Exercise‐induced bronchospasm diagnosis in children. Utility of combined lung function tests

Abstract

Methacholine and mannitol tests detect BHR in most children with suspected EIB. Bronchodilator and exercise tests show a low positivity rate. A combination of the methacholine test, followed by the mannitol test, gives the highest return to identify BHR in children for the diagnosis of EIB.

Perceived exercise limitation in asthma: The role of disease severity, overweight, and physical activity in children

“…Overweight children were more than twice likely to report EL irrespectively of any other included factor. The 20% of children reporting EL is lower than the general activity limitation reported in 52% of children with current asthma (23), although the frequency of EIB (35%) among children reporting EL in the present study was comparable to previously reported range between 8 and 42% in studies comparing self-reported symptoms with EIB test (5,6,8,9,24). Nevertheless, 67 of 264 (25%) had a positive EIB compared to previously reported 51-55% (25,26) including also children with current asthma and ICS treatment.…”

“…Despite no significant association between a positive EIB and perceived EL, the associations between R max %FEV 1 as well as severe BHR and EL suggest that perceived EL reflects BHR. This is supported by a report by Sanchez-Garcia et al (24), suggesting that the direct methacholine challenge and the indirect mannitol tests have high sensitivities to detect BHR in steroid-naive children complaining of one or more symptoms after exercise. Sanchez-Garcia et al (24) reported a detection rate of BHR in 96.7% with a methacholine test, increasing to 100% when combined with mannitol test (24).…”

“…This is supported by a report by Sanchez-Garcia et al (24), suggesting that the direct methacholine challenge and the indirect mannitol tests have high sensitivities to detect BHR in steroid-naive children complaining of one or more symptoms after exercise. Sanchez-Garcia et al (24) reported a detection rate of BHR in 96.7% with a methacholine test, increasing to 100% when combined with mannitol test (24). In contrast, Anderson et al (28) reported a sensitivity of 59% and 56%, and a specificity of 65% and 69% to identify objectively measured EIB by mannitol and methacholine, respectively (28).…”

“…Nevertheless, neither methacholine bronchial challenge, nor EIB test individually or combined with FEV 1 /FVC ≤80% or bronchial lability index ≤10% confirmed EIB in more than 67% of children reporting EL. This may be related to the anti‐inflammatory BHR reducing effect of ICS , used by many of our study subjects compared to the steroid‐naive children in the study by Sanchez‐Garcia et al .The associations between perceived EL and asthma severity and allergic disease may additionally reflect the impact of uncontrolled asthma.…”

Biomarkers in inflammometry pediatric asthma: utility in daily clinical practice

“…Pediatric asthma is an enormous challenge for clinicians, not only for diagnosis but also in terms of prognosis and follow-up. [ 96 ] An inflammatory biomarker, giving additional information, would represent an immense benefit in daily clinical practice. However, at present, an optimal inflammometry biomarker does not exist.…”