Assessing Exercise-Induced Bronchoconstriction in Children; The Need for Testing.

Natasja Lammers,Marjolein Brusse-Keizer,Maaike H. T. van Hoesel,Marije Kamphuis,Boony J. Thio,Job van der Palen,Jean M. M. Driessen,Reina Visser

doi:10.3389/fped.2019.00157

Abstract

Objective: Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and a sign of insufficient disease control. EIB is diagnosed and monitored based on lung function changes after a standardized exercise challenge test (ECT). In daily practice however, EIB is often evaluated with self-reported respiratory symptoms and spirometry. We aimed to study the capacity of pediatricians to predict EIB based on information routinely available during an outpatient clinic visit.Methods: A clinical assessment was performed in 20 asthmatic children (mean age 11.6 years) from the outpatient clinic of the MST hospital from May 2015 to July 2015. During this assessment, video images were made. EIB was measured with a standardized ECT performed in cold, dry air. Twenty pediatricians (mean years of experience 14.4 years) each evaluated five children, providing 100 evaluations, and predicted EIB severity based on their medical history, physical examination, and video images. EIB severity was predicted again after additionally providing baseline spirometry results.Results: Nine children showed no EIB, four showed mild EIB, two showed moderate, and five showed severe EIB. Based on clinical information and spirometry results, pediatricians detected EIB with a sensitivity of 84% (95% CI 72–91%) and a specificity of 24% (95% CI 14–39%).The agreement between predicted EIB severity classifications and the validated classifications after the ECT was slight [Kappa = 0.05 (95% CI 0.00–0.17)]. This agreement still remained slight when baseline spirometry results were provided [Kappa = 0.19 (95% CI 0.06–0.32)].Conclusion: Pediatricians' prediction of EIB occurrence was sensitive, but poorly specific. The prediction of EIB severity was poor. Pediatricians should be aware of this in order to prevent misjudgement of EIB severity and disease control.

Highlights

Exercise-induced bronchoconstriction (EIB) is defined as an acute narrowing of the airways that occurs as a result of exercise [1]
Children 6–17 years old with pediatrician diagnosed asthma were recruited from the outpatient clinic of the pediatric department of Medisch Spectrum Twente, Enschede, The Netherlands from May 2015 to July 2015
Based on clinical information and spirometry results, pediatricians detected EIB with a sensitivity of 84% and a specificity of 24%

Summary

Introduction

Exercise-induced bronchoconstriction (EIB) is defined as an acute narrowing of the airways that occurs as a result of exercise [1]. EIB is diagnosed and monitored based on lung function changes after a standardized exercise challenge test (ECT) according to American Thoracic Society and European Respiratory Society (ATS/ERS) protocol [7, 8]. In daily practice, ECT’s are not often performed and pediatricians usually assess EIB based on a medical history, self- or parent-reported, a physical examination, and possibly lung function. This clinical strategy is in line with guidelines from The Global Initiative for Asthma (GINA), which recommends that an ECT should be undertaken if it is otherwise difficult to assess asthma control [6]

Methods

Results

Conclusion