Bronchodilator responsiveness in wheezy infants and toddlers is not associated with asthma risk factors

Abstract

Background There are limited data assessing bronchodilator responsiveness (BDR) in infants and toddlers with recurrent wheezing, and factors associated with a positive response. Objectives In a multicenter study of children ≤ 36 months old we assessed the prevalence of and factors associated with BDR among infants/toddlers with recurrent episodes of wheezing. Methods Forced expiratory flows and volumes using the raised-volume rapid thoracic compression method were measured in 76 infants/toddlers (mean (sd) age 16.8 (7.6) mos.) with recurrent wheezing before and after administration of albuterol. Prior history of hospitalization or emergency department treatment for wheezing, use of inhaled or systemic corticosteroids, physician treatment of eczema, environmental tobacco smoke exposure, and family history of asthma or allergic rhinitis were ascertained. Results Using the published upper limit of normal for post bronchodilator change (FEV0.5 ≥ 13% and/or FEF25–75 ≥ 24%) in healthy infants, 24% (n=18) of children in our study exhibited BDR. The BDR response was not associated with any clinical factor other than body size. Dichotomizing subjects into responders (defined by published limits of normal)or by quartile to identify children with the greatest change from baseline (4th quartile vs. other) did not identify any other factor associated with BDR. Conclusions Approximately one quarter of infants/toddlers with recurrent wheezing exhibited BDR at their clinical baseline. However, BDR in wheezy infants/toddlers was not associated with established clinical asthma risk factors.

Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants

“…Our findings of boys with airway obstruction compared with girls are consistent with prior reports (27,(34)(35)(36), and the finding of black infants with increased airway obstruction compared with white infants also supports previous studies (37)(38)(39). The responsiveness to bronchodilators in our study (29% of infants) is comparable to that reported by Goldstein and colleagues (40), who found response to albuterol in 20 to 25% of a small cohort of healthy infants and young children born at more than 36 weeks of age, and to those of Debley and colleagues, who reported a bronchodilator response in 24% of 76 infants with recurrent wheezing (41). Bronchodilator response in infants with bronchopulmonary dysplasia is reported to be slightly higher at 35% (42).…”

Utility of bronchodilator response for asthma diagnosis in Latino preschoolers

“…The thresholds for a positive bronchodilator response in our study (Table 4) were similar to those obtained in other studies that included younger children. 24,25 In a recent publication, designed to assess the reproducibility and repeatability of spirometry in preschool children, thresholds were 14% for FEV 0.75 and 33% for FEF 25---75 , because coefficients of repeatability were higher than that in our study. 26 That could be explained because in the Borrego study they included a placebo inhaler, which may explain the greater variability and consequently an increase in the cut-off points for considering a significant response to bronchodilator.…”

Birth cohorts in asthma and allergic diseases: Report of a NIAID/NHLBI/MeDALL joint workshop

“…In older infants, increased bronchial tone can be present prior to any wheeze episodes, 72 but bronchodilator response of infants with history of wheeze has been inconsistently associated with asthma risk. 73,74 …”