Related Experiment Video
Updated: Mar 19, 2026
Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
Published on: February 9, 2022
The bronchodilator response in preschool children: A systematic review
Emma Raywood1, Sooky Lum1, Paul Aurora1,2
1Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom.
Insights
Bronchodilator response testing in preschool children lacks strong evidence. Spirometry is unreliable, and further research on alternative methods is needed for diagnosing wheezing in this age group.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Bronchodilator response (BDR) testing is commonly used for diagnosing and treating wheezing in children.
- Limited evidence exists for BDR's role in preschool children, with uncertainty regarding adult-derived cut-off values.
- Preschool children present unique challenges for respiratory assessments.
Purpose of the Study:
- To review the evidence for bronchodilator response testing in preschool children with wheezing.
- To evaluate the applicability of existing BDR cut-off values to this population.
- To identify optimal BDR techniques for preschool children.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, EMBASE, Web of Science, Cochrane).
- Studies included were those reporting BDR in healthy preschool children, placebo response, and diagnostic efficacy compared to clinical diagnosis.
- Data from 14 studies were analyzed, focusing on BDR measurements and technique success rates.
Main Results:
- Spirometry-based BDR showed limited clinical utility in preschool children with wheezing.
- Alternative techniques like interrupter resistance, oscillometry, and plethysmography were more consistently completed.
- Significant heterogeneity between studies prevented the determination of an optimal BDR technique.
Conclusions:
- Current evidence does not strongly support the use of spirometry-based BDR for assessing preschool children with wheezing.
- Further research is needed to evaluate simpler, alternative BDR techniques in this age group.
- Future studies should focus on children with suspected airway disease and assess BDR's predictive value for treatment response.
Background:
The bronchodilator response (BDR) is frequently used to support diagnostic and therapeutic decision-making for children who wheeze. However, there is little evidence-based guidance describing the role of BDR testing in preschool children and it is unclear whether published cut-off values, which are derived from adult data, can be applied to this population.
Methods:
We searched MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception-September 2015) for studies reporting response to a bronchodilator in healthy preschool children, response following placebo inhalation, and the diagnostic efficacy of BDR compared with a clinical diagnosis of asthma/recurrent wheezing.
Findings:
We included 14 studies. Thirteen studies provided BDR data from healthy preschool children. Two studies reported response to placebo in preschool children with asthma/recurrent wheezing. Twelve studies compared BDR measurements from preschool children with asthma/recurrent wheeze to those from healthy children and seven of these studies reported diagnostic efficacy. Significant differences between the BDR measured in healthy preschool children compared with that in children with asthma/recurrent wheeze were demonstrated in some, but not all studies. Techniques such as interrupter resistance, oscillometry, and plethysmography were more consistently successfully completed than spirometry. Between study heterogeneity precluded determination of an optimum technique.
Interpretation:
There is little evidence to suggest spirometry-based BDR can be used in the clinical assessment of preschool children who wheeze. Further evaluation of simple alternative techniques is required. Future studies should recruit children in whom airways disease is suspected and should evaluate the ability of BDR testing to predict treatment response. Pediatr Pulmonol. 2016;51:1242-1250. © 2016 Wiley Periodicals, Inc.
Related Concept Videos
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce...
01:23Inhaled Medications
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include: