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Published on: May 12, 2023
A clinical study to determine the threshold of bronchodilator response for diagnosing asthma in Chinese children
Xiao-Hui Kang1, Wan Wang2, Ling Cao3
1Children's Hospital Affiliated to the Capital Institute of Pediatrics, No.2 Ya bao Road, Chaoyang District, Beijing, China.
Insights
A bronchodilator response (BDR) threshold of 7.5% is valuable for diagnosing childhood asthma. This simple spirometry test offers a better balance of sensitivity and specificity than a 12% threshold.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Diagnostic Testing
Background:
- Childhood asthma diagnosis lacks objective, feasible, and inexpensive tests.
- Current diagnostic methods may not meet clinical needs for accuracy and accessibility.
- There is a need for an improved diagnostic approach for pediatric asthma.
Purpose of the Study:
- To evaluate the diagnostic value of bronchodilator response (BDR) in childhood asthma.
- To determine an optimal BDR threshold for diagnosing asthma in children.
- To compare the effectiveness of different BDR thresholds in asthma diagnosis.
Main Methods:
- Spirometry tests were conducted before and after bronchodilator administration in 286 asthmatic and 301 non-asthmatic children.
- Bronchodilator response (BDR) was calculated as the change in forced expiratory volume in the first second (FEV1) post-bronchodilator.
- Receiver-operating characteristic (ROC) curve analysis was used to identify the optimal BDR threshold.
Main Results:
- Asthmatic children showed significantly lower pre-bronchodilator FEV1 compared to non-asthmatic children (P≤0.01).
- Mean BDR was 9.45±9.15% in asthmatic children versus 3.30±3.85% in non-asthmatic children.
- A BDR threshold of ≥7.5% yielded 50.7% sensitivity and 87.7% specificity, while ≥12% yielded 28.7% sensitivity and 96.3% specificity.
Conclusions:
- A bronchodilator response (BDR) threshold of ≥7.5% demonstrates greater diagnostic utility in childhood asthma compared to a ≥12% threshold.
- The BDR test, particularly at a 7.5% threshold, offers a clinically feasible and potentially valuable tool for asthma diagnosis in children.
- Further research may refine the role of BDR in pediatric asthma management and diagnosis.
Background:
There is few objective, clinically feasible and inexpensive test for diagnosing childhood asthma. We want to find an ideal way to solve it.
Methods:
The control group was 301 non-asthmatic children, and the asthma group was 286 asthmatic children. The asthmatic children were divided into three groups according to the severity of their disease. Pre- and post-bronchodilator spirometer tests were performed, and the main spirometer parameters were compared. The bronchodilator response (BDR) [BDR is used to determine the reversibility of airway obstruction by measuring the changes of forced expiratory volume in the first second (FEV1) before and after inhalation of bronchodilators] was then determined, and the optimal threshold of BDR for diagnosing childhood asthma was found.
Results:
301 non-asthmatic children and 286 asthmatic children participated in the study, the demographics were similar. FEV1 for pre-bronchodilator of asthmatic children was significantly lower than that of non-asthmatic children (P ≤ 0.01). BDR of non-asthmatic children was 3.30 ± 3.85%. BDR of asthmatic children was 9.45 ± 9.15%. There was no significant difference in BDR for patients with different severities of asthma within the group. BDR had no statistical correlation with gender, age, height, weight in neither non-asthmatic children nor asthmatic children. On the receiver-operating characteristic curve, a BDR threshold of ≥ 7.5% offered an optimal balance in asthma diagnosis with a sensitivity rate of 50.7% and specificity rate of 87.7%. Meanwhile, with a BDR threshold of ≥ 12%, the sensitivity rate was 28.7% and the specificity rate was 96.3%.
Conclusion:
A BDR threshold of ≥ 7.5% has more value in childhood asthma diagnosis as compared to ≥ 12%.
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