Spirographic Parameters and Their Change in Bronchial Patency Variability Tests in Control Level Assessment of Bronchial Asthma in Children

The task of bronchial asthma (BA) treatment is the control of the symptoms and the course of the disease implemented through baseline anti-inflammatory therapy. There is the necessity for objective estimation of control level using pathogenically supported techniques including the assessment of key pathophysiological features of asthma — bronchial hyperresponsiveness (BHR) and/or inflammation.

The aim of the investigation was to develop a method of control assessment objectivization based on the analysis of spirographic parameters and their change in BHR tests.

Materials and Methods. We examined 134 patients aged from 5 to 16 years with atopic BA. In addition to standard examination, we determined BA control level using ACQ-5, spirographic parameters (Master-Screen Pneumo; Germany). BHR was studied in exercise tests — pedaling 60 rpm, the stress load being 1 W/kg within 10 minutes on bicycle ergometer Kettler AX1. If initial spirogram parameters were below conditional standard, BHR was determined in a test using bronchodilator. The changes of forced expiratory volume 1-second (FEV1) under the above mentioned stimuli (exercise, bronchodilators) were statistically processed in one amount of data, and FEV1 changed under bronchodilator were taken with the sign opposite to that of the obtained result (multiplying by –1). The data were presented as М±SD, where М — mean, SD — standard deviation.

Results. Correlation coefficient in this sampling was the following: between ACQ-5 and FEV1 values R=–0.66, p<0.00001, between ACQ-5 values and BHR intensity R=–0.59, p<0.00001. FEV1 application enables to verify correctly BA control level in 64.93% of patients (coincidence with clinical verification of control level), BHR determination enables to verify control level in 60.47% of patients, and integrated use of these parameters increases the level of correct control diagnosis up to 78.29%. When the patients are grouped according to control level (complete control patients and patients with partial control level and lack of control), a part of verified cases using FEV1 increases up to 77.78%, using BHR test with indirect stimuli — up to 74.81%, using integrated assessment of these parameters — up to 86.67%.

Based on the determined regularities we developed a computer program to objectivize control level in BA patients using the analysis of initial spirographic data results and their variability in tests with bronchodilators or indirect stimuli. The program enables to assess objectively a control level in particular patients engaging pathologically significant BA markers under real-life clinical setting.

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Eliseeva Т.I., Knyazeva Е.V., Bochkova Y.S., Kononova S.V., Geppe N.A., Balabolkin I.I. Spirographic Parameters and Their Change in Bronchial Patency Variability Tests in Control Level Assessment of Bronchial Asthma in Children. Sovremennye tehnologii v medicine 2013; 5(4): 94