Wheezing Characteristics and Predicting Reactivity to Inhaled β2-Agonist in Children for Home Medical Care.

Chizu Habukawa,Haruyuki Makata,Katsumi Murakami,Tomoki Nishikido,Naoto Ohgami,Morimitsu Tomikawa,Takahiro Arai

doi:10.3389/fped.2021.667094

Abstract

Background: Given that wheezing is treated with inhaled β2-agonists, their effect should be reviewed before the condition becomes severe; however, few methods can currently predict reactivity to inhaled β2-agonists. We investigated whether preinhalation wheezing characteristics identified by lung sound analysis can predict reactivity to inhaled β2-agonists.Methods: In 202 children aged 10–153 months, wheezing was identified by auscultation. Lung sounds were recorded for 30 s in the chest region on the chest wall during tidal breathing. We analyzed the wheezing before and after β2-agonist inhalation. Wheezing was displayed as horizontal bars of intensity defined as a wheeze power band, and the wheezing characteristics (number, frequency, and maximum intensity frequency) were evaluated by lung sound analysis. The participants were divided into two groups: non-disappears (wheezing did not disappear after inhalation) and disappears (wheezing disappeared after inhalation). Wheezing characteristics before β2-agonist inhalation were compared between the two groups.The characteristics of wheezing were not affected by body size. The number of wheeze power bands of the non-responder group was significantly higher than those of the responder group (P < 0.001). The number of wheeze power bands was a predictor of reactivity to inhaled β2-agonists, with a cutoff of 11.1. The 95% confidence intervals of sensitivity, specificity, and positive and negative predictive values were 88.8, 42, 44, and 81.1% (P < 0.001), respectively.Conclusions: The number of preinhalation wheeze power bands shown by lung sound analysis was a useful indicator before treatment. This indicator could be a beneficial index for managing wheezing in young children.

Highlights

In the medical field, technical innovation has engendered telemedicine and home-based therapy; the practical use of these technologies has been limited
Acute exacerbation typically occurs at night and needs to be treated promptly; caregivers need to cope with the symptoms of this acute exacerbation
All participants had more than 3 episodes of wheezing and were diagnosed with asthma according to the Japanese pediatric guidelines for the treatment and management of asthma [6]

Summary

Introduction

Technical innovation has engendered telemedicine and home-based therapy; the practical use of these technologies has been limited. Lung sounds represent simple physical data, which have no value by themselves and are only clinically important when evaluated by a physician [1,2,3]. Appropriate judgment of lung sound data by specialists is required, especially when determining the patient’s response to treatment, which constitutes important information in telemedicine. Properly managing these exacerbations in young children is challenging, especially in infants. There is no specific tool or criterion for treating these exacerbations. Given that wheezing is treated with inhaled β2-agonists, their effect should be reviewed before the condition becomes severe; few methods can currently predict reactivity to inhaled β2-agonists. We investigated whether preinhalation wheezing characteristics identified by lung sound analysis can predict reactivity to inhaled β2-agonists

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Conclusion