Airway obstruction at time of symptoms prompting use of reliever therapy in children with asthma.
BACKGROUND
In asthma treatment, doses of inhaled corticosteroids are often adapted to symptoms and need for bronchodilators. However, in cross-sectional studies in emergency room settings, lung function and respiratory symptoms are not always concordant. Available longitudinal data are based on written peak flow diaries, which are unreliable. Using home spirometry, we studied prospectively whether mild respiratory symptoms, prompting reliever therapy are accompanied by a clinically relevant drop in lung function in children with asthma.


METHODS
For 8 weeks, children with asthma scored symptoms and measured peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV(1)) on a home spirometer twice daily. Additional measurements were recorded when respiratory symptoms prompted them to use bronchodilators.


RESULTS
The mean difference between symptom free days and at times of symptoms was 6.6% of personal best for PEF (95% CI: 3.2-10.0; p = 0.0004) and 6.0% of predicted for FEV(1) (95% CI: 3.0-9.0; p = 0.0004). There was complete overlap in PEF and FEV(1) distributions between symptom free days and at times of symptoms.


CONCLUSIONS
Although statistically significant, the degree of airway narrowing at times of respiratory symptoms, prompting the use of reliever therapy, is highly variable between patients, limiting the usefulness of home spirometry to monitor childhood asthma.
Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands. a.f.j.brouwer@bkk.umcg.nl
A F J
AF
Brouwer
P L P
PL
Brand
R J
RJ
Roorda
E J
EJ
Duiverman
D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology; D001249:Asthma / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D010366:Peak Expiratory Flow Rate; D011446:Prospective Studies; D012648:Self Care; D012720:Severity of Illness Index; D013147:Spirometry
D001993:Bronchodilator Agents