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The role of bronchial challenge test in guiding therapy in preschool children with atypical recurrent respiratory symptoms
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  • Yonatan Wolfson,
  • Avigdor Mandelberg,
  • Tal Golan-Lagziel ,
  • Suzanne Sosnovsky,
  • Dorit Ater,
  • Keren Armoni Domany
Yonatan Wolfson
Edith Wolfson Medical Center
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Avigdor Mandelberg
Edith Wolfson Medical Center
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Tal Golan-Lagziel
Edith Wolfson Medical Center
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Suzanne Sosnovsky
Edith Wolfson Medical Center
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Dorit Ater
Assuta Ashdod Hospital
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Keren Armoni Domany
Edith Wolfson Medical Center

Corresponding Author:kerenar@wmc.gov.il

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Abstract

Objective: This retrospective observational cohort study aimed to assess the real-life application of bronchial challenge test (BCT) in the management of preschool children presenting with atypical recurrent respiratory symptoms (ARRS). Methods: We included children, aged 0.5-6 years referred to a pediatric-pulmonology clinic, who underwent BCT using methacholine or adenosine between 2012-2018 due to ARRS including uncertain severity of airway hyperactivity. BCT was considered positive based on spirometry results and/or wheezing, desaturation, and tachypnea reactions. We collected data on demographics, BCT results, pre-BCT treatment, post-BCT treatment change and post-BCT symptoms control. The primary outcome measure was the change in treatment post-BCT (step-up or step-down). Secondary outcome included clinical improvement observed 3-6 months after BCT. Results: A total of 228 children (55% males) with a mean age of 4.2±0.6 years underwent BCT (52% adenosine-BCT, 48% methacholine-BCT). Children referred for methacholine were significantly younger compared to adenosine (3.6±1.2 vs. 4.2±1.2 years, P<0.01). Methacholine and adenosine BCTs were positive in 95% and 61%, respectively. Overall, changes in management were observed in 122(53.5%) children following BCT, with 83(36.4%) being stepped up and 37(17%) being stepped down. Significantly more children in the methacholine group were stepped up compared to the adenosine (46% vs 28%, p=0.004). During the follow-up assessment, we observed a clinical improvement in 119/162 (73.4%) of the children. Conclusion: This study demonstrates the importance of BCT in the management of preschool children presenting to pediatric pulmonary-units with ARRS. The change in treatment and subsequent clinical improvement observed, highlight the added-value of BCT in this populations.
31 May 2023Submitted to Pediatric Pulmonology
07 Jun 2023Submission Checks Completed
07 Jun 2023Assigned to Editor
07 Jun 2023Review(s) Completed, Editorial Evaluation Pending
19 Jun 2023Reviewer(s) Assigned
21 Jul 2023Editorial Decision: Revise Major
19 Oct 20231st Revision Received
19 Oct 2023Submission Checks Completed
19 Oct 2023Assigned to Editor
19 Oct 2023Review(s) Completed, Editorial Evaluation Pending
19 Oct 2023Reviewer(s) Assigned
01 Nov 2023Editorial Decision: Accept