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Published on: December 17, 2017
The 'clinically significant' bronchodilator responsiveness (BDR) in children: a comparative study between six
Fatma Guezguez1,2,3, Hend Knaz1,2,3, Ichraf Anane1,2,3
1Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.
Insights
The definition of a clinically significant bronchodilator reversibility (BDR) in children varies significantly depending on the criteria used. This study highlights that different BDR definitions yield different results in both obstructive and non-obstructive pediatric groups.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Trials
Background:
- Bronchodilator reversibility (BDR) is a key indicator in diagnosing obstructive airway diseases in children.
- Multiple international guidelines exist for defining a 'clinically significant' BDR, leading to potential inconsistencies in interpretation.
- Understanding these differences is crucial for accurate diagnosis and management of pediatric respiratory conditions.
Purpose of the Study:
- To compare the prevalence of a 'clinically significant' BDR in children with and without airway obstruction, using six distinct definitions.
- To evaluate how different BDR criteria (GINA, ATS/ERS, BTS, NAEPP, GPRAP, SATS) impact the classification of reversibility in pediatric patients.
- To determine if the definition of significant BDR is consistent across different pediatric respiratory groups.
Main Methods:
- A multicenter comparative study involving 278 children aged 6-16 years.
- Participants were categorized into obstructive (n=116) and non-obstructive (n=162) groups based on spirometry.
- Spirometry was conducted pre- and post-bronchodilator, with the Cochrane Q test used for comparing responder percentages across six BDR definitions.
Main Results:
- The percentage of children identified with a significant BDR was highly dependent on the specific definition used.
- In the obstructive group, significant BDR ranged from 51.72% (NAEPP) to 74.14% (SATS).
- In the non-obstructive group, significant BDR ranged from 0.62% (NAEPP, BTS) to 8.64% (SATS), indicating potential for misclassification.
Conclusions:
- A 'clinically significant' bronchodilator reversibility in children is not universally defined and is critically dependent on the chosen criteria.
- The study underscores the need for standardization or clear understanding of BDR definitions in pediatric respiratory assessments.
- Different BDR definitions yield varying results, impacting the diagnosis and potential management strategies for children with and without airway obstruction.
Abstract:
Objective: To compare the percentages of children with and without airway obstruction (obstructive and non-obstructive groups, respectively) presenting a 'clinically significant' BDR according to the following definitions: GINA: FEV1 increase >12% predicted (∆Predicted), ATS/ERS: FEV1 increase ≥12% initial (∆Initial) and ∆FEV1 absolute (∆) ≥200 ml and/or ∆FVCInitial ≥12% and ∆FVC ≥200 ml, British thoracic society (BTS): ∆FEV1Initial ≥12%, National asthma education and prevention program (NAEPP): ∆FEV1Initial ≥12% and ∆FEV1 > 200 ml, Group of research on advances in pediatric pneumology: ∆FEV1Initial ≥12% or ∆PEFInitial ≥20%, and South African thoracic society (SATS): ∆FEV1Initial ≥12% or ∆FEV1 >200 ml and/or ∆FVCInitial ≥12% or ∆FVC >200 ml.Methods: This was a multicenter comparative study involving 278 children aged 6 to16 years: obstructive group (FEV1/FVC < lower-limit-of-normal, n = 116) and non-obstructive group (FEV1/FVC ≥ lower-limit-of-normal, n = 162). Spirometry was performed before/after a bronchodilator test. The Cochrane Q test was used to compare the percentage of responders according to the six definitions.Results: The percentages of responders among the obstructive [ranging from 51.72 (NAEPP) to 74.14% (SATS)] and the non-obstructive [ranging from 0.62 (NAEPP, BTS) to 8.64% (SATS)] groups were definition-dependent.Conclusion: In children, a 'clinically significant' BDR is definition-dependent.
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