NDLI: Diagnostic accuracy of the bronchodilator response in children.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	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.
Description	Country affiliation: United States Author Affiliation: Tse SM ( Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. reszt@channing.harvard.edu)
Abstract	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 ± 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%). 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.
File Format	HTM / HTML
ISSN	00916749
e-ISSN	10976825
DOI	10.1016/j.jaci.2013.03.031
Journal	Journal of Allergy and Clinical Immunology
Issue Number	3
Volume Number	132
Language	English
Publisher	Elsevier
Publisher Date	2013-09-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Immunology Asthma Diagnosis Bronchodilator Agents Budesonide Nedocromil Physiopathology Forced Expiratory Volume Sensitivity And Specificity Multicenter Study Randomized Controlled Trial Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Immunology

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