Vilozni Daphna, Hakim Fahed, Livnat Galit, Ofek Miryam, Bar-Yoseph Ronen, Bentur Lea
Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, 31096 Haifa, Israel; The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Sackler Medical School, 52621 Tel Aviv, Israel.
Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, 31096 Haifa, Israel; The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 31096 Haifa, Israel.
Can Respir J. 2016;2016:5394876. doi: 10.1155/2016/5394876. Epub 2016 Jun 9.
A reversibility test by an increase of greater than 12% in FEV1 can support a diagnosis of asthma and alter a patient's treatment plan but may not be applicable to the young ages. We retrospectively gathered spirometric data from 85/271 asthmatic children having mild obstruction (FEV1 > 80% predicted), age 2.6-6.9 years. Spirometry was performed before and 20 min after inhalation of 200 mcg Albuterol. We defined a deviation below -1.64 z scores from control as obstruction and an increased above 1.64 scores from control as a positive response to bronchodilators. Sensitivity of the index was considered significant if it captured >68% of the participants. The sensitivity of detecting airway obstruction in these children by FEV1 was 15.3% and 62.4% by FEF25-75. A positive response to Albuterol was an increase of 9.2% for FEV1 (12% for adults) and 18.5% for FEF25-75. The sensitivity for detecting a response to Albuterol in mild asthma was 64.7% by FEV1 and 91.8% by FEF25-75. Young children having normal spirometry can demonstrate airway reversibility. The response of spirometry parameters to bronchodilators may be more sensitive than obstruction detection and may help to support the diagnosis of asthma and adjust treatment plan.
通过第1秒用力呼气容积（FEV1）增加超过12%进行的可逆性测试可支持哮喘诊断并改变患者的治疗方案，但可能不适用于低龄儿童。我们回顾性收集了85名/271名患有轻度阻塞（FEV1>预测值的80%）、年龄在2.6至6.9岁的哮喘儿童的肺功能数据。在吸入200微克沙丁胺醇之前和之后20分钟进行肺功能测定。我们将低于对照-1.64 z分数的偏差定义为阻塞，高于对照1.64分数的增加定义为对支气管扩张剂的阳性反应。如果该指标能涵盖>68%的参与者，则认为其敏感性显著。通过FEV1检测这些儿童气道阻塞的敏感性为15.3%，通过FEF25-75检测为62.4%。对沙丁胺醇的阳性反应是FEV1增加9.2%（成人增加12%），FEF25-75增加18.5%。通过FEV1检测轻度哮喘对沙丁胺醇反应的敏感性为64.7%，通过FEF25-75检测为91.8%。肺功能正常的幼儿可表现出气道可逆性。肺功能参数对支气管扩张剂的反应可能比对阻塞的检测更敏感，可能有助于支持哮喘诊断和调整治疗方案。
