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Different cutoff values of methacholine bronchial provocation test depending on age in children with asthma

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Abstract

Background

Bronchial hyperresponsiveness (BHR) is a fundamental pathophysiological characteristic of asthma. Although several factors such as airway caliber can affect BHR, no study has established age-dependent cutoff values of BHR to methacholine for the diagnosis of asthma in children. We investigated the cutoff values of the methacholine challenge test (MCT) in the diagnosis of asthma according to age.

Methods

A total of 2383 individuals aged from 6 to 15 years old were included in this study. MCTs using the five-breath technique were performed in 350 children with suspected asthma based on symptoms by pediatric allergists and in 2033 healthy children from a general population-based cohort. We determined the provocative concentration of methacholine producing a 20% decrease in forced expiratory volume in 1 second from baseline (PC20). A modified Korean version of the International Study of Asthma and Allergies in Childhood questionnaire was used to distinguish asthmatics and healthy subjects. Receiver-operator characteristic curve analysis was used to assess the cutoff value of PC20 for the diagnosis of asthma.

Results

Cutoff values of methacholine PC20, which provided the best combination of diagnostic sensitivity and specificity, showed an increasing pattern with age: 5.8, 9.1, 11.8, 12.6, 14.9, 21.7, 23.3, 21.1, 21.1, and 24.6 mg/mL at ages 6, 7, 8, 9, 10, 11, 12, 13, 14, and 15 years, respectively.

Conclusion

The application of different cutoff values of methacholine PC20 depending on age might be a practical modification for the diagnosis of asthma in children and adolescents with asthmatic symptoms.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea

    Eun Lee

  2. Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea

    Young-Ho Kim

  3. Department of Applied Statistics, Gachon University, Seongnam, Korea

    Seungbong Han

  4. Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea

    Song-I Yang

  5. Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea

    Young-Ho Jung

  6. Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea

    Ju-Hee Seo

  7. Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea

    Hyo-Bin Kim

  8. Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    So Yeon Lee & Soo-Jong Hong

  9. Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Songnam-si, Gyeuonggi-do, 463-707, Korea

    Ji-Won Kwon

Authors
  1. Eun Lee
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Corresponding author

Correspondence to Ji-Won Kwon.

Additional information

Funding: This research was supported by a fund (2014-ER5602-00) from Research of Korea Centers for Disease Control and Prevention.

Ethical approval: This study was performed according to the guideline of Asan Medical Center, which abides by the Helsinki Declaration on ethical principles for medical research.

Competing interest: The authors declare that they have no competing interests.

Contributors: Hong SJ (Email: sjhong@amc.seoul.kr) and Kwon JW contributed equally to this work as co-corresponding authors. Hong SJ and Kwon JW designed and supervised the execution of the study. Lee E and Han S performed the analyses. Lee E wrote the manuscript. Kim YH, Yang SI, Jung YH, Seo JH, Kim HB, and Lee SY participated in the interpretations.

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Lee, E., Kim, YH., Han, S. et al. Different cutoff values of methacholine bronchial provocation test depending on age in children with asthma. World J Pediatr 13, 439–445 (2017). https://doi.org/10.1007/s12519-017-0026-5

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  • DOI: https://doi.org/10.1007/s12519-017-0026-5

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