Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2005 Jan;60(1):13–16. doi: 10.1136/thx.2004.029934

Diagnostic accuracy of bronchodilator responsiveness in wheezy children

I Dundas 1, E Chan 1, P Bridge 1, S McKenzie 1
PMCID: PMC1747153  PMID: 15618576

Abstract

Background: The aim of this study was to evaluate the diagnostic accuracy of bronchodilator responsiveness for asthma in 5–10 year old children.

Methods: Spirometric measurements were made in 142 children (58 wheezers) before and after 400 µg inhaled salbutamol.

Results: On a receiver operating characteristic curve, a 9% increase in predicted forced expiratory volume in 1 second was the cut off point that provided an acceptable balance of sensitivity and specificity for previous wheeze. This figure was 50% (95% CI 38 to 62) sensitive and 86% (95% CI 78 to 92) specific for detecting previous wheeze and multiplied the initial odds in favour of wheeze by a factor of 3.6 (95% CI 2.0 to 6.3).

Discussion: With an estimated pretest probability of wheeze of 10% in the community and 50% in a specialist clinic, the positive predictive values are 29% and 78%, respectively, for a 9% change. The value of bronchodilator responsiveness testing depends on the prevalence of wheeze in the population in which it is to be used.

Full Text

The Full Text of this article is available as a PDF (72.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bachmann Lucas M., Steurer Johann, ter Riet Gerben. Simple presentation of test accuracy may lead to inflated disease probabilities. BMJ. 2003 Feb 15;326(7385):393–393. doi: 10.1136/bmj.326.7385.393/a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Borrill Z., Houghton C., Sullivan P. J., Sestini P. Retrospective analysis of evidence base for tests used in diagnosis and monitoring of disease in respiratory medicine. BMJ. 2003 Nov 15;327(7424):1136–1138. doi: 10.1136/bmj.327.7424.1136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bossuyt Patrick M., Reitsma Johannes B., Bruns David E., Gatsonis Constantine A., Glasziou Paul P., Irwig Les M., Lijmer Jeroen G., Moher David, Rennie Drummond, de Vet Henrica C. W. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ. 2003 Jan 4;326(7379):41–44. doi: 10.1136/bmj.326.7379.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bridge P. D., McKenzie S. A. Bronchodilator responsiveness testing in young children. Arch Dis Child. 2001 Jun;84(6):525–525. doi: 10.1136/adc.84.6.525n. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cane R. S., Ranganathan S. C., McKenzie S. A. What do parents of wheezy children understand by "wheeze"? Arch Dis Child. 2000 Apr;82(4):327–332. doi: 10.1136/adc.82.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Casan P., Roca J., Sanchis J. Spirometric response to a bronchodilator. Reference values for healthy children and adolescents. Bull Eur Physiopathol Respir. 1983 Nov-Dec;19(6):567–569. [PubMed] [Google Scholar]
  7. Dales R. E., Spitzer W. O., Tousignant P., Schechter M., Suissa S. Clinical interpretation of airway response to a bronchodilator. Epidemiologic considerations. Am Rev Respir Dis. 1988 Aug;138(2):317–320. doi: 10.1164/ajrccm/138.2.317. [DOI] [PubMed] [Google Scholar]
  8. Dalén G., Kjellman B. Assessment of lung function on healthy children using an electronic spirometer and an air-flowmeter before and after inhalation of an adrenergic receptor stimulant. Acta Paediatr Scand. 1979 Jan;68(1):103–108. doi: 10.1111/j.1651-2227.1979.tb04968.x. [DOI] [PubMed] [Google Scholar]
  9. Ekwo E. E., Weinberger M. M., Dusdieker L. B., Huntley W. H., Rodgers P., Maxwell G. A. Airways responses to inhaled isoproterenol in normal children. Am Rev Respir Dis. 1983 Jan;127(1):108–109. doi: 10.1164/arrd.1983.127.1.108. [DOI] [PubMed] [Google Scholar]
  10. Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  11. Jaeschke R., Guyatt G., Sackett D. L. Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1994 Feb 2;271(5):389–391. doi: 10.1001/jama.271.5.389. [DOI] [PubMed] [Google Scholar]
  12. Joseph-Bowen Jacqui, de Klerk Nicholas H., Firth Martin J., Kendall Garth E., Holt Patrick G., Sly Peter D. Lung function, bronchial responsiveness, and asthma in a community cohort of 6-year-old children. Am J Respir Crit Care Med. 2004 Jan 23;169(7):850–854. doi: 10.1164/rccm.200304-556OC. [DOI] [PubMed] [Google Scholar]
  13. Lis G., Hałuszka J. Standardy oceny testu odwracalności obturacji na podstawie krzywej przepływ--objetoś. Pneumonol Alergol Pol. 1991;59(11-12):20–24. [PubMed] [Google Scholar]
  14. López-Ríos Fernando, Illei Peter B., Rusch Valerie, Ladanyi Marc. Evidence against a role for SV40 infection in human mesotheliomas and high risk of false-positive PCR results owing to presence of SV40 sequences in common laboratory plasmids. 2004 Sep 25-Oct 1Lancet. 364(9440):1157–1166. doi: 10.1016/S0140-6736(04)17102-X. [DOI] [PubMed] [Google Scholar]
  15. Pardos Martínez C., Fuertes Fernández-Espinar J., Nerín De La Puerta I., González Pérez-Yarza E. Cuándo se considera positivo el test de broncodilatación. An Esp Pediatr. 2002 Jul;57(1):5–11. [PubMed] [Google Scholar]
  16. Rossi G. A., Tomà P., Sacco O., Fregonese B., Podestà E., Dodero P., Silvestri G., Gambini C. A 14-yr-old male with dyspnoea, productive cough and chest pain. Eur Respir J. 2003 Aug;22(2):387–391. doi: 10.1183/09031936.03.00101602. [DOI] [PubMed] [Google Scholar]
  17. Strachan D. P. Repeatability of ventilatory function measurements in a population survey of 7 year old children. Thorax. 1989 Jun;44(6):474–479. doi: 10.1136/thx.44.6.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Van Noord J. A., Smeets J., Clément J., Van de Woestijne K. P., Demedts M. Assessment of reversibility of airflow obstruction. Am J Respir Crit Care Med. 1994 Aug;150(2):551–554. doi: 10.1164/ajrccm.150.2.8049845. [DOI] [PubMed] [Google Scholar]
  19. Waalkens H. J., Merkus P. J., van Essen-Zandvliet E. E., Brand P. L., Gerritsen J., Duiverman E. J., Kerrebijn K. F., Knol K. K., Quanjer P. H. Assessment of bronchodilator response in children with asthma. Dutch CNSLD Study Group. Eur Respir J. 1993 May;6(5):645–651. [PubMed] [Google Scholar]
  20. Zweig M. H., Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993 Apr;39(4):561–577. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES