Pediatric Pulmonology Unit, The Edith Wolfson Medical Center, Holon, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Pulmonol. 2021 Oct;56(10):3200-3208. doi: 10.1002/ppul.25614. Epub 2021 Aug 18.
Bronchial challenge test (BCT) measures current airways-hyperreactivity, however, its predictive role in pre-school children (<6 years) for the diagnosis of asthma at school age is still debatable. We aimed to find whether preschool children with a positive adenosine or methacholine BCT are more prone to asthma at school age.
We included children aged 6-13 years with respiratory symptoms that were previously referred to our pulmonary function laboratory for BCT (methacholine or adenosine, depending on the question asked) at age 10 months to 6 years (baseline). BCT was considered positive based on spirometry results or wheezing, desaturation, and tachypnea reactions. The primary outcome measure was asthma diagnosis at school age using the well-validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used logistic regression analysis to explore whether positive BCT could predict school-age asthma while including age and collected modified asthma predictive index in the model.
One hundred and fifty-one of 189 children (53% males), completed the ISAAC questionnaire (response rate = 80%). Mean ages at BCT and at follow-up were 3.9 ± 1.28 and 9.4 ± 1.85 years, respectively. At baseline, 40 of 67 had a positive adenosine test and 73 of 84 had a positive methacholine BCT. Thirty-nine children were diagnosed with asthma at school age. Logistic regression analysis showed that a positive adenosine test at pre-school age was the best predictor, significantly increasing the odds of asthma at school age by 6.34 (95% CI: 1.23-32.81, p = .028), while methacholine did not show significance (p = .69).
Choosing the relevant BCT for the question asked, positive adenosine, but not methacholine test, at pre-school, may predict asthma at school age.
支气管激发试验（BCT）可测量当前气道高反应性，但在学龄前儿童（<6 岁）中，其对学龄期哮喘的预测作用仍存在争议。我们旨在确定在学龄前时接受阳性腺苷或乙酰甲胆碱 BCT 的儿童是否更容易在学龄期患哮喘。
我们纳入了 10 个月至 6 岁（基线）时因呼吸道症状而被转诊至我院肺功能实验室进行 BCT（根据所提问题选择乙酰甲胆碱或腺苷）的 6-13 岁儿童。BCT 阳性基于肺量计结果或喘息、低氧血症和呼吸急促反应确定。主要结局指标是使用经过充分验证的儿童哮喘国际研究（ISAAC）问卷调查得出的学龄期哮喘诊断。我们使用逻辑回归分析来探讨阳性 BCT 是否可以预测学龄期哮喘，同时将年龄和收集的改良哮喘预测指数纳入模型。
189 名儿童中有 151 名（53%为男性）完成了 ISAAC 问卷调查（应答率为 80%）。BCT 和随访时的平均年龄分别为 3.9±1.28 岁和 9.4±1.85 岁。基线时，40 名儿童的腺苷检测阳性，84 名儿童的乙酰甲胆碱 BCT 阳性。39 名儿童在学龄期被诊断为哮喘。逻辑回归分析表明，学龄前阳性腺苷试验是最佳预测指标，显著增加了学龄期哮喘的患病风险 6.34 倍（95%CI：1.23-32.81，p=0.028），而乙酰甲胆碱无显著差异（p=0.69）。
针对所提问题选择相关的 BCT，学龄前阳性腺苷，而非乙酰甲胆碱试验，可能预测学龄期哮喘。
