Assessing bronchodilator response in preschool children using spirometry

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.