Diagnostic accuracy of the bronchodilator response in children
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CitationTse, Sze Man, Diane R. Gold, Joanne E. Sordillo, Elaine B. Hoffman, Matthew W. Gillman, Sheryl L. Rifas-Shiman, Anne L. Fuhlbrigge, Kelan G. Tantisira, Scott T. Weiss, and Augusto A. Litonjua. 2013. Diagnostic accuracy of the bronchodilator response in children. Journal of Allergy and Clinical Immunology 132, no. 3: 554–559.e5. 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.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:27005840
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