SOVREMENNAYA PEDIATRIYA.2018.1(89):56-62; doi 10.15574/SP.2018.89.56

Rechkina O. O., Doroshenkova A. S., Kravczova O. N.
State Institution «Yanovsky National Institute of Phthisiology and Pulmonology, NAMS of Ukraine», Kyiv

Objective — to explore the feasibility of using formoterol fumarate (Zafiron) for reversibility test in children with asthma (BA) and determine the selecting criteria for this study.
Material and methods. In total 36 paediatric patients with BA of different severity and control aged from 6 to 17 years were examined. A comparative estimation of reversibility of the main indicators of the respiratory function with the fast1acting bronchodilators as salbutamol and formoterol was conducted.
Results. The indices of bronchial obstruction reversibility (the mean increase of forced expiratory volume — FEV1) in tests with salbutamol and formoterol were not significantly different, although in some studies, formoterol demonstrated a potentially higher ability to bronchodilation than salbutamol. The analysis of the obtained data shows that in the patients with a doubtful increase of FEV1 in salbutamol test (within the limits of physiological variation — 140–150 ml), during the test with formoterol, the FEV1 increase of 200-210 ml can be achieved. The predictable increase of FEV1 with the use of formoterol (ml) = 0.67 x increase of FEV1 with salbutamol (ml) +111 with the correlation coefficient r=0.54. The sensitivity and specificity (68.8% and 60.0%) of the formoterol test, as well as its predictive value, are satisfactory for the diagnosis of bronchial obstruction reversal in children with BA.
Conclusions. When conducting the inverse evaluation of the respiratory function, the bronchodilator reversibility test with formoterol (Zafiron) is recommended in case of the doubtful salbutamol test, or negative response to salbutamol, or intolerance to salbutamol in patients with FEV1 higher than 80% of the normal limits, regardless of the disease severity and BA control.
Key words: reversibility test, children, bronchial asthma, respiratory function, salbutamol, formoterol.

References

1. Vlasov VV. (2006). Izuchenie metodov diagnostiki. Mezhdunarodnyiy zhurnal meditsinskoy praktiki. 4: 7—17.

2. Lapach SN, Chubenko AV, Babich PN. (2000). Statisticheskie metodyi v mediko-biologicheskih issledovaniyah s ispolzovaniem  Excel. Kyiv: Moryon.

3. Moskalenko VF, Puzanova OH. (2011). Metodolohiia diahnostyky ta dokazovyi pidkhid, abo dokazova diahnostyka Therapia. Ukrainskyi medychnyi visnyk. 6: 20—26.

4. Okhotnykova OM. (2016). Pomylky diahnostyky bronkhialnoi astmy u ditei ta suchasni pidkhody do vyznachennia tiazhkosti zakhvoriuvannia khvoroby. Klinichna imunolohiia. Alerholohiia. Infektolohiia.1: 10—18.

5. Rechkina ОО, Rudenko SM, Doroshenkova FS, Kravtsova OM. (2017). Spirometry peculiarities in children with different degrees of bronchial asthma controllability. Sovremennaya pediatriya. 2(82): 97-101. doi 10.15574/SP.2017.82.97

6. Struchkov PV, Drozdov DV, Lukina OF. (2015). Spirometriya: rukovodstvo dlya vrachey. Moskva: GEOTAR-Media.

7. Hayden SR, Brown MD. (1999). Likelihood ratio: a powerful tool for incorporating the results of a diagnostic test into clinical decision making. Ann. Emerg. Med. 33: 575—80.

8. Linares Passerini M, Meyer Peirano R, Contreras I Estay et al. (2014). Utility of bronchodilator response for asthma diagnosis in Latino preschoolers. Allergol Immunopathol (Madr). 42(6): 553—559.

9. Miller MR et al. (2005). Standartization of spirometry. Series «ATS/ERS TASK FORSE: Standartization of Lung Function Testing». Eur Resir J. 26: 319—338.

10. Raghunathan K, Nagajothi N. (2006). Paradoxical bronchospasm: a potentially life threatening adverse effect of albuterol. South Med J. 99(3): 288—289.

11. Seed MJ, Agius RM. (2008). Paradoxical asthma hazard of short-acting beta2-agonists. Allergy. 63(2): 241.

12. Wang N, Zeng NN, Zhu W. (2010). Sensitivity, Specificity, Accuracy, Associated Confidence Interval And ROC Analysis With Practical SAS Implementations. Health Care and Life Sciences. 14: 32—39.