Wheeze is an unreliable endpoint for bronchial methacholine challenges in preschool children.

Lora Stewart, Naomi Miyazawa, Ronina Covar, Christopher Mjaanes, Reed Shimamoto, Melanie Gleason, Diego Peroni, Joseph D Spahn, Pasquale Comberiati

Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2022 Apr

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Onset of wheeze is the endpoint often used in the determination of a positive bronchial challenge test (BCT) in young children who cannot perform spirometry. We sought to assess several clinical endpoints at the time of a positive BCT in young children with recurrent wheeze compared to findings in school-aged children with asthma. Positive BCT was defined in: (1) preschool children (n = 22) as either persistent cough, wheeze, fall in oxygen saturation (SpO2 ) of ≥5%, or ≥50% increase in respiratory rate (RR) from baseline; and (2) school-aged children (n = 22) as the concentration of methacholine (MCh) required to elicit a 20% decline in FEV1 (PC20 ). All preschool children (mean age 3.4 years) had a positive BCT (median provocative MCh concentration 1.25 mg/ml [IQR, 0.62, 1.25]). Twenty (91%) school-aged children (mean age 11.3 years) had a positive BCT (median PC20 1.25 mg/ml [IQR, 0.55, 2.5]). At the time of the positive BCT, the mean fall in SpO2 (6.9% vs. 3.8%; p = .001) and the mean % increase in RR (61% vs. 22%; p < .001) were greater among preschool-aged than among school-aged children. A minority of children developed wheeze at time of positive BCT (23% preschool- vs. 15% school-aged children; p = .5). The use of wheeze as an endpoint for BCT in preschool children is unreliable, as it rarely occurs. The use of clinical endpoints, such as ≥25% increase in RR or fall in SpO2 of ≥3%, captured all of our positive BCT in preschool children, while minimizing undue respiratory distress. © 2022 The Authors. Pediatric Allergy and Immunology published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

Citation

Lora Stewart, Naomi Miyazawa, Ronina Covar, Christopher Mjaanes, Reed Shimamoto, Melanie Gleason, Diego Peroni, Joseph D Spahn, Pasquale Comberiati. Wheeze is an unreliable endpoint for bronchial methacholine challenges in preschool children. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. 2022 Apr;33(4):e13767