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Article Dans Une Revue Journal of Allergy and Clinical Immunology: In Practice Année : 2023

Sensitivity of FEV1 and Clinical Parameters in Children With a Suspected Asthma Diagnosis

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Background: Asthma is the most common chronic disease in children and a robust diagnosis is crucial to optimize patient care and reduce its burden. To diagnose asthma in children, the Global Initiative for Asthma (GINA) recommendations propose a 12% improvement in forced expiratory volume in 1 second (FEV1) after a bronchodilation test. Nevertheless, such a criterion is rarely confirmed in these patients in clinical practice. Objective: The objective of this study was to evaluate the sensitivity of spirometric and clinical parameters in identifying children with possible asthma. Methods: The VERI-VEMS Study is a multicenter international retrospective cohort study. Data were collected, from January 2008 until January 2019, for all consecutive children (aged 5-18 years), with a diagnosis of asthma, who performed a spirometry at the time of the diagnosis. We compared the sensitivity of the reversibility criterion proposed by GINA guidelines, with other spirometric and clinical variables, using physician-diagnosed asthma and response to treatment as the standard. Results: The study included 871 children. The reversibility criterion of 12% of FEV1 showed a sensitivity of 30.4%. The 3 best spirometric or clinical criteria were the presence of dry cough, or wheezing or atopy and dry cough, or wheezing or exercise-induced dyspnea, with a sensitivity reaching 99.5%, with no added value of the spirometric parameters in the calculation of the cumulated sensitivity for the diagnosis of pediatric asthma. Conclusions: Postbronchodilator reversibility of 12%, although essential for patients' follow-up, has an insufficient low sensitivity in reaching a diagnosis of asthma in pediatric patients, compared with a combination of clinical symptoms, that show a better sensitivity. Further studies on specificity will help clarify the role of this change in the diagnostic paradigm in formally diagnosing children with asthma.
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hal-03930657 , version 1 (05-04-2024)

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Anouchka Fillard, Amelia Licari, Nicolas Molinari, Gianluigi Marseglia, Pascal Demoly, et al.. Sensitivity of FEV1 and Clinical Parameters in Children With a Suspected Asthma Diagnosis. Journal of Allergy and Clinical Immunology: In Practice, 2023, 11 (1), pp.238-247. ⟨10.1016/j.jaip.2022.10.011⟩. ⟨hal-03930657⟩
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