Resumen

BORREGO, Luís Miguel; COUTO, Mariana; ALMEIDA, Isabel  y  MORAIS-ALMEIDA, Mário. Pre-school spirometry in clinical practice. Rev Port Imunoalergologia [online]. 2012, vol.20, n.1, pp.23-31. ISSN 0871-9721.

Introduction: Spirometry is essential for evaluating asthmatic patients, and it is possible to perform it in preschool age children. However, there are no studies that demonstrate spirometry and bronchodilator test (BD) differences in asthmatic children and those with other clinical conditions, such as nonatopic recurrent wheezing (NRW) and chronic cough. Aims: To compare spirometryparameters in preschoolers diagnosed with asthma, NRW or chronic cough. To assess the recently published positive BD criteria on children in this study. Methods: During 2010, preschoolers with asthma,cough or NRW underwent spirometry on an outpatient basis. Bronchodilator response was evaluated, with BD considered positive (+) with a documented forced expiratory volume (FEV)_0.75 increase > 14%. Additionally we studied children with FEV_0.75 variation > 12% but <14%, to document how many would have been included in the BD+ group if the BD > 12% criterion (used in school children and adults) was chosen. Results: We studied 88 children with asthma and 99 with other diagnoses. In the majority it was possible to report FEV₁. Most children with other diagnoses (n=60; 61%) had normal spirometrywith negative BD, a statistically significant difference in relation to asthmatics (n=36;41%) (p=0.014). Of the asthmatics, 21% had obstruction with BD+, versus 4% of the cough/wheezing group, the differences beingstatistically significant (p=0.001). 20% (n=20) of children with cough/NRW had BD+ with normal spirometryand 11% had FEV variation between 12 and 14%. The BD differentiates asthmatic children from the remaining, since 40% of the asthmatics had BD+, regardless of any obstruction. Conclusions: 'Assessing lung function is now a reality in daily practice in preschool children,differentiatingasthmatic children from other groups with chronic cough or wheezing. This is useful for clarification and eventual diagnosis of asthma in cases of atypical presentation. It is essential to use appropriate BD cut-offs to avoid overdiagnosingasthma.

Palabras clave : Asthma; bronchodilator; chronic cough; lung function evaluation; preschool; recurrent wheezing.

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