Assessing exercise-induced bronchoconstriction in children: The need for testing

Natasja Lammers (Corresponding Author), Maaike H.T. van Hoesel, Marije Kamphuis, Marjolein Brusse-Keizer, Job van der Palen, Reina Visser, Boony J. Thio, Jean M.M. Driessen

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Abstract

Objective Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and a sign of insufficient disease control. EIB is diagnosed and monitored based on lung function changes after a standardized exercise challenge test (ECT). In daily practice however, EIB is often evaluated with self-reported respiratory symptoms and spirometry. We aimed to study the capacity of pediatricians to predict EIB based on information routinely available during an outpatient clinic visit. Methods A clinical assessment was performed in 20 asthmatic children (mean age 11.6 years) from the outpatient clinic of the MST hospital from May 2015 to July 2015. During this assessment, video images were made. EIB was measured with a standardized ECT performed in cold, dry air. Twenty pediatricians (mean years of experience 14.4 years) each evaluated 5 children, providing 100 evaluations, and predicted EIB severity based on their medical history, physical examination and video images. EIB severity was predicted again after additionally providing baseline spirometry results. Results Nine children showed no EIB, 4 showed mild EIB, 2 showed moderate and 5 showed severe EIB. Based on clinical information and spirometry results, pediatricians detected EIB with a sensitivity of 84% (95% CI 72%-91%) and a specificity of 24% (95% CI 14%-39%).The agreement between predicted EIB severity classifications and the validated classifications after the ECT was slight (Kappa = 0.05 (95% CI 0.00-0.17)). This agreement still remained slight when baseline spirometry results were provided (Kappa = 0.19 (95% CI 0.06-0.32)). Conclusion Pediatricians' prediction of EIB occurrence was sensitive, but poorly specific. The prediction of EIB severity was poor. Pediatricians should be aware of this in order to prevent misjudgment of EIB severity and disease control.

Original languageEnglish
Article number157
Number of pages6
JournalFrontiers in Pediatrics
Volume7
Issue numberAPR
DOIs
Publication statusPublished - 26 Apr 2019

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Bronchoconstriction
Exercise
Spirometry
Exercise Test
Hospital Outpatient Clinics
Ambulatory Care
Ambulatory Care Facilities
Physical Examination

Keywords

  • Asthma
  • Children
  • Disease history
  • EIB exercise-induced bronchoconstriction
  • Pediatrician

Cite this

Lammers, Natasja ; van Hoesel, Maaike H.T. ; Kamphuis, Marije ; Brusse-Keizer, Marjolein ; van der Palen, Job ; Visser, Reina ; Thio, Boony J. ; Driessen, Jean M.M. / Assessing exercise-induced bronchoconstriction in children : The need for testing. In: Frontiers in Pediatrics. 2019 ; Vol. 7, No. APR.
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title = "Assessing exercise-induced bronchoconstriction in children: The need for testing",
abstract = "Objective Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and a sign of insufficient disease control. EIB is diagnosed and monitored based on lung function changes after a standardized exercise challenge test (ECT). In daily practice however, EIB is often evaluated with self-reported respiratory symptoms and spirometry. We aimed to study the capacity of pediatricians to predict EIB based on information routinely available during an outpatient clinic visit. Methods A clinical assessment was performed in 20 asthmatic children (mean age 11.6 years) from the outpatient clinic of the MST hospital from May 2015 to July 2015. During this assessment, video images were made. EIB was measured with a standardized ECT performed in cold, dry air. Twenty pediatricians (mean years of experience 14.4 years) each evaluated 5 children, providing 100 evaluations, and predicted EIB severity based on their medical history, physical examination and video images. EIB severity was predicted again after additionally providing baseline spirometry results. Results Nine children showed no EIB, 4 showed mild EIB, 2 showed moderate and 5 showed severe EIB. Based on clinical information and spirometry results, pediatricians detected EIB with a sensitivity of 84{\%} (95{\%} CI 72{\%}-91{\%}) and a specificity of 24{\%} (95{\%} CI 14{\%}-39{\%}).The agreement between predicted EIB severity classifications and the validated classifications after the ECT was slight (Kappa = 0.05 (95{\%} CI 0.00-0.17)). This agreement still remained slight when baseline spirometry results were provided (Kappa = 0.19 (95{\%} CI 0.06-0.32)). Conclusion Pediatricians' prediction of EIB occurrence was sensitive, but poorly specific. The prediction of EIB severity was poor. Pediatricians should be aware of this in order to prevent misjudgment of EIB severity and disease control.",
keywords = "Asthma, Children, Disease history, EIB exercise-induced bronchoconstriction, Pediatrician",
author = "Natasja Lammers and {van Hoesel}, {Maaike H.T.} and Marije Kamphuis and Marjolein Brusse-Keizer and {van der Palen}, Job and Reina Visser and Thio, {Boony J.} and Driessen, {Jean M.M.}",
year = "2019",
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Assessing exercise-induced bronchoconstriction in children : The need for testing. / Lammers, Natasja (Corresponding Author); van Hoesel, Maaike H.T.; Kamphuis, Marije; Brusse-Keizer, Marjolein; van der Palen, Job; Visser, Reina; Thio, Boony J.; Driessen, Jean M.M.

In: Frontiers in Pediatrics, Vol. 7, No. APR, 157, 26.04.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Assessing exercise-induced bronchoconstriction in children

T2 - The need for testing

AU - Lammers, Natasja

AU - van Hoesel, Maaike H.T.

AU - Kamphuis, Marije

AU - Brusse-Keizer, Marjolein

AU - van der Palen, Job

AU - Visser, Reina

AU - Thio, Boony J.

AU - Driessen, Jean M.M.

PY - 2019/4/26

Y1 - 2019/4/26

N2 - Objective Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and a sign of insufficient disease control. EIB is diagnosed and monitored based on lung function changes after a standardized exercise challenge test (ECT). In daily practice however, EIB is often evaluated with self-reported respiratory symptoms and spirometry. We aimed to study the capacity of pediatricians to predict EIB based on information routinely available during an outpatient clinic visit. Methods A clinical assessment was performed in 20 asthmatic children (mean age 11.6 years) from the outpatient clinic of the MST hospital from May 2015 to July 2015. During this assessment, video images were made. EIB was measured with a standardized ECT performed in cold, dry air. Twenty pediatricians (mean years of experience 14.4 years) each evaluated 5 children, providing 100 evaluations, and predicted EIB severity based on their medical history, physical examination and video images. EIB severity was predicted again after additionally providing baseline spirometry results. Results Nine children showed no EIB, 4 showed mild EIB, 2 showed moderate and 5 showed severe EIB. Based on clinical information and spirometry results, pediatricians detected EIB with a sensitivity of 84% (95% CI 72%-91%) and a specificity of 24% (95% CI 14%-39%).The agreement between predicted EIB severity classifications and the validated classifications after the ECT was slight (Kappa = 0.05 (95% CI 0.00-0.17)). This agreement still remained slight when baseline spirometry results were provided (Kappa = 0.19 (95% CI 0.06-0.32)). Conclusion Pediatricians' prediction of EIB occurrence was sensitive, but poorly specific. The prediction of EIB severity was poor. Pediatricians should be aware of this in order to prevent misjudgment of EIB severity and disease control.

AB - Objective Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and a sign of insufficient disease control. EIB is diagnosed and monitored based on lung function changes after a standardized exercise challenge test (ECT). In daily practice however, EIB is often evaluated with self-reported respiratory symptoms and spirometry. We aimed to study the capacity of pediatricians to predict EIB based on information routinely available during an outpatient clinic visit. Methods A clinical assessment was performed in 20 asthmatic children (mean age 11.6 years) from the outpatient clinic of the MST hospital from May 2015 to July 2015. During this assessment, video images were made. EIB was measured with a standardized ECT performed in cold, dry air. Twenty pediatricians (mean years of experience 14.4 years) each evaluated 5 children, providing 100 evaluations, and predicted EIB severity based on their medical history, physical examination and video images. EIB severity was predicted again after additionally providing baseline spirometry results. Results Nine children showed no EIB, 4 showed mild EIB, 2 showed moderate and 5 showed severe EIB. Based on clinical information and spirometry results, pediatricians detected EIB with a sensitivity of 84% (95% CI 72%-91%) and a specificity of 24% (95% CI 14%-39%).The agreement between predicted EIB severity classifications and the validated classifications after the ECT was slight (Kappa = 0.05 (95% CI 0.00-0.17)). This agreement still remained slight when baseline spirometry results were provided (Kappa = 0.19 (95% CI 0.06-0.32)). Conclusion Pediatricians' prediction of EIB occurrence was sensitive, but poorly specific. The prediction of EIB severity was poor. Pediatricians should be aware of this in order to prevent misjudgment of EIB severity and disease control.

KW - Asthma

KW - Children

KW - Disease history

KW - EIB exercise-induced bronchoconstriction

KW - Pediatrician

U2 - 10.3389/fped.2019.00157

DO - 10.3389/fped.2019.00157

M3 - Article

VL - 7

JO - Frontiers in Pediatrics

JF - Frontiers in Pediatrics

SN - 2296-2360

IS - APR

M1 - 157

ER -