Usefulness of bronchodilator response as an index of asthma control in children

Jong Deok Kim; Soo Yeon Kim; Yoon Hee Kim; Kyung Won Kim; Myung Hyun Sohn; In Suk Sol

doi:10.4168/aard.2019.7.2.92

Journal List > Allergy Asthma Respir Dis > v.7(2) > 1126506

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Kim, Kim, Kim, Kim, Sohn, and Sol: Usefulness of bronchodilator response as an index of asthma control in children

Original Article

Allergy Asthma Respir Dis 2019;7(2):92-98.

Published online: 12 April 2019

DOI: https://doi.org/10.4168/aard.2019.7.2.92

Usefulness of bronchodilator response as an index of asthma control in children

Jong Deok Kim^1,, Soo Yeon Kim^2,, Yoon Hee Kim^2,, Kyung Won Kim^2,, Myung Hyun Sohn^2,, In Suk Sol^3,

^¹Department of Pediatrics, Hanyang University Seoul Hospital, Seoul Korea

^²Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul Korea

^³Department of Pedaitrics, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea

Correspondence to: In Suk Sol https://orcid.org/0000-0003-2470-9682 Department of Pedaitrics, Hallym University Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon 24253, Korea Tel: +82-33-240-5169, Fax: +82-33-255-6244, E-mail: issolkk0312@gmail.com

Received 14 March 2019 Revised 30 March 2019 Accepted 5 April 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Assessing asthma control is important for proper management, and various indices for objective assessment of asthma control, such as fractional exhaled nitric oxide (FeNO) and asthma control test (ACT) score have been proposed. Recently, bronchodilator response (BDR) was reported as a marker of poor asthma control in adults. This study aimed to assess the usefulness of BDR as a biomarker for childhood asthma.

Methods

A total of 305 children diagnosed with asthma were included. Spirometry with bronchodilator test was done at the time of diagnosis and about 14 months after asthma treatment. All children were evaluated by childhood asthma control test (c-ACT) and FeNO after asthma treatment. The patients were divided into 2 groups according to BDR results: the positive and negative BDR groups. Various biomarkers for asthma control, such as c-ACT, FeNO and changes of forced expiratory volume in 1 second (FEV1), were compared between the 2 groups.

Results

Of the 305 patients, 143 (46.9%) were positive and 162 (53.1%) were negative for BDR. The BDR-positive group showed lower FEV1. In the BDR positive group, FEV1 was significantly increased after asthma treatment, especially in children with airflow limitation which was defined as below 80% of FEV₁ or atopy. In atopic children, BDR showed a significant negative correlation with c-ACT and a positive correlation with FeNO.

Conclusion

In asthmatic children with airflow limitation at the time of diagnosis, BDR can be a useful index for predicting improvement in lung function by asthma maintenance treatment. BDR could be a reliable marker for the assessment of asthma control in atopic children.

Keywords: Asthma control test, Atopy, Lung function, Fractional exhaled nitric oxide, Bronchodilator response

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Fig. 1.

Comparison of results of pulmonary function test at asthma diagnosis and after asthma treatment. According to absence or presence of bronchodilator response (BDR) (A), more or less than 80% of FEV1, among presence of BDR (B), absence or presence of airway hyperresponsiveness, among presence of BDR and less than 80% of FEV₁ (C), absence or presence of atopy, among presence of BDR and less than 80% of FEV₁ (D). FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; PEF, peak expiratory flow; FEF_25%–75%, forced expiratory flow from 25% to 75% of vital capacity; Pre BD, prebronchodilator; Post BD, postbronchodilator. * P<0.001, ^† P<0.05.

Fig. 2.

Correlation between bronchodilator response and childhood asthma control test (c-ACT) using scatter plot in total (A), nonatopic (B), and atopic children (C).

Fig. 3.

Correlation between bronchodilator response and fractional exhaled nitric oxide (FeNO) using scatter plot in total (A), nonatopic (B), and atopic children (C).

Table 1.

Subject characteristics according to bronchodilator response in baseline pulmonary function test

Characteristic	BDR <12% (n=162)	BDR ≥12% (n=143)	P-value
Male sex	113 (69.8)	95 (66.4)	0.541
Age (yr)	8.42±1.58	8.58±1.96	0.415
Body mass index (kg/m²)	18.2±3.3	17.6±2.9	0.077
Atopy	113/154 (73.4)	90/137 (65.7)	0.162
Severity			0.209
Mild	67 (41.4)	55 (38.5)
Moderate	78 (48.1)	63 (44.1)
Severe	17 (10.5)	25 (17.5)
FVC (% predicted)	99.9±15.4	89.5±17.0	<0.001
FEV₁ (% predicted)	100.7±18.0	82.2±177	<0.001
PEF (% predicted)	85.5±17.9	70.7±16.5	<0.001
FEV₁/FVC (%)	100.5±8.7	90.5±11.6	<0.001
FEF25%–75% (% predicted)	80.3±26.1	52.6±24.9	<0.001

Values are presented as number (%) or mean±standard deviation.

BDR, bronchodilator response; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; PEF, peak expiratory flow; FEV1/FVC, forced expiratory volume in 1 second/Forced vital capacity; FEF25%–75%, forced expiratory flow from 25% to 75% of vital capacity.

Table 2.

Association of c-ACT and atopy with changes in bronchodilator response after asthma management

Baseline PFT		Follow-up PFT	c-ACT	P-value	Atopy	P-value
FEV1 <80%	BDR <12% (n=24)	BDR <12% (n=14)	25.4±3.0	0.015	13/14 (92.9)	0.028
		BDR ≥12% (n=10)	21.7±3.9		5/10 (50)
	BDR ≥12% (n=67)	BDR <12% (n=33)	20.6±8.9	0.057	22/32 (68.8)	0.097
		BDR ≥12% (n=34)	22.9±4.0		17/34 (50)
FEV1 ≥80%	BDR <12% (n=138)	BDR <12% (n=114)	22.1±3.9	0.387	77/106 (72.6)	0.518
		BDR ≥12% (n=24)	21.4±4.3		18/24 (75)
	BDR ≥12% (n=76)	BDR <12% (n=41)	22.1±4.9	0.206	27/38 (71.1)	0.544
		BDR ≥12% (n=35)	20.7±4.7		24/33 (72.7)

Values are presented as mean±standard deviation or number (%). c-ACT, childhood asthma control test; PFT, pulmonary function test; FEV₁, forced expiratory volume in 1 second; BDR, bronchodilator response.

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