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  • Title: Value of the bronchodilator response in assessing controller naïve asthmatic children.
    Author: Galant SP, Morphew T, Amaro S, Liao O.
    Journal: J Pediatr; 2007 Nov; 151(5):457-62, 462.e1. PubMed ID: 17961685.
    Abstract:
    OBJECTIVE: To define the bronchodilator response (BDR) cutoff point that best identified asthma to determine the frequency of abnormal spirometry results across severity. STUDY DESIGN: Controller naïve children were evaluated with clinical criteria alone to establish a diagnosis of asthma and severity classification, then compared with the BDR, which was calculated as the percent change from the initial forced expiratory volume in 1 second. Receiver operator characteristic analysis determined the cutoff point for asthma diagnosis that gave the best combination of sensitivity and specificity. RESULTS: Children with asthma (n = 346) and 51 children without asthma, aged 4 to 17 years, who met entry criteria for spirometry were identified. The mean BDR in asthmatics was 8.6% (95% CI, 7.5-9.8), compared with 2.2% (95% CI, 0.2-4.3) for non-asthmatics (P < .001). A BDR > or = 9% best differentiated these populations with a sensitivity rate of 42.5% and a specificity rate of 86.3%. Abnormal spirometry results, defined as a BDR > or = 9%, a forced expiratory volume in 1 second < 80% predicted, or both, ranged from 44.4% for mild intermittent bronchial asthma to 57.0% for severe persistent bronchial asthma. CONCLUSION: Spirometric criteria that include BDR can potentially identify children who have clinically mild asthma and might benefit from controller therapy.
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