Methacholine bronchial provocation measured by spirometry versus wheeze detection in preschool children.
BACKGROUND
Determination of PC20-FEV1 during Methacholine bronchial provocation test (MCT) is considered to be impossible in preschool children, as it requires repetitive spirometry sets. The aim of this study was to assess the feasibility of determining PC20-FEV1 in preschool age children and compares the results to the wheeze detection (PCW) method.


METHODS
55 preschool children (ages 2.8-6.4 years) with recurrent respiratory symptoms were recruited. Baseline spirometry and MCT were performed according to ATS/ERS guidelines and the following parameters were determined at baseline and after each inhalation: spirometry-indices, lung auscultation at tidal breathing, oxygen saturation, respiratory and heart rate. Comparison between PCW and PC20-FEV1 and clinical parameters at these end-points was done by paired Student's t-tests.


CONCLUSIONS
Thirty-six of 55 children (65.4%) successfully performed spirometry-sets up to the point of PCW. PC20-FEV1 occurred at a mean concentration of 1.70+/-2.01 mg/ml while PCW occurred at a mean concentration of 4.37+/-3.40 mg/ml (p < 0.05). At PCW, all spirometry-parameters were markedly reduced: FVC by 41.3+/-16.4% (mean +/-SD); FEV1 by 44.7+/-14.5%; PEFR by 40.5+/-14.5 and FEF25-75 by 54.7+/-14.4% (P < 0.01 for all parameters). This reduction was accompanied by de-saturation, hyperpnoea, tachycardia and a response to bronchodilators.


CONCLUSIONS
Determination of PC20-FEV1 by spirometry is feasible in many preschool children. PC20-FEV1 often appears at lower provocation dose than PCW. The lower dose may shorten the test and encourage participation. Significant decrease in spirometry indices at PCW suggests that PC20-FEV1 determination may be safer.
Pediatric Pulmonary Unit, Meyer Children's Hospital, Rambam Medical Center, and the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. l_bentur@rambam.health.gov.il
Lea
L
Bentur
Raphael
R
Beck
Nael
N
Elias
Asher
A
Barak
Ori
O
Efrati
Yaacov
Y
Yahav
Daphna
D
Vilozni
D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology*; D001314:Auscultation; D001985:Bronchial Provocation Tests / Q000379:methods*; D016085:Bronchoconstrictor Agents; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D012135:Respiratory Sounds / Q000187:drug effects; D013147:Spirometry
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride