilator responsiveness (BDR) can be reliably assessed using FEV(0.75) in wheezy preschoolers.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
- Clinical Trials
Background:
- Spirometry is crucial for diagnosing and monitoring respiratory conditions in children.
- Assessing lung function and bronchodilator responsiveness (BDR) in preschool children presents unique challenges due to variability.
- Reliable spirometry measurements are essential for accurate asthma diagnosis and management in young children.
Purpose of the Study:
- To evaluate the repeatability and reproducibility of spirometry measurements in healthy and asthmatic preschool children aged 3-6 years.
- To determine the reliability of assessing bronchodilator responsiveness (BDR) in this age group.
- To establish reference values for spirometry and BDR in preschool children.
Main Methods:
- Spirometry was conducted before and after administering placebo or salbutamol.
- Measurements were repeated on two separate occasions, 3-23 days apart, to assess reproducibility.
- Forced expired volume in 0.75 s (FEV(0.75)) and forced mid-expiratory flows (FEF(25-75)) were the primary outcome measures.
Main Results:
- Successful spirometry was achieved in 86% of participants.
- Asthmatic children showed significantly lower baseline FEV(0.75) compared to healthy controls.
- Bronchodilator responsiveness (FEV(0.75) increase) was significantly greater in asthmatic children post-salbutamol.
- Between-occasion variability was higher in asthmatic children than in controls.
Conclusions:
- Spirometry measurements, including bronchodilator responsiveness (BDR), can be reliably assessed in preschool children with asthma using FEV(0.75).
- Consideration of within-subject variability and normal responsiveness in healthy children is important for accurate BDR assessment.
- FEV(0.75) is a suitable parameter for evaluating BDR in wheezy preschoolers.
Objective:
To assess repeatability and reproducibility of spirometry measurements, and bronchodilator responsiveness (BDR), in healthy 3-6-year-old preschool children and those with asthma.
Design:
Spirometry was performed before and 20 minutes after administering either inhaled placebo (for repeatability) or 400 μg salbutamol (for BDR) on two separate occasions (reproducibility) 3-23 days apart in asthmatic preschoolers and healthy controls.
Settings:
Lung Function Laboratory, Hospital de Dona Estefania, Lisbon.
Participants:
Healthy preschool children and those with physician-diagnosed asthma, recruited from local Health Clinics and Outpatient Clinic.
Main Outcome Measures:
Paired measurements of forced expired volume in 0.75 s (FEV(0.75)) and forced mid-expiratory flows (FEF(25-75)).
Results:
Technically successful baseline results were obtained in 86% of children assessed. Paired data were obtained in 43 asthmatic and 22 controls (median (range) age: 5.1 (3.4-6.8) years). Baseline FEV(0.75) was significantly lower in asthmatic children (mean (SD): 90 (15)% predicted) than in controls (102 (13) % predicted; p<0.001). Within-occasion coefficient of repeatability following placebo was similar in both groups, being 10.4% in asthma and 13.2% in controls for FEV(0.75). Following bronchodilator, FEV(0.75) increased significantly more in asthmatic preschoolers (mean (SD): 15.0 (12) %) than in controls (4.5 (5) %; p<0.001), with no significant difference between groups post-bronchodilator. Between-occasion variability was similar to within-day repeatability in controls, but almost twice as high in asthmatic children.
Conclusions:
BDR can be assessed reliably using FEV(0.75) in wheezy preschoolers, provided within-subject variability and responsiveness in health are taken into consideration.
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