Methacholine bronchial provocation measured by spirometry versus wheeze detection in preschool children

Lea Bentur, Raphael Beck, Nael Elias, Asher Barak, Ori Efrati, Yaacov Yahav, Daphna Vilozni, Lea Bentur, Raphael Beck, Nael Elias, Asher Barak, Ori Efrati, Yaacov Yahav, Daphna Vilozni

Abstract

Background: Determination of PC20-FEV1 during Methacholine bronchial provocation test (MCT) is considered to be impossible in preschool children, as it requires repetitive spirometry sets. The aim of this study was to assess the feasibility of determining PC20-FEV1 in preschool age children and compares the results to the wheeze detection (PCW) method.

Methods: 55 preschool children (ages 2.8-6.4 years) with recurrent respiratory symptoms were recruited. Baseline spirometry and MCT were performed according to ATS/ERS guidelines and the following parameters were determined at baseline and after each inhalation: spirometry-indices, lung auscultation at tidal breathing, oxygen saturation, respiratory and heart rate. Comparison between PCW and PC20-FEV1 and clinical parameters at these end-points was done by paired Student's t-tests.

Results and discussion: Thirty-six of 55 children (65.4%) successfully performed spirometry-sets up to the point of PCW. PC20-FEV1 occurred at a mean concentration of 1.70+/-2.01 mg/ml while PCW occurred at a mean concentration of 4.37+/-3.40 mg/ml (p < 0.05). At PCW, all spirometry-parameters were markedly reduced: FVC by 41.3+/-16.4% (mean +/-SD); FEV1 by 44.7+/-14.5%; PEFR by 40.5+/-14.5 and FEF25-75 by 54.7+/-14.4% (P < 0.01 for all parameters). This reduction was accompanied by de-saturation, hyperpnoea, tachycardia and a response to bronchodilators.

Conclusion: Determination of PC20-FEV1 by spirometry is feasible in many preschool children. PC20-FEV1 often appears at lower provocation dose than PCW. The lower dose may shorten the test and encourage participation. Significant decrease in spirometry indices at PCW suggests that PC20-FEV1 determination may be safer.

Figures

Figure 1
Figure 1
Number of children responding to each MCH concentration (mg/ml) at PCW and at PC20-FEV1
Figure 2
Figure 2
A representative example of forced expiratory flow-volume curves from one child. Predicted, Baseline, PC20-FEV1 and PCW curves are presented
Figure 3
Figure 3
Analysis of the difference in dose values at end of test (PCW) and the dose at PC20, as compared with mean Dose values of the two, in a Bland and Altman analysis (20). Dotted lines represent 95% coefficient of variation values.
Figure 4
Figure 4
A representative example of poor-effort forced expiratory flow-volume curves from one child. Baseline, Post challenge and poor effort during teaching process are presented.

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