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Sensitivity of FEV1 and Clinical Parameters in Children With a Suspected Asthma Diagnosis
Anouchka Fillard1, Amelia Licari2, Nicolas Molinari3
1Allergy Unit, Département de Pneumologie et Addictology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France.
Insights
Diagnosing childhood asthma is challenging. Clinical symptoms like dry cough or wheezing are more sensitive than lung function tests for identifying asthma in children. Further research is needed to refine diagnostic approaches.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Asthma is the most common chronic childhood disease, necessitating accurate diagnosis for effective management.
- Current Global Initiative for Asthma (GINA) guidelines suggest a 12% improvement in forced expiratory volume in 1 second (FEV1) post-bronchodilation for asthma diagnosis.
- This GINA criterion demonstrates low confirmation rates in clinical practice for pediatric asthma diagnosis.
Purpose of the Study:
- To evaluate the diagnostic sensitivity of spirometric and clinical parameters in identifying children with potential asthma.
- To compare the effectiveness of the GINA reversibility criterion against other variables for pediatric asthma diagnosis.
Main Methods:
- A multicenter international retrospective cohort study (VERI-VEMS) analyzed data from January 2008 to January 2019.
- Included 871 children aged 5-18 years with a physician-diagnosed asthma and spirometry at diagnosis.
- Compared sensitivity of GINA's 12% FEV1 reversibility criterion with clinical symptoms and other spirometric variables, using physician diagnosis and treatment response as the gold standard.
Main Results:
- The GINA 12% FEV1 reversibility criterion showed a low sensitivity of 30.4%.
- The most sensitive diagnostic indicators were combinations of clinical symptoms: dry cough, wheezing, atopy, or exercise-induced dyspnea, achieving 99.5% sensitivity.
- Spirometric parameters did not significantly improve the cumulative sensitivity when combined with clinical symptoms for pediatric asthma diagnosis.
Conclusions:
- The 12% post-bronchodilator reversibility criterion has insufficient sensitivity for diagnosing asthma in children.
- Clinical symptom assessment demonstrates superior sensitivity compared to spirometric reversibility for pediatric asthma diagnosis.
- Further studies on specificity are required to fully establish the role of these findings in the pediatric asthma diagnostic paradigm.
Background:
Asthma is the most common chronic disease in children and a robust diagnosis is crucial to optimize patient care and reduce its burden. To diagnose asthma in children, the Global Initiative for Asthma (GINA) recommendations propose a 12% improvement in forced expiratory volume in 1 second (FEV1) after a bronchodilation test. Nevertheless, such a criterion is rarely confirmed in these patients in clinical practice.
Objective:
The objective of this study was to evaluate the sensitivity of spirometric and clinical parameters in identifying children with possible asthma.
Methods:
The VERI-VEMS Study is a multicenter international retrospective cohort study. Data were collected, from January 2008 until January 2019, for all consecutive children (aged 5-18 years), with a diagnosis of asthma, who performed a spirometry at the time of the diagnosis. We compared the sensitivity of the reversibility criterion proposed by GINA guidelines, with other spirometric and clinical variables, using physician-diagnosed asthma and response to treatment as the standard.
Results:
The study included 871 children. The reversibility criterion of 12% of FEV1 showed a sensitivity of 30.4%. The 3 best spirometric or clinical criteria were the presence of dry cough, or wheezing or atopy and dry cough, or wheezing or exercise-induced dyspnea, with a sensitivity reaching 99.5%, with no added value of the spirometric parameters in the calculation of the cumulated sensitivity for the diagnosis of pediatric asthma.
Conclusions:
Postbronchodilator reversibility of 12%, although essential for patients' follow-up, has an insufficient low sensitivity in reaching a diagnosis of asthma in pediatric patients, compared with a combination of clinical symptoms, that show a better sensitivity. Further studies on specificity will help clarify the role of this change in the diagnostic paradigm in formally diagnosing children with asthma.
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