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Bronchodilator response by interrupter technique to guide management of preschool wheeze

Paul C Seddon1, Rhian Willson2, Catherine Olden2

  • 1Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK seddop@gmail.com.

Archives of Disease in Childhood
|May 31, 2023
PubMed

Insights

Bronchodilator response in preschool children with recurrent wheeze may predict effectiveness of inhaled corticosteroids (ICS). Measuring this response can help identify children likely to benefit from ICS treatment.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Allergy

Background:

  • Recurrent wheeze in preschool children presents a diagnostic challenge.
  • Predicting response to inhaled corticosteroids (ICS) is crucial for effective management.
  • Bronchodilator response (BDR) is a potential biomarker for treatment efficacy.

Purpose of the Study:

  • To investigate the relationship between clinical features and pulmonary function in wheezy preschool children.
  • To determine if measuring bronchodilator response (BDR) can predict ICS treatment benefit.
  • To assess the utility of interrupter resistance (Rint) BDR in guiding ICS therapy.

Main Methods:

  • A non-randomized intervention study involving preschool children (2 to <6 years) with recurrent wheeze.
  • Pulmonary function (Rint) and symptom scores were measured before and after bronchodilator administration at multiple time points.
  • Inhaled corticosteroids (ICS) were initiated based on symptom severity, and response was evaluated.

Main Results:

  • A significant reduction in Rint and daily symptom scores was observed after ICS treatment.
  • Positive Rint BDR before ICS initiation was significantly associated with a greater reduction in symptom scores post-treatment.
  • Modified Asthma Predictive Index (mAPI) and parental perception did not reliably predict ICS response.

Conclusions:

  • Bronchodilator response, specifically using interrupter resistance (Rint), may serve as a valuable tool for selecting wheezy preschool children who are likely to benefit from inhaled corticosteroid (ICS) therapy.
  • This finding supports the use of objective BDR measurements in clinical decision-making for pediatric respiratory conditions.
Abstract

Keywords:
allergy and Immunologypaediatricsrespiratory medicinetherapeutics

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