Diagnostic accuracy of the bronchodilator response in children

• Published in: Journal of allergy and clinical immunology Vol. 132; no. 3; pp. 554 - 559.e5
• Main Authors: Tse, Sze Man, Gold, Diane R., Sordillo, Joanne E., Hoffman, Elaine B., Gillman, Matthew W., Rifas-Shiman, Sheryl L., Fuhlbrigge, Anne L., Tantisira, Kelan G., Weiss, Scott T., Litonjua, Augusto A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2013; Elsevier; Elsevier Limited
• Subjects: Accuracy; Age; air flow; allergens; Allergies; Allergy and Immunology; Asthma; Asthma - diagnosis; Asthma - physiopathology; Biological and medical sciences; Body mass index; Bronchodilator Agents; bronchodilator response; bronchodilators; Budesonide; Child; childhood; children; Chronic obstructive pulmonary disease, asthma; diagnosis; Eczema; Female; Forced Expiratory Volume; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hispanic people; Humans; Immunopathology; Male; males; Maternal & child health; Medical sciences; Nedocromil; patients; Pneumology; Population; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sensitivity and Specificity; BDR; bronchodilator response; diagnosis; CAMP; Asthma; AUC; Area under the curve; Childhood Asthma Management Program; Human; Lung disease; Immunopathology; Immunology; Respiratory disease; Bronchodilator; Bronchus disease; Obstructive pulmonary disease; Diagnosis; Child; Bronchodilator response
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2013.03.031

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. We sought to examine the diagnostic accuracy of the BDR test by using 3 large pediatric cohorts. 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. A total of 1041 cases (59.7% male; mean age, 8.9 ± 2.1 years) and 250 control subjects (46.8% male; mean age, 8.7 ± 1.7 years) were analyzed, with mean BDRs of 10.7% ± 10.2% and 2.7% ± 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%). 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.