scholarly journals Novel predictors of airway hyperresponsiveness in children with respiratory symptoms without obstructive pattern

2021 ◽  
Author(s):  
Max Reinsberg ◽  
Stephanie Siebert ◽  
Charlotte Dreher ◽  
Thomas Bogs ◽  
Rainer Ganschow ◽  
...  
Keyword(s):  
Diagnostic Tool ◽  
Airway Hyperresponsiveness ◽  
Respiratory Symptoms ◽  
Vital Capacity ◽  
Multivariate Logistic Regression Analysis ◽  
Pollen Allergy ◽  
Prediction Rule ◽  
Tree Pollen ◽  
Forced Expiratory Flow ◽  
Nocturnal Cough

Background: Methacholine challenge (MCC) is the most common method to detect airway hyperresponsiveness (AHR). Although MCC is accepted as safe diagnostic tool, it is time consuming and could be exhausting for patients. Thus, it might be helpful to identify predictive factors for AHR. We aimed to develop a diagnostic tool for predicting AHR in children with respiratory symptoms without obstructive pattern. Methods: Data from children who had undergone MCC were analyzed retrospectively. The demographic features of patients along with laboratory results were collected. Results: A total of 123 children with a median age of 10.5 years were enrolled. AHR was detected in 81 children (65.8%). The age of the children with AHR was significantly younger. The prevalences of aeroallergen sensitization, nocturnal cough, wheezing and a baseline forced expiratory flow at 75% of vital capacity (FEF75) <65% were significantly more frequent in children with AHR. Multivariate logistic regression analysis revealed age, ever wheezing, nocturnal cough, tree pollen allergy and FEF75<65% as independent predictors of the AHR. A weighted clinical risk score was developed (range, 0-75 points). At a cutoff point of 35 the presence of AHR is predicted with a specificity of 90.5% and a positive predictive value (PPV) of 91.5%. Conclusion: In children suspected of having asthma, but without an obstructive pattern, combining independent predictors, which can be easily obtained in clinical practice, in a novel prediction rule might be used to identify children with AHR.

Predictors of Airway Hyperresponsiveness in Symptomatic Children with Normal Spirometry and Suspicious of Possible Asthma

2021 ◽  
pp. 1-9
Author(s):  
Max Reinsberg ◽  
Stephanie Siebert ◽  
Charlotte Dreher ◽  
Thomas Bogs ◽  
Rainer Ganschow ◽  
...  
Keyword(s):  
Airway Hyperresponsiveness ◽  
Vital Capacity ◽  
Multivariate Logistic Regression Analysis ◽  
Pollen Allergy ◽  
Multivariate Logistic Regression ◽  
Tree Pollen ◽  
Laboratory Results ◽  
Important Diagnostic Tool ◽  
Forced Expiratory Flow ◽  
Nocturnal Cough

<b><i>Background:</i></b> Asthma diagnosis may be challenging particularly in patients with mild symptoms without an obstructive pattern in spirometry. Detection of airway hyperresponsiveness (AHR) by a positive methacholine challenge (MCC) is still an important diagnostic tool to confirm the presence of asthma with reasonable certainty. However, it is time consuming and could be exhausting for patients. We aimed to identify the predictive factors for AHR in children with respiratory symptoms without obstructive pattern in spirometry. <b><i>Methods:</i></b> Data from children who had undergone MCC were analyzed retrospectively. The demographic features of patients along with laboratory results were collected. <b><i>Results:</i></b> A total of 123 children with a median age of 10.5 years were enrolled. AHR was detected in 81 children (65.8%). The age of the children with AHR was significantly younger. The prevalences of aeroallergen sensitization, nocturnal cough, wheezing, and a baseline forced expiratory flow at 75% of vital capacity (FEF<sub>75</sub>) &#x3c;65% were significantly more frequent in children with AHR. Multivariate logistic regression analysis revealed age, ever wheezing, nocturnal cough, tree pollen allergy, and FEF<sub>75</sub> &#x3c;65% as independent predictors of AHR. A weighted clinical risk score was developed (range, 0–75 points). At a cutoff point of 35, the presence of AHR is predicted with a specificity of 90.5% and a positive predictive value of 91.5%. <b><i>Conclusion:</i></b> In children suspected of having asthma, but without an obstructive pattern in the spirometry, combining independent predictors, which can be easily obtained in clinical practice, might be used to identify children with AHR.

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

scholarly journals Relation of Airway Responsiveness to Methacholine to Parent and Child Reporting of Symptoms Suggecting Asthma

1996 ◽  
Vol 3 (2) ◽  
pp. 115-123 ◽  
Author(s):  
JM FitzGerald ◽  
DE Fester ◽  
MM Morris ◽  
M Schulzer ◽  
FE Hargreave ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Airway Hyperresponsiveness ◽  
Respiratory Symptoms ◽  
Respiratory Illness ◽  
Airway Responsiveness ◽  
Methacholine Challenge ◽  
Cut Point ◽  
The Past ◽  
History Of

BACKGROUND:The lack of a relationship between airway responsiveness and respiratory symptoms in epidemiological studies of children may, in part, reflect inaccuracies in symptom reporting or inadequate knowledge by the parent of the child's symptoms.OBJECTIVE:To relate airway responsiveness to methacholine in children with symptoms of respiratory illness in the child as reported by the parent and as reported by the child.POPULATION:Eight- to 10-year-old (n=290) randomly sampled schoolchildren.SETTING:Seven randomly selected schools in Ontario.METHODS:Parents completed a mailed questionnaire regarding the child's respiratory health. Children completed a similar interview-administered questionnaire at school and underwent methacholine challenge testing by the tidal breathing method.RESULTS:The cumulative prevalence of a history of physician-diagnosed asthma was 9.0%, and of any wheezing it was 25.5%. A further 9% of children reported wheezing not documented by their parent. Of 229 children consenting to methacholine challenge, 78 (34.1%) showed airway responsiveness in the range generally associated with asthma in adults (provocation concentration of methacholine causing a 20% fall [PC20] in forced expired volume in 1 s [FEV1] 8 mg/mL or less); half of these children had no history of respiratory symptoms reported by the parent. The sensitivity of airway hyperresponsiveness defined by a cut-point for PC208 mg/mL or less in relation to any history of recurrent wheezing reported by the parent was 48% and did not improve if only symptoms within the past year were considered (sensitivity 44%); the specificity of the test for parent-reported symptoms ever was 71%, and 68% in those with symptoms in the past year. None of these sensitivities or specificities was increased by using symptoms reported by the child or by combining parent and child reported symptoms. Receiver operating characteristic (ROC) curves for sensitivity and specificity of the methacholine test were constructed for parent and child reports of symptoms. For all symptom strata, the cut-point of PC20producing optimal balance of sensitivity and specificity was between 4 and 8 mg/mL. A parental questionnaire positive for physician-diagnosed asthma was strongly related to methacholine response, producing an ROC curve with an area significantly different from 0.5 (P=0.006), as did all parent-reported wheezing (P=0.009). If the child reported asthma, there was an equally strong relationship, with a positive ROC curve (P=0.001), as there was for all child-reported wheezing (P=0.048).CONCLUSIONS:Airway hyperresponsiveness to methacholine in children relates closely with asthma and wheezing reported by either the parent or the child. In addition, the results confirm that respiratory symptoms and airway hyperresponsiveness are common in Canadian children, and that airway hyperresponsiveness may be found in children with no history of respiratory illness either at present or in the past.

Volume history and effect on airway reactivity in infants and adults

2002 ◽  
Vol 93 (3) ◽  
pp. 1069-1074 ◽  
Author(s):  
A. Weist ◽  
T. Williams ◽  
J. Kisling ◽  
C. Clem ◽  
R. S. Tepper
Keyword(s):  
Vital Capacity ◽  
Healthy Adults ◽  
Airway Hyperreactivity ◽  
Airway Reactivity ◽  
Maximal Expiratory Flow ◽  
Healthy Infants ◽  
Forced Expiratory Flow ◽  
Residual Capacity ◽  
Expiratory Flow ◽  
Volume History

Volume history is an important determinant of airway responsiveness. In healthy adults undergoing airway challenge, deep inspiration (DI) provides bronchodilating and bronchoprotective effects; however, the effectiveness of DI is limited in asthmatic adults. We hypothesized that, when assessed under similar conditions, healthy infants have heightened airway reactivity compared with healthy adults and that the effectiveness of DI is limited in infants. We compared the effect of DI on reactivity by using full (DI) vs. partial (no DI) forced-expiratory maneuvers on 2 days in supine, healthy nonasthmatic infants (21) and adults (10). Reactivity was assessed by methacholine doses that decreased forced expiratory flow after exhalation of 75% forced vital capacity during a full maneuver and maximal expiratory flow at functional residual capacity during a partial maneuver by 30% from baseline. Reactivity in adults increased when DI was absent, whereas infants' reactivity was unchanged. Infants were more reactive than adults in the presence of DI; however, adult and infant reactivity was similar in its absence. Our findings indicate that healthy infants are more reactive than adults and, like asthmatic adults, do not benefit from DI; this difference may be an important characteristic of airway hyperreactivity.

Does regional pollen load affect the prevalence of clinical allergy to those pollen groups?

2009 ◽  
Vol 124 (3) ◽  
pp. 297-301 ◽  
Author(s):  
I H Can ◽  
A İslam ◽  
D S Karasoy ◽  
E E Samim
Keyword(s):  
Allergic Rhinitis ◽  
Seasonal Allergic Rhinitis ◽  
Pollen Allergy ◽  
Common Type ◽  
Pollen Load ◽  
Tree Pollen ◽  
Grass Pollen Allergy ◽  
Clinical Allergy ◽  
Allergic Sensitisation ◽  
Airborne Pollens

AbstractObjective:To test the association between clinical allergic sensitisation to pollens and the profile and load of those pollens, in Ankara, Turkey.Materials and methods:Forty-three patients with seasonal allergic rhinitis were included. Clinical sensitisation to various pollens was compared with 10-year counts of the same pollens. The ratios of sensitisation to various pollen groups, and the association between clinical sensitisation and pollen load, were investigated.Results:Grass pollen allergy was the leading cause of seasonal allergic rhinitis, followed by tree pollen allergy. In Ankara, the most common type of airborne tree pollen was salicacea; however, the commonest clinical tree pollen allergies were due to the betulaceae and fagaceae families.Conclusions:Higher concentrations of airborne pollens may not always result in a higher prevalence of clinical allergy to those pollens.

Bronchial responsiveness to inhaled methacholine in young asymptomatic smokers

1982 ◽  
Vol 52 (6) ◽  
pp. 1464-1470 ◽  
Author(s):  
J. L. Malo ◽  
S. Filiatrault ◽  
R. R. Martin
Keyword(s):  
Respiratory Symptoms ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Threshold Concentration ◽  
Base Line ◽  
Similar Reaction ◽  
Response Curves ◽  
Bronchial Responsiveness ◽  
Young Smokers ◽  
Males And Females

Methacholine inhalation challenges were performed in 10 young smokers who denied having respiratory symptoms and in 10 nonsmokers of the same age. There were five males and five females in each group. The bronchoconstriction was evaluated with specific lung conductance (sGL), maximum partial (initiated from end-inspiratory lung volume) expiratory flows assessed at 40% vital capacity breathing air (Vmax40p air), and a He-O2 mixture (Vmax40p He), and with maximum complete flows breathing He-O2 [forced expiratory volume at 1 s (FEV1), Vmax50c He]. Dose-response curves were studied for 1) threshold concentration (TC) where values depart by more than two SD from base line; 2) provocative concentration (PC) causing a fixed fall in a parameter. Smokers differed significantly from nonsmokers for TC and PC accessed by Vmax40p He (P less than 0.001 and P less than 0.01, respectively), Vmax40p air (P less than 0.01), and Vmax50c He (P less than 0.01 and P less than 0.05, respectively). TC and PC estimated by sGL and FEV1 were not significantly different. Males and females showed a similar reaction.

Bet v 1 and its Homologs: Triggers of Tree-Pollen Allergy and Birch Pollen-Associated Cross-Reactions

2017 ◽  
pp. 21-42 ◽  
Author(s):  
J. Kleine-Tebbe ◽  
B. K. Ballmer-Weber ◽  
H. Breiteneder ◽  
S. Vieths
Keyword(s):  
Birch Pollen ◽  
Pollen Allergy ◽  
Tree Pollen ◽  
Cross Reactions ◽  
Bet V 1

scholarly journals The Smartphone: A Novel Diagnostic Tool in Pollen Allergy?

2016 ◽  
Vol 26 (3) ◽  
pp. 204-207 ◽  
Author(s):  
A Bianchi ◽  
O Tsilochristou ◽  
F Gabrielli ◽  
S Tripodi ◽  
PM Matricardi
Keyword(s):  
Diagnostic Tool ◽  
Pollen Allergy

scholarly journals Oscillometric and Spirometric Bronchodilator Response in Preschool Children with and without Asthma

2012 ◽  
Vol 19 (4) ◽  
pp. 273-277 ◽  
Author(s):  
Youn Ho Shin ◽  
Sun Jung Jang ◽  
Jung Won Yoon ◽  
Hye Mi Jee ◽  
Sun Hee Choi ◽  
...  
Keyword(s):  
Preschool Children ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Bronchodilator Response ◽  
Asthmatic Children ◽  
Before And After ◽  
Forced Expiratory Flow ◽  
Quality Control Criteria ◽  
Control Criteria

BACKGROUND: Bronchodilator responses (BDR) are routinely used in the diagnosis and management of asthma; however, their acceptability and repeatability have not been evaluated using quality control criteria for preschool children.OBJECTIVES: To compare conventional spirometry with an impulse oscillometry system (IOS) in healthy and asthmatic preschool children.METHODS: Data from 30 asthmatic children and 29 controls (two to six years of age) who underwent IOS and spirometry before and after salbutamol administration were analyzed.RESULTS: Stable asthmatic subjects significantly differed versus controls in their spirometry-assessed BDR (forced expiratory volume in 1 s [FEV1], forced vital capacity and forced expiratory flow at 25% to 75% of forced vital capacity) as well as their IOS-assessed BDR (respiratory resistance at 5 Hz [Rrs5], respiratory reactance at 5 Hz and area under the reactance curve). However, comparisons based on the area under the ROC curve for ΔFEV1% initial versus ΔRrs5% initial were 0.82 (95% CI 0.71 to 0.93) and 0.75 (95% CI 0.62 to 0.87), respectively. Moreover, the sensitivity and specificity for ΔFEV1≥9% were 0.53 and 0.93, respectively. Importantly, sensitivity increased to 0.63 when either ΔFEV1≥9% or ΔRrs5≥29% was considered as an additional criterion for the diagnosis of asthma.CONCLUSION: The accuracy of asthma diagnosis in preschool children may be increased by combining spirometry with IOS when measuring BDR.

scholarly journals Tree Pollen Spectra and Pollen Allergy Risk in the Osijek-Baranja County

2013 ◽  
Vol 64 (1) ◽  
pp. 115-122 ◽  
Author(s):  
Magdalena Sikora ◽  
Marina Valek ◽  
Zdenka Šušić ◽  
Vera Santo ◽  
Dario Brdarić
Keyword(s):  
Airborne Pollen ◽  
Pollen Allergy ◽  
Pollen Grains ◽  
Weather Conditions ◽  
Research Information ◽  
Tree Pollen ◽  
Pollen Concentrations ◽  
North Eastern ◽  
Measuring Site ◽  
Monitoring Stations

The forests of north-eastern Croatia, as well as various plants and trees in the parks and streets of the Osijek-Baranja County, produce large amounts of pollen during the pollen season, which can cause allergy symptoms in pollen sensitive individuals. The aim of this study was to determine the most frequent types of pollen in this area and estimate possible health risks, especially the risk of allergy. In 2009 and 2010, the staff of the Health Ecology Department of the Osijek Public Health Institute monitored tree pollen concentrations in four cities from the Osijek - Baranja County (Osijek, Našice, Đakovo and Beli Manastir) using a Burkard volumetric instrument. The results were affected by weather conditions. Windy and sunny days facilitated the transfer of pollen, whereas during rainy days, the concentration of pollen grains decreased. High pollen concentrations of Cupressaceae/Taxaceae, Betulaceae, Salicaceae and Aceraceae could be the cause for symptoms of pollen allergy. In 2009, conifers, birch and poplar pollen were dominant at all monitoring stations with 5000 pollen grains (PG), 3188 PG and 3113 PG respectively. The highest number of pollen grains was recorded at measuring site Osijek. The variations in airborne pollen concentration between pollen seasons were recorded at all monitoring stations. The most obvious variations were recorded at measuring site Osijek. The usual pollination period lasts two to three months, which means that most pollen grains remain present from February to early June. However, the Cupressaceae / Taxaceae pollination periods last the longest and their pollen grains remain present until the end of summer. The risk of allergy was determined at four monitored measuring stations and the obtained data confirmed that the largest number of days with a high health risk was at the Đakovo measuring station for a species of birch. The research information aims to help allergologists and individuals allergic to plant pollen develop preventive measures and proper treatment therapies.

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