Bronchodilator responsiveness testing in young children
Editor,—There is some concern that asthma may be misdiagnosed when reported symptoms only are considered.1In Britain, asthma is usually diagnosed without any lung function testing whereas in the USA, measurement of bronchodilator responsiveness (BDR) is recommended.2 Perhaps routine spirometry is perceived as impractical. If lung function testing is to be recommended for the diagnosis of asthma, the method used must be easy.
Measurement of BDR using spirometry in children over 7 years has been reported feasible in children.3 We have shown that in 55% (49/89) of 5–7 year olds and 30% (14/47) of 7–10 year olds, BDR could not be measured because a satisfactory FEV1 could not be obtained. These were children with respiratory symptoms who were attending the laboratory for the first time and so had no previous practice. Of the 63 with unusable spirometry, in 48 the effort for forced expiration was submaximal or they did not breathe in to total lung capacity (TLC) before the expiration, nine coughed, and three did not blow for one second. Three refused the test. Modern spirometers have expiratory incentive devices, but inspiratory incentive displays are still needed to encourage children to reach TLC before a forced expiration.
Using the interrupter technique (Rint), all but three could successfully undertake BDR testing. This test is no more difficult from a technical viewpoint and takes no more time than spirometry. We have shown that Rint can detect BDR in preschool children with previous wheeze but not wheezy at the time of test, with 80% specificity and 76% sensitivity.4 If the specificity and sensitivity profile for BDR is acceptable in older children using Rint, we suggest that this method is preferred to spirometry.
