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Assessing bronchodilator response in preschool children using spirometry
Luciano E Busi1,2, Sebastián Restuccia2, Ricardo Tourres2
1Pulmonology Committee of the Argentinean Pediatric Society, Trelew, Argentina.
Insights
Bronchodilator response (BDR) measurement using spirometry can help diagnose asthma in preschool children. An 11% increase in FEV0.75 suggests asthma, while a negative BDR makes asthma less likely.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Diagnosis
Background:
- Lung function testing, including bronchodilator response (BDR), is crucial for managing asthma in older children.
- While spirometry is feasible in preschool-aged children (3-5 years), its utility in diagnosing asthma via BDR remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of measuring bronchodilator response (BDR) using spirometry for diagnosing asthma in preschool-aged children.
- To determine optimal BDR thresholds for distinguishing between healthy children and those with asthma in this age group.
Main Methods:
- A study involving 431 healthy children and 289 children with asthma (aged 3-5 years) was conducted.
- Spirometry was performed twice, with participants randomized to placebo or salbutamol, to assess within-session repeatability and between-session reproducibility.
- Receiver operating characteristic curve analysis identified optimal BDR thresholds for spirometry outcomes.
Main Results:
- Children with asthma exhibited lower lung function (FEV0.75) and a greater BDR compared to healthy children.
- An 11% increase in FEV0.75 demonstrated the best balance of sensitivity (51%) and specificity (88%) for asthma diagnosis.
- A negative BDR was found to make an asthma diagnosis less likely.
Conclusions:
- Bronchodilator response measurement via spirometry can aid in asthma diagnosis for preschool-aged children.
- An 11% increase in FEV0.75 is a potential indicator for asthma in this population.
- The absence of a significant BDR may suggest an alternative diagnosis.
Background:
Measuring lung function, including bronchodilator response (BDR), is an integral part of asthma management in older children. While spirometry is possible in preschool-aged children, the question remains whether measuring BDR aids in asthma diagnosis in this age group.
Methods:
431 healthy children and 289 children with asthma, aged 3-5 years, were recruited from kindergartens and the pulmonology clinic in Trelew, Argentina. Spirometry was performed at visit 1 and repeated after 15 min, with children randomised to placebo or salbutamol (400 µg). Spirometry was again performed within 8 weeks at visit 2. Within-session repeatability from visit 1 and between-session reproducibility were calculated using baseline spirometry. The within-session repeatability and receiver operating characteristic curve analyses were used to determine the optimal threshold values for BDR for spirometry outcome variables measured at the first visit, and sensitivity, specificity and diagnostic accuracy were determined.
Results:
As a group, children with asthma had lower lung function (FVC 1.11±0.12 L vs 1.01±0.15 L; FEV0.75 1.01±0.10 L vs 0.91±0.15 L) and a greater BDR (FEV0.75 group difference 8.6 (95% CI -5.0 to 14.3)%) than healthy children. BDR was best defined by change in FEV0.75; an increase of 11% showed the best balance between sensitivity (51%), specificity (88%), positive predictive value (47%) and negative predictive value (89%) for discriminating healthy from preschool-aged children with asthma.
Conclusions:
A negative BDR in a child suspected of having asthma makes a diagnosis of asthma less likely.
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