Pediatr Allergy Respir Dis.  2012 Dec;22(4):336-343.

Changes in the Indices of Bronchial Reversibility Assessed by the Office Spirometry and Their Relationship to Asthma Symptoms after Discontinuing Controller Medication in Children with Controlled Asthma: Pilot Study

• Lee EJ
• Kim KH
• Lee JK
• Song JH
• Park JD
• Koh YY
• Suh DI

Abstract

PURPOSE
It is important to assess the level of control in asthmatic children who were well-controlled and thus discontinued controller medications. Office spirometry has been regarded to provide objective measures. We aimed to see time changes in lung function indices measured by the office spirometry and their relationship to clues for asthma exacerbation after discontinuation of controller medications.
METHODS
As a pilot study, a total of 20 well-controlled children with persistent asthma were included. After discontinuing controller medications, each made follow-up visits at the 2nd, 6th, and 12th week. At each visit, spirometric values before and after bronchodilators were evaluated by the office-based spirometer. Time changes and their relationship to clues for asthma exacerbation were assessed.
RESULTS
Among 20 children, 13 (65%) were successfully followed-up for 12 weeks with asthma kept stable. They presented similar spirometric values (forced expiratory volume in 1 second [FEV1], peak expiratory flow rate [PEFR], bronchodilator responses [BDRs] based on the FEV1 and PEFR) across all time-points. No differences in spirometric values were found between those who were stable and those who exhibited clues for asthma exacerbation. BDRs calculated from FEV1 values (BDRFEV1) correlated well with those calculated from PEFR values (BDRPEFR).
CONCLUSION
When controller medications were discontinued in children with well-controlled asthma, many of them were able to maintain the stable condition. Since the spirometric measures including BDR failed to differentiate clues for asthma exacerbation, the usefulness of office spirometry needs to be reevaluated by the larger population of children with controlled asthma after discontinuing medications.

Keyword

Association; Asthma; Child; Office spirometry; Wellcontrolled

MeSH Terms

Asthma
Bronchodilator Agents
Child
Follow-Up Studies
Humans
Lung
Peak Expiratory Flow Rate
Pilot Projects
Spirometry
Bronchodilator Agents

Figure

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  Fig. 1 Changes in forced expiratory volume in 1 second (FEV1) (A) and peak expiratory flow rate (PEFR) (B) of each subject after discontinuing controller medications. A dotted line represents change of pre/post bronchodilator response based on the FEV1 and PEFR of each subject. A solid line represents trend of pre bronchodilator response based on the FEV1 and PEFR during observation. ○, subjects who showed an aggravation of asthmatic symptoms at follow up point; ●, subjects who did not show an aggravation of asthmatic symptoms at follow up point. BD, bronchodilator.

• 

  Fig. 2 Changes in BDRFEV1 (A, open squares) and BDRPEFR (B, closed squares) values expressed as mean±standard error of mean after discontinuation of controller treatment. *After discontinuation vs. baseline. BDRFEV1, bronchodilator response based on the change in FEV1; BDRPEFR, bronchodilator response based on the change in PEFR.

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  Fig. 3 Scatter plots of the bronchodilator response based on the forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate in the whole study population at all times. BDRPEFR, bronchodilator response based on the change in PEFR; BDRFEV1, bronchodilator response based on the change in FEV1.

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