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Disparate diagnostic accuracy of lung function tests as predictors of poor asthma control in children.
Smith, Clyde J; Spaeder, Michael C; Sorkness, Ronald L; Teague, W Gerald.
Afiliación
  • Smith CJ; Division of Critical Care Medicine, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
  • Spaeder MC; Division of Critical Care Medicine, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
  • Sorkness RL; School of Pharmacy and Departments of Medicine and Pediatrics, University of Wisconsin-Madison, Madison, WI, USA.
  • Teague WG; Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
J Asthma ; 57(3): 327-334, 2020 03.
Article en En | MEDLINE | ID: mdl-30663912
ABSTRACT
Rationale In practice, asthma control is assessed according to symptom burden and office spirometry. However, spirometry poorly tests peripheral lung function, which may be abnormal in asthma. Impluse oscillometry (IOS) and multiple-breath washout (MBW) are novel methods which measure reactance (X5) and ventilation heterogeneity (VH) in the peripheral lung, but how well these tests reflect asthma control is poorly understood.

Objective:

To compare the diagnostic accuracy of tests of large airways caliber (FEV1, FEV1/FVC, R20), peripheral zone properties (X5, VH), and airways inflammation (FeNO) as predictors of poor control in asthmatic children (44 poorly controlled/10 controlled).

Methods:

54 children enriched in severe asthma completed a symptom-based control scale (ACT/cACT) and lung function tests after overnight bronchodilator withhold. The accuracy of each variable to predict poor control was ranked by area under the receiver operating characteristic (ROC) curve, sensitivity and specificity.

Results:

Among measures of large airways caliber, the FEV1% had the highest ROC curve area, with low sensitivity but perfect specificity. Among measures of peripheral lung function, X5 and VH in the conducting zone had fair curve areas with higher sensitivity but lower specificity compared to the FEV1%. VH in the acinar zone and FeNO both had poor accuracy.

Conclusion:

Tests of large airway and peripheral zone lung function performed disparately as predictors of poor control in a sample of children enriched in severe asthma. Further studies in a larger sample with more diverse phenotypic features are necessary to validate this preliminary conclusion.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Pruebas de Función Respiratoria / Asma / Broncodilatadores / Antiasmáticos Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Female / Humans / Male Idioma: En Revista: J Asthma Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Pruebas de Función Respiratoria / Asma / Broncodilatadores / Antiasmáticos Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Female / Humans / Male Idioma: En Revista: J Asthma Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos