Assessing bronchodilator response in preschool children using spirometry

Busi, Luciano E., Restuccia, Sebastián, Tourres, Ricardo and Sly, Peter D. (2016) Assessing bronchodilator response in preschool children using spirometry. Thorax, 72 4: 367-372. doi:10.1136/thoraxjnl-2015-207961


Author Busi, Luciano E.
Restuccia, Sebastián
Tourres, Ricardo
Sly, Peter D.
Title Assessing bronchodilator response in preschool children using spirometry
Journal name Thorax   Check publisher's open access policy
ISSN 1468-3296
0040-6376
Publication date 2016-10-14
Year available 2017
Sub-type Article (original research)
DOI 10.1136/thoraxjnl-2015-207961
Open Access Status Not yet assessed
Volume 72
Issue 4
Start page 367
End page 372
Total pages 7
Place of publication London, United Kingdom
Publisher BMJ Publishing Group
Language eng
Subject 2740 Pulmonary and Respiratory Medicine
Abstract Background Measuring lung function, including bronchodilator response (BDR), is an integral part of asthma management in older children. While spirometry is possible in preschool-Aged children, the question remains whether measuring BDR AIDS in asthma diagnosis in this age group. Methods 431 healthy children and 289 children with asthma, aged 3-5â €..years, were recruited from kindergartens and the pulmonology clinic in Trelew, Argentina. Spirometry was performed at visit 1 and repeated after 15â €..min, with children randomised to placebo or salbutamol (400â €..μg). Spirometry was again performed within 8â €..weeks at visit 2. Within-session repeatability from visit 1 and between-session reproducibility were calculated using baseline spirometry. The within-session repeatability and receiver operating characteristic curve analyses were used to determine the optimal threshold values for BDR for spirometry outcome variables measured at the first visit, and sensitivity, specificity and diagnostic accuracy were determined. Results As a group, children with asthma had lower lung function (FVC 1.11±0.12 L vs 1.01±0.15 L; FEV 0.75 1.01±0.10 L vs 0.91±0.15 L) and a greater BDR (FEV 0.75 group difference 8.6 (95% CI â '5.0 to 14.3)%) than healthy children. BDR was best defined by change in FEV 0.75; an increase of 11% showed the best balance between sensitivity (51%), specificity (88%), positive predictive value (47%) and negative predictive value (89%) for discriminating healthy from preschool-Aged children with asthma. Conclusions A negative BDR in a child suspected of having asthma makes a diagnosis of asthma less likely.
Formatted abstract
Background: Measuring lung function, including bronchodilator response (BDR), is an integral part of asthma management in older children. While spirometry is possible in preschool-aged children, the question remains whether measuring BDR aids in asthma diagnosis in this age group.

Methods: 431 healthy children and 289 children with asthma, aged 3-5 years, were recruited from kindergartens and the pulmonology clinic in Trelew, Argentina. Spirometry was performed at visit 1 and repeated after 15 min, with children randomised to placebo or salbutamol (400 mg). Spirometry was again performed within 8 weeks at visit 2. Within-session repeatability from visit 1 and between-session reproducibility were calculated using baseline spirometry. The within-session repeatability and receiver operating characteristic curve analyses were used to determine the optimal threshold values for BDR for spirometry outcome variables measured at the first visit, and sensitivity, specificity and diagnostic accuracy were determined.

Results: As a group, children with asthma had lower lung function (FVC 1.11±0.12 L vs 1.01±0.15 L; FEV0.75 1.01±0.10 L vs 0.91±0.15 L) and a greater BDR (FEV0.75 group difference 8.6 (95% CI -5.0 to 14.3)%) than healthy children. BDR was best defined by change in FEV0.75; an increase of 11% showed the best balance between sensitivity (51%), specificity (88%), positive predictive value (47%) and negative predictive value (89%) for discriminating healthy from preschool-aged children with asthma.

Conclusions: A negative BDR in a child suspected of having asthma makes a diagnosis of asthma less likely.
Keyword Respiratory System
Respiratory System
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Child Health Research Centre Publications
 
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