Bronchodilator responsiveness after ICS treatment

Introduction: Pulmonary function testing (PFT) is essential in respiratory medicine. In contrast to adults, children often have normal pre-bronchodilator spirometry, even when they are symptomatic. The bronchodilator responsiveness (BDR) is safe and widely used in the clinical practice tool for detecting active asthma. Objectives: To evaluate the PFT data of children with confirmed bronchial asthma after at least 1 year of treatment with inhaled corticosteroids (ICS). To determine the value of bronchodilator response (BDR) after ICS therapy. Materials and methods: In a 24 month period pre- and post-bronchodilator spirometry was conducted in 240 children, confirming the presence of asthma with positive BDR (ΔFEV1%pred.≥12%). All children were started on ICS treatment according the GINA guidelines – step 3 and step 4. A year after initiation of ICS treatment the children had BDR test, ACQ and their clinical status evaluated. Results: From all the patients, one year after therapy positive BDR (ΔFEV1%pred.≥12%) had 53 (22.08%) with statistically significant lower mean values of MMEF70%pred., MMEF 25/75%pred, FEV1% pred. and FEV1/FVC then the children with negative BDR (p 0.005). In children that were hospitalized for the last 12 months is found a greater likelihood of positive BDR. Conclusion: BDR test widely used for initial diagnosis, could be also a reliable tool in follow up children with asthma. In children with continuously positive BDR despite good ACQ results a step-up therapy change evaluation probably would be necessary.