Adenosine bronchial provocation with computerized wheeze detection in young infants with prolonged cough: correlation with long-term follow-up.
BACKGROUND
Chronic cough in babies is often associated with bronchial hyperreactivity (BHR). The objective documentation of BHR in babies is difficult, and acoustic methods have been described (provocative concentration of a substance causing wheeze) for conducting bronchial provocation tests (BPTs). We conducted a study to evaluate automatic computerized wheeze detection (CWD) in determining BHR in young infants with prolonged cough, and its correlation with the subsequent development of wheezing.


METHODS
Infants aged < 24 months with prolonged cough (ie, > 2 months) underwent acoustic BPTs with the response determined by CWD and auscultation by a physician. Telephone interviews with parents were conducted after 1 month and yearly for the next 3 years.


RESULTS
A total of 28 infants who were 4 to 24 months old with prolonged cough were included in the study. Twenty of these infants (71.4%) had BHR as determined by a positive acoustic BPT result. In 11 of these 20 tests, the CWD occurred earlier, and in 9 tests it occurred at the same step as auscultation by a physician. Rhonchi or whistles often preceded wheezes. Seventeen of the 20 patients with BHR completed 3 years of follow-up. Of these, 14 had recurrent episodes of wheezing and shortness of breath, and 3 were well. Six of the eight adenosine-negative patients completed 3 years of follow-up and had no symptoms of BHR.


CONCLUSIONS
Acoustic BPT is a technically feasible test for the detection of BHR in young infants. CWD provides an earlier detection of wheeze than stethoscope auscultation. In our group of infants, a positive acoustic BPT result had high correlation with symptoms compatible with BHR over the next 3 years.
Pediatric Pulmonary Unit, Rambam Medical Center, PO Box 9602, Haifa, Israel 31096. l_bentur@rambam.health.gov.il
Lea
L
Bentur
Raphael
R
Beck
Drora
D
Berkowitz
Jamal
J
Hasanin
Irit
I
Berger
Nael
N
Elias
Noam
N
Gavriely
D000162:Acoustics; D000241:Adenosine; D016535:Bronchial Hyperreactivity / Q000150:complications* / Q000175:diagnosis*; D001985:Bronchial Provocation Tests; D002908:Chronic Disease; D003371:Cough / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000209:etiology
D000241:Adenosine