%0 Journal Article
%T Assessment of bronchodilator response in preschoolers: A systematic review.
%A Wong MD
%A Condon K
%A Robinson PD
%A Suresh S
%A Zahir SF
%A Sly PD
%A Blake TL
%J Pediatr Pulmonol
%V 0
%N 0
%D 2024 Jul 2
%M 38953717
%F 4.09
%R 10.1002/ppul.27112
%X <B>BACKGROUND: </B>Several techniques can be used to assess bronchodilator response (BDR) in preschool-aged children, including spirometry, respiratory oscillometry, the interrupter technique, and specific airway resistance. However, there has not been a systematic comparison of BDR thresholds across studies yet.<BR><B>METHODS: </B>A systematic review was performed on all studies up to May 2023 measuring a bronchodilator effect in children 2-6 years old using one of these techniques (PROSPERO CRD42021264659). Studies were identified using MEDLINE, Cochrane, EMBASE, CINAHL via EBSCO, Web of Science databases, and reference lists of relevant manuscripts.<BR><B>RESULTS: </B>Of 1224 screened studies, 43 were included. Over 85% were from predominantly European ancestry populations, and only 22 studies (51.2%) calculated a BDR cutoff based on a healthy control group. Five studies included triplicate testing with a placebo to account for the within-subject intrasession repeatability. A relative BDR was most consistently reported by the included studies (95%) but varied widely across all techniques. Various statistical methods were used to define a BDR, with six studies using receiver operating characteristic analyses to measure the discriminative power to distinguish healthy from wheezy and asthmatic children.<BR><B>CONCLUSIONS: </B>A BDR in 2- to 6-year-olds cannot be universally defined based on the reviewed literature due to inconsistent methodology and cutoff calculations. Further studies incorporating robust methods using either distribution-based or clinical anchor-based approaches to define BDR are required.