Asthma and lower airway diseaseDiagnostic accuracy of the bronchodilator response in children
Section snippets
Subjects
Participants from 3 pediatric cohorts were included in this study. Asthma cases consisted of children enrolled in the Childhood Asthma Management Program (CAMP). The demographics of the CAMP subjects and the study design have been previously reported.15 Briefly, this multicenter trial randomized 1041 children with mild-to-moderate asthma aged 5 to 13 years to budesonide, nedocromil, or placebo. Children were included if they had asthma symptoms 2 or more times per week, used an asthma
Patient demographics
A total of 1041 children with mild-to-moderate asthma were included from the CAMP cohort (cases). Control subjects consisted of 250 children from the Project Viva and Home Allergens cohorts who had no history of wheezing and asthma at the time of the BDR test. Baseline characteristics of the study population by asthma status are presented in Table I. Although their baseline FEV1 percent predicted values were similar and within normal limits (93.7% ± 14.3% in cases and 98.4% ± 12.2% in control
Discussion
In this analysis of the diagnostic accuracy of the BDR test, we found that the commonly used BDR cutoff of 12% was associated with a poor sensitivity and that a BDR cutoff of 8% or lower performed better than 12% at differentiating between children with and without asthma using 3 predominantly white populations.
The BDR test is recommended as an adjunct in the diagnosis of asthma, along with the clinical history and signs of inflammation, such as eosinophilia and increased IgE levels. This test
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2020, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Data from Tse et al28 suggest that a threshold of less than 8% performs better than 12% in younger populations. Given the variability in spirometric testing in children, it might not be appropriate to choose a specific bronchodilator reversibility cutoff as a criterion for the diagnosis of asthma in younger children.28 Response to therapy can be assessed subjectively in terms of symptom control and exercise tolerance.
The Childhood Asthma Management Program is supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051, M01RR0099718-24, M01RR02719-14, and RR00036 from the National Center for Research Resources. Additional support for this research came from grants P50 HL67664, U01 HL65899, and T32 HL07427 from the National Institutes of Health and the National Heart, Lung, and Blood Institute. Home Allergens is funded by National Institute of Allergy and Infectious Diseases/R01 grant AI035786. Project Viva is funded by R01 HL064925 and R01 HD034568.
Disclosure of potential conflict of interest: S. M. Tse, M. W. Gillman, and K. G. Tantisira have been supported by/have received one or more grants from or have one or more grants pending with the National Institutes of Health (NIH). D. R. Gold has been supported by one or more grants from the National Institute of Allergy and Infectious Diseases. A. L. Fuhlbrigge has been supported by one or more grants from and has received support for travel from the National Heart, Lung, and Blood Institute (NHLBI); is a Board member for Merck; has consultancy arrangements with Merck, GlaxoSmithKline, ICON Medical Imaging, Sunovion, the Lovelace Respiratory Research Institute, and Dmagi; and has received one or more grants from or has one or more grants pending with the NHLBI and the Agency for Healthcare Research and Quality. A. A. Litonjua has been supported by one or more grants from the NIH and has received royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest.