Hevroni Avigdor, Nemet Shay, Ringel Amit, Boursheh Laurice, Handler Nitay Alter, Bar-Yishay Ephraim
Department of Pediatrics and the Pediatric Pulmonology and CF Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Pediatrics, Assuta Medical Center, Ashdod, Israel.
Clinical Immunology Allergy and AIDS Center, Kaplan Medical Center, Rehovot, Israel.
J Pediatr. 2025 Jan;276:114250. doi: 10.1016/j.jpeds.2024.114250. Epub 2024 Aug 22.
To evaluate the safety of an abbreviated methacholine challenge test (MCT) protocol in children.
This prospective, observational study enrolled children aged 6 through 18 years referred for the MCT. The abbreviated protocol was initiated with a methacholine dose of 0.03 mg/ml and escalated in fourfold increments, unless the forced expiratory volume at 1 second decline exceeded 10%, at which point the next dose was only doubled. The safety of this abbreviated approach was assessed by monitoring adverse events, and specifically, decreases in forced expiratory volume at 1 second over 40%, hypoxemia, or uncontrollable cough. The number of methacholine doses and test duration were recorded and compared with estimated outcomes derived from the full-length MCT protocol.
One hundred twelve participants, aged 13.7 years (±3.3), successfully completed the protocol. Fifty-seven (51%) presented a positive MCT response. No significant clinical adverse events were observed. Of all participants, 2.7% exhibited an exaggerated response, in line with previously reported findings for the full-length protocol. The abbreviated approach resulted in an estimated average time-savings of 18:19 minutes per participant, thus reducing test length by 22:47 minutes for a negative MCT and by 14:34 minutes for a positive outcome.
This abbreviated MCT protocol is safe for children and effectively shortens the duration of the MCT.
评估简化的乙酰甲胆碱激发试验（MCT）方案在儿童中的安全性。
这项前瞻性观察性研究纳入了因MCT前来就诊的6至18岁儿童。简化方案起始的乙酰甲胆碱剂量为0.03mg/ml，并以四倍增量递增，除非第1秒用力呼气量下降超过10%，此时下一剂量仅加倍。通过监测不良事件，特别是第1秒用力呼气量下降超过40%、低氧血症或无法控制的咳嗽，来评估这种简化方法的安全性。记录乙酰甲胆碱剂量数和测试持续时间，并与从完整MCT方案得出的估计结果进行比较。
112名年龄为13.7岁（±3.3）的参与者成功完成了该方案。57名（51%）呈现出MCT阳性反应。未观察到显著的临床不良事件。在所有参与者中，2.7%表现出过度反应，这与之前关于完整方案的报道结果一致。简化方法使每位参与者估计平均节省时间18分19秒，因此对于MCT阴性结果，测试时长缩短了22分47秒，对于阳性结果，缩短了14分34秒。
这种简化的MCT方案对儿童是安全的，并有效缩短了MCT的时长。
