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

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

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.

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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; FEF25%–75%, forced expiratory flow from 25% to 75% of vital capacity; Pre BD, prebronchodilator; Post BD, postbronchodilator. * P<0.001, P<0.05.
aard-7-92f1.tif
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).
aard-7-92f2.tif
Fig. 3.
Correlation between bronchodilator response and fractional exhaled nitric oxide (FeNO) using scatter plot in total (A), nonatopic (B), and atopic children (C).
aard-7-92f3.tif
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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