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Methacholine challenge testing is superior to the exercise challenge for detecting asthma in children
Magdalena Zaczeniuk1, Katarzyna Woicka-Kolejwa1, Wlodzimierz Stelmach2
1Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland.
Insights
Methacholine challenge testing (MCCT) is more effective than exercise treadmill challenge (ETC) for diagnosing asthma in children with exercise-induced symptoms. MCCT confirmed asthma in 24.3% more children, highlighting its value in pediatric asthma diagnosis.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Diagnostic Medicine
Background:
- Exercise-induced bronchoconstriction (EIB) is common in children with asthma.
- Accurate diagnosis of asthma in children presenting with post-exercise symptoms is crucial.
Purpose of the Study:
- To compare the diagnostic accuracy of methacholine challenge testing (MCCT) and exercise treadmill challenge (ETC) in children with asthma and post-exercise symptoms.
- To evaluate the predictive value of both tests for identifying asthma in this pediatric population.
Main Methods:
- Prospective study involving 101 children aged 10-18 years with post-exercise symptoms.
- Children underwent both MCCT and ETC during their asthma diagnostic workup.
- Tests were administered on separate visits, with ETC first, followed by MCCT one week later.
Main Results:
- Asthma was confirmed in 43.6% of participants.
- MCCT demonstrated higher sensitivity (90.9%) and positive predictive value (80.0%) compared to ETC (77.3% sensitivity, 65.4% PPV).
- MCCT identified an additional 24.3% of children with asthma who had negative ETC results.
Conclusions:
- MCCT is a more sensitive and predictive tool than ETC for diagnosing asthma in children with exercise-induced symptoms.
- A significant number of children with asthma and EIB may have negative ETC results, underscoring the utility of MCCT.
- Delayed diagnosis or misdiagnosis due to reliance on ETC alone could lead to exclusion from physical education activities.
Background:
Exercise-induced bronchoconstriction occurs in a large proportion of children with asthma.
Objective:
To compare the predictive value of methacholine challenge testing (MCCT) and the exercise treadmill challenge (ETC) for detecting asthma in children with postexercise symptoms.
Methods:
This was a prospective study of children 10 to 18 years old with postexercise symptoms. During asthma diagnosis, they underwent MCCT and ETC. There were 2 study visits. All subjects underwent ECT at visit 1 and MCCT 1 week later at visit 2.
Results:
One hundred one children were included; 62.9% had a history of atopy, and asthma was confirmed in 43.6%. MCCT showed 90.9% sensitivity, 82.5% specificity, 80.0% positive predictive value, and 92.2% negative predictive value; the respective values for ECT were 77.3%, 68.4%, 65.4%, and 79.6%. Positive MCCT results showed significantly higher sensitivity and higher positive predicative value in the diagnosis of asthma in children with postexercise symptoms compared with a 10% decrease in forced expiratory volume in 1 second for ECT (P = 0.034). Conducting MCCT during asthma diagnosis confirmed asthma in an additional 24.3% of children with exercise-induced symptoms. With a cutoff level at 17% of forced expiratory volume in 1 second for ECT, the discrepancy was decreased and reasonable values for sensitivity, specificity, positive predictive value, and negative predictive value were attained (61.0%, 77.1%, 69.4%, and 69.8%, respectively).
Conclusion:
A large number of school children with asthma and postexercise symptoms could have positive MCCT and negative ECT findings. Untreated asthma in children with exercise-induced bronchoconstriction could cause them to be discharged from physical education classes.
Trial Registration:
www.ClinicalTrials.gov, identifier NCT01798823.
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