Article Text

Download PDFPDF
Bronchodilator response by interrupter technique to guide management of preschool wheeze
  1. Paul C Seddon1,
  2. Rhian Willson1,
  3. Catherine Olden1,
  4. Elizabeth Symes1,
  5. Enrico Lombardi2,
  6. Nicole Beydon3
  1. 1 Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  2. 2 Paediatric Pulmonary Unit, Ospedale Pediatrico Meyer, Firenze, Toscana, Italy
  3. 3 Unité Fonctionnelle de Physiologie Explorations Fonctionnelles Respiratoires, Armand-Trousseau Childrens' Hospital, Paris, Île-de-France, France
  1. Correspondence to Dr Paul C Seddon, Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK; seddop{at}


Objective We examined relationships between clinical features and pulmonary function before and after inhaled corticosteroid (ICS) treatment in wheezy preschool children, and specifically, whether measuring bronchodilator response (BDR) could predict benefit from ICS.

Design Clinical non-randomised intervention study

Setting Secondary care.

Patients Preschool children (2 years to <6 years) with recurrent wheeze.

Interventions Inhaled beta-agonist, ICS.

Outcome measures We measured prebronchodilator and postbronchodilator interrupter resistance (Rint) and symptom scores at 0 (V1), 4 (V2) and 12 (V3) weeks. At V2, those with a predetermined symptom level commenced ICS. Modified Asthma Predictive Index (mAPI) and parental perception of response to bronchodilator were recorded. Response to ICS was defined as a reduction in daily symptom score of >0.26. Positive BDR was defined as fall in Rint of ≥0.26 kPa.s/L, ≥35% predicted or ≥1.25 Z Scores.

Results Out of 138 recruited children, 67 completed the full study. Mean (SD) prebronchodilator Rint at V2 was 1.22 (0.35) kPa.s/L, and fell after starting ICS (V3) to 1.09 (0.33) kPa.s/L (p<0.001), while mean (SD) daily symptom score fell from 0.56 (0.36) to 0.28 (0.36) after ICS (p<0.001). Positive Rint BDR before ICS (at V1 and/or V2), using all three threshold criteria, was significantly associated with response to ICS on symptom scores at V3 (p<0.05). mAPI was not significantly associated with response to ICS, and parents’ perception of response to bronchodilator was not related to measured Rint BDR .

Conclusions Rint BDR may be helpful in selecting which wheezy preschool children are likely to benefit from ICS.

  • respiratory medicine
  • allergy and Immunology
  • paediatrics
  • therapeutics

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Contributors PCS, NB, EL, CO and ES contributed to the conception and design of the work. PCS, NB, CO, ES and RW contributed to the acquisition and analysis of data. PCS, NB, RW and EL contributed to the interpretation of data. PCS, NB and RW drafted the work, and all other authors revised it critically for important intellectual content. Tragically CO died in 2017. All other authors have seen and approved the final version of the manuscript, and agree to be accountable for all aspects of the work. PCS agrees to act as guarantor.

  • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0706–10521).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.