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The bronchodilator response in preschool children: A systematic review

Raywood, E; Lum, S; Aurora, P; Pike, K; (2016) The bronchodilator response in preschool children: A systematic review. Pediatric Pulmonology , 51 (11) pp. 1242-1250. 10.1002/ppul.23459. Green open access

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Abstract

BACKGROUND: The bronchodilator response (BDR) is frequently used to support diagnostic and therapeutic decision-making for children who wheeze. However, there is little evidence-based guidance describing the role of BDR testing in preschool children and it is unclear whether published cut-off values, which are derived from adult data, can be applied to this population. METHODS: We searched MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception-September 2015) for studies reporting response to a bronchodilator in healthy preschool children, response following placebo inhalation, and the diagnostic efficacy of BDR compared with a clinical diagnosis of asthma/recurrent wheezing. FINDINGS: We included 14 studies. Thirteen studies provided BDR data from healthy preschool children. Two studies reported response to placebo in preschool children with asthma/recurrent wheezing. Twelve studies compared BDR measurements from preschool children with asthma/recurrent wheeze to those from healthy children and seven of these studies reported diagnostic efficacy. Significant differences between the BDR measured in healthy preschool children compared with that in children with asthma/recurrent wheeze were demonstrated in some, but not all studies. Techniques such as interrupter resistance, oscillometry, and plethysmography were more consistently successfully completed than spirometry. Between study heterogeneity precluded determination of an optimum technique. INTERPRETATION: There is little evidence to suggest spirometry-based BDR can be used in the clinical assessment of preschool children who wheeze. Further evaluation of simple alternative techniques is required. Future studies should recruit children in whom airways disease is suspected and should evaluate the ability of BDR testing to predict treatment response.

Type: Article
Title: The bronchodilator response in preschool children: A systematic review
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/ppul.23459
Publisher version: http://dx.doi.org/10.1002/ppul.23459
Language: English
Additional information: This is the peer reviewed version of the following article: Raywood, E; Lum, S; Aurora, P; Pike, K; (2016) The bronchodilator response in preschool children: A systematic review. Pediatric Pulmonology, which has been published in final form at: http://dx.doi.org/10.1002/ppul.23459. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html#terms).
Keywords: asthma and early wheeze, bronchodilator response, preschool child, pulmonary function testing (PFT), spirometry
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1498588
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