Diagnostic accuracy of the bronchodilator response in children

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• 作者：Sze Man Tse ; Diane R. Gold ; Joanne E. Sordillo ; Elaine B. Hoffman ; Matthew W. Gillman ; Sheryl L. Rifas-Shiman ; Anne L. Fuhlbrigge ; Kelan G. Tantisira ; Scott T. Weiss ; Augusto A. Litonjua
• 关键词：Asthma ; bronchodilator response ; diagnosis
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：132
• 期：3
• 页码：554-559.e5
• 全文大小：405 K

文摘

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Background

The bronchodilator response (BDR) reflects the reversibility of airflow obstruction and is recommended as an adjunctive test to diagnose asthma. The validity of the commonly used definition of BDR, a 12 % or greater change in FEV₁ from baseline, has been questioned in childhood.

Objectives

We sought to examine the diagnostic accuracy of the BDR test by using 3 large pediatric cohorts.

Methods

Cases include 1041 children with mild-to-moderate asthma from the Childhood Asthma Management Program. Control subjects (nonasthmatic and nonwheezing) were chosen from Project Viva and Home Allergens, 2 population-based pediatric cohorts. Receiver operating characteristic curves were constructed, and areas under the curve were calculated for different BDR cutoffs.

Results

A total of 1041 cases (59.7 % male; mean age, 8.9?¡À?2.1?years) and 250 control subjects (46.8 % male; mean age, 8.7?¡À?1.7?years) were analyzed, with mean BDRs of 10.7 % ?¡À?10.2 % and 2.7 % ?¡À?8.4 % , respectively. The BDR test differentiated asthmatic patients from nonasthmatic patients with a moderate accuracy (area under the curve, 73.3 % ). Despite good specificity, a cutoff of 12 % was associated with poor sensitivity (35.6 % ). A?cutoff of less than 8 % performed significantly better than a cutoff of 12 % (P?=?.03, 8 % vs 12 % ).

Conclusions

Our findings highlight the poor sensitivity associated with the commonly used 12 % cutoff for BDR. Although our data show that a threshold of less than 8 % performs better than 12 % , given the variability of this test in children, we conclude that it might be not be appropriate to choose a specific BDR cutoff as a criterion for the diagnosis of asthma.