儿童支气管舒张试验检查及临床应用

doi:10.12372/jcp.2023.23e0206

Abstract

Abstract:

Bronchodilation test (BDT) is a method to detect the reversibility of spastic airway, which is mainly used in the diagnosis, differential diagnosis, treatment and follow-up of wheezing diseases. As awareness of the importance of the bronchodilatation test has increased, its clinical use has rapidly increased. Recently, a large number of researches both nationally and internationally have focued on how to interpret the results in clinical and define the positive thresholds. The purpose of this paper is to explore new standards and opinions, sort out the idea and make recommendations that are suitable for Chinese children.

Key words: bronchodilation test, threshold value, asthmatic disease, clinical application, child

ZHANG Hao, CHI Yanxia. Bronchodilation test and its clinical application in children[J].Journal of Clinical Pediatrics, 2023, 41(5): 321-327.

Figures/Tables 3

References 44

[1]	中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南(第四部分)——支气管舒张试验[J]. 中华结核和呼吸杂志, 2014, 37(9): 655-658.
[2]	中华医学会儿科学分会呼吸学组肺功能协作组, 中华实用儿科临床杂志编辑委员会. 儿童肺功能系列指南(五): 支气管舒张试验[J]. 中华实用儿科临床杂志, 2017, 32(1): 17-21.
[3]	中华医学会儿科分会呼吸学组, 中华儿科杂志编辑委员会. 儿童支气管哮喘诊断与防治指南[J]. 中华儿科杂志, 2016, 54(3): 167-181.
[4]	中华医学会儿科学分会呼吸学组肺功能协作组, 中华实用儿科临床杂志编辑委员会. 儿童肺功能系列指南(三): 脉冲振荡[J]. 中华实用儿科临床杂志, 2016, 31(11): 821-825.
[5]	King GG, Bates J, Berger KI, et al. Technical standards for respiratory oscillometry[J]. Eur Respir J, 2020, 55(2): 1900753. doi: 10.1183/13993003.00753-2019
[6]	Kelly VJ, Brown NJ, Sands SA, et al. Effect of airway smooth muscle tone on airway distensibility measured by the forced oscillation technique in adults with asthma[J]. J Appl Physiol (1985), 2012, 112(9): 1494-1503. doi: 10.1152/japplphysiol.01259.2011
[7]	Barnas GM, Sprung J, Craft TM, et al. Effect of lung volume on lung resistance and elastance in awake subjects measured during sinusoidal forcing[J]. Anesthesiology, 1993, 78(6): 1082-1090. pmid: 8512101
[8]	Thamrin C, Gangell C, Kusel M, et al. Expression of bronchodilator response using forced oscillation technique measurements: absolute versus relative[J]. Eur Respir J, 2010, 36(1): 212-213. doi: 10.1183/09031936.00025310 pmid: 20595169
[9]	Thamrin C, Gangell CL, Udomittipong K, et al. Assessment of bronchodilator responsiveness in preschool children using forced oscillations[J]. Thorax, 2007, 62(9): 814-819. pmid: 17412777
[10]	Oostveen E, Dom S, Desager K, et al. Lung function and bronchodilator response in 4-year-old children with different wheezing phenotypes[J]. Eur Respir J, 2010, 35(4): 865-872. doi: 10.1183/09031936.00023409 pmid: 19926751
[11]	Calogero C, Parri N, Baccini A, et al. Respiratory impedance and bronchodilator response in healthy Italian preschool children[J]. Pediatr Pulmonol, 2010, 45(11): 1086-1094. doi: 10.1002/ppul.21292
[12]	Harrison J, Gibson AM, Johnson K, et al. Lung function in preschool children with a history of wheezing measured by forced oscillation and plethysmographic specific airway resistance[J]. Pediatr Pulmonol, 2010, 45(11): 1049-1056. doi: 10.1002/ppul.v45:11
[13]	Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests[J]. Eur Respir J, 2005, 26(5): 948-968. doi: 10.1183/09031936.05.00035205 pmid: 16264058
[14]	Kroegel C. Global Initiative for asthma management and prevention--GINA 2006[J]. Pneumologie, 2007, 61(5): 295-304. pmid: 17523070
[15]	中华医学会儿科学会呼吸学组, 中华儿科杂志编辑委员会. 儿童支气管哮喘诊断与防治指南[J]. 中华儿科杂志, 2008, 46(10): 745-753.
[16]	Galant SP, Morphew T, Amaro S, et al. Value of the bronchodilator response in assessing controller naïve asthmatic children[J]. J Pediatr, 2007, 151(5): 457-662. doi: 10.1016/j.jpeds.2007.05.004
[17]	Tse SM, Gold DR, Sordillo JE, et al. Diagnostic accuracy of the bronchodilator response in children[J]. J Allergy Clin Immunol, 2013, 132(3): 554-559. doi: S0091-6749(13)00520-4 pmid: 23683464
[18]	Kang XH, Wang W, Cao L. A clinical study to determine the threshold of bronchodilator response for diagnosing asthma in Chinese children[J]. World J Pediatr, 2019, 15(6): 559-564. doi: 10.1007/s12519-019-00293-9
[19]	Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests[J]. Eur Respir J, 2022, 60(1): 2101499. doi: 10.1183/13993003.01499-2021
[20]	Brand PL, Quanjer PH, Postma DS, et al. Interpretation of bronchodilator response in patients with obstructive airways disease. The Dutch Chronic Non-Specific Lung Disease (CNSLD) Study Group[J]. Thorax, 1992, 47(6): 429-436. doi: 10.1136/thx.47.6.429 pmid: 1496502
[21]	Quanjer PH, Ruppel GL, Langhammer A, et al. Bronchodilator response in FVC is larger and more relevant than in FEV1 in severe airflow obstruction[J]. Chest, 2017, 151(5): 1088-1098. doi: S0012-3692(16)62696-X pmid: 28040521
[22]	Tan WC, Vollmer WM, Lamprecht B, et al. Group BCR. Worldwide patterns of bronchodilator responsiveness: results from the Burden of Obstructive Lung Disease study[J]. Thorax, 2012, 67(8): 718-726. doi: 10.1136/thoraxjnl-2011-201445 pmid: 22544896
[23]	Ward H, Cooper BG, Miller MR. Improved criterion for assessing lung function reversibility[J]. Chest, 2015, 148(4): 877-886. doi: S0012-3692(15)50275-4 pmid: 25879725
[24]	Koga T, Kamimura T, Oshita Y, et al. Determinants of bronchodilator responsiveness in patients with controlled asthma[J]. J Asthma, 2006, 43(1): 71-74. pmid: 16448969
[25]	Burity EF, Pereira CA, Jones MH, et al. Bronchodilator response cut-off points and FEV_0.75 reference values for spirometry in preschoolers[J]. J Bras Pneumol, 2016, 42(5): 326-332. doi: 10.1590/S1806-37562015000000216
[26]	Chen C, Jian W, Gao Y, et al. Early COPD patients with lung hyperinflation associated with poorer lung function but better bronchodilator responsiveness[J]. Int J Chron Obstruct Pulmon Dis, 2016, 11: 2519-2526. doi: 10.2147/COPD
[27]	Lee JS, Huh JW, Chae EJ, et al. Response patterns to bronchodilator and quantitative computed tomography in chronic obstructive pulmonary disease[J]. Clin Physiol Funct Imaging, 2012, 32(1): 12-18. doi: 10.1111/cpf.2011.32.issue-1
[28]	Song TW, Kim KW, Kim ES, et al. Utility of impulse oscillometry in young children with asthma[J]. Pediatr Allergy Immunol, 2008, 19(8): 763-768. doi: 10.1111/pai.2008.19.issue-8
[29]	Sheen YH, Jee HM, Ha EK, et al. Impulse oscillometry and spirometry exhibit different features of lung function in bronchodilation[J]. J Asthma, 2018, 55(12): 1343-1351. doi: 10.1080/02770903.2017.1418884 pmid: 29300537
[30]	Batmaz SB, Kuyucu S, Arıkoglu T, et al. Impulse oscillometry in acute and stable asthmatic children: a comparison with spirometry[J]. J Asthma, 2016, 53(2): 179-186. doi: 10.3109/02770903.2015.1081699 pmid: 26367097
[31]	Shin YH, Jang SJ, Yoon JW, et al. Oscillometric and spirometric bronchodilator response in preschool children with and without asthma[J]. Can Respir J, 2012, 19(4): 273-277. doi: 10.1155/2012/560323 pmid: 22891189
[32]	Rao DR, Gaffin JM, Baxi SN, et al. The utility of forced expiratory flow between 25% and 75% of vital capacity in predicting childhood asthma morbidity and severity[J]. J Asthma, 2012, 49(6): 586-592. doi: 10.3109/02770903.2012.690481 pmid: 22742446
[33]	Galant SP, Morphew T, Guijon O, et al. The bronchodilator response as a predictor of inhaled corticosteroid responsiveness in asthmatic children with normal baseline spirometry[J]. Pediatr Pulmonol, 2014, 49(12): 1162-1169. doi: 10.1002/ppul.v49.12
[34]	Fernandes AL, Amorim MM, Caetano LB, et al. Bronchodilator response as a hallmark of uncontrolled asthma: a randomised clinical trial[J]. J Asthma, 2014, 51(4): 405-410. doi: 10.3109/02770903.2013.878845 pmid: 24404797
[35]	中国医药教育协会儿科专业委员会, 中华医学会儿科学分会呼吸学组, 中华医学会儿科学分会新生儿学组, 等. 支气管肺发育不良的儿童期管理专家共识[J]. 中华实用儿科临床杂志, 2022, 37(20): 1527-1538.
[36]	Simpson SJ, Turkovic L, Wilson AC, et al. Lung function trajectories throughout childhood in survivors of very preterm birth: a longitudinal cohort study[J]. Lancet Child Adolesc Health, 2018, 2(5): 350-359. doi: S2352-4642(18)30064-6 pmid: 30169268
[37]	Islam JY, Keller RL, Aschner JL, et al. Understanding the short- and long-term respiratory outcomes of prematurity and bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2015, 192(2): 134-156. doi: 10.1164/rccm.201412-2142PP
[38]	Duijts L, van Meel ER, Moschino L, et al. European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia[J]. Eur Respir J, 2020, 55(1): 1900788. doi: 10.1183/13993003.00788-2019
[39]	Doyle LW, Andersson S, Bush A, et al. Expiratory airflow in late adolescence and early adulthood in individuals born very preterm or with very low birthweight compared with controls born at term or with normal birthweight: a meta-analysis of individual participant data[J]. Lancet Respir Med, 2019, 7(8): 677-686. doi: 10.1016/S2213-2600(18)30530-7 pmid: 31078498
[40]	Barker AF, Bergeron A, Rom WN, et al. Obliterative bronchiolitis[J]. N Engl J Med, 2014, 370(19): 1820-1828. doi: 10.1056/NEJMra1204664
[41]	Jerkic S P, Brinkmann F, Calder A, et al. Postinfectious bronchiolitis obliterans in children: diagnostic workup and therapeutic options: a workshop report[J]. Can Respir J, 2020, 2020: 5852827.
[42]	仲玉强. 肥胖对支气管哮喘患儿肺功能和炎性因子的影响[J]. 中华实用儿科临床杂志, 2016, 31(21): 1668-1670.
[43]	Barjaktarevic I, Kaner R, Buhr RG, et al. Bronchodilator responsiveness or reversibility in asthma and COPD - a need for clarity[J]. Int J Chron Obstruct Pulmon Dis, 2018, 13: 3511-3513. doi: 10.2147/COPD
[44]	Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests[J]. Eur Respir J, 2005, 26(5): 948-968. doi: 10.1183/09031936.05.00035205 pmid: 16264058

支气管舒张剂	停用时间/h
吸入型短效（SABA，如沙丁胺醇、特布他林）	8
吸入型中效（如异丙托溴胺）	24
吸入型长效（LABA，如沙美特罗、福莫特罗）	24~48
口服型短效（如氨茶碱）	12
口服型长效（如缓释茶碱或LABA）	24~48

药物剂型及规格	<6岁	6~12岁	>12岁
0.5%硫酸沙丁胺醇溶液/mL	0.500	0.750	1.000
0.2%硫酸沙丁胺醇溶液/mL	1.250	1.875	2.500
沙丁胺醇气雾剂/100 μg·掀^-1	200 μg	200 μg	400 μg
0.25%特布他林溶液/mL	体重<20 kg者1 mL，体重≥20 kg 者2 mL

Bronchodilation test and its clinical application in children

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 44

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LIN Jinfeng, CHEN Yi, DENG Yan, FENG Ai, HUANG Juan, CHEN Lizhu, XIE Jingqi, NIE Xiaojing. A comparative study on the detection of anti-Nephrin antibodies in children's nephrotic syndrome by chemiluminescence method and cell-based assay [J]. Journal of Clinical Pediatrics, 2026, 44(8): 682-689.
[2]	ZHENG Fangyuan, WANG Miao, DING Mingming, LU Aidong, JIA Yueping, ZENG Huimin, ZHANG Leping. Next-generation sequencing identified gene variants and their prognostic impact in pediatric Philadelphia chromosome positive acute lymphoblastic leukemia [J]. Journal of Clinical Pediatrics, 2026, 44(8): 690-697.
[3]	ZHANG Xiao, FANG Hongjun, KUANG Xiaojun, WANG Lijuan, WU Zhao, JIANG Sha, LI Pei, WU Liwen. Analysis of the clinical and electrophysiological characteristics of atonic seizures in children [J]. Journal of Clinical Pediatrics, 2026, 44(8): 698-704.
[4]	WANG Mengqian, YANG Hui. Case series analysis of 13 intestinal Behcet’s syndrome in children [J]. Journal of Clinical Pediatrics, 2026, 44(8): 705-711.
[5]	WU Xirong, GAO Qi, GUO Siyuan, YIN Qingqin, QIN Qiang, YIN Ju, JIAO Anxia, CHEN Chenghao, WU Di, WANG Bei, DUAN Xiaomin, PENG Yun, XU Baoping, GAO Liwei. Clinical characteristics and prognosis of pulmonary mucormycosis in children with diabetes mellitus [J]. Journal of Clinical Pediatrics, 2026, 44(8): 712-720.
[6]	HAN Yanan, GE Lanlan, CUI Jieyuan. A case report of branchio-oto-renal syndrome caused by EYA1 gene variant with a 6-year follow-up [J]. Journal of Clinical Pediatrics, 2026, 44(8): 721-726.
[7]	SHI Jiayi, GAO Chunlin, JIA Lili, LU Yunyun, SUN Tao, ZHU Xiaodong, XIA Zhengkun, ZHANG Pei. Phenotypic characteristics and prognostic analysis of a pedigree with childhood isolated nephrotic syndrome caused by compound heterozygous mutations in the COQ2 gene [J]. Journal of Clinical Pediatrics, 2026, 44(8): 727-732.
[8]	Rachel Rosen, Osvaldo Borrelli, Christophe Faure, Katja Karrento, Usha Krishnan, Samuel Nurko, Nathalie Rommel, Alan Silverman, Michiel van Wijk, Marc Benninga (Author), Chinese Medical Association Parenteral and Enteral Nutrition Branch Pediatrics Group, The Subspecialty Group of Gastroenterology, The Society of Pediatric, Chinese Medical Association, Gastroenterology Group, Pediatrician Branch, Chinese Medical Doctor Association (Translator). Core interpretation and explanation of Rome Ⅴ diagnostic criteria: upper gastrointestinal disorders of gut-brain interaction in children and adolescents [J]. Journal of Clinical Pediatrics, 2026, 44(7): 595-608.
[9]	Carlo Di Lorenzo, Miguel Saps, Bruno P. Chumpitazi, Shaman Rajindrajith, Annamaria Staiano, Nikhil Thapar, Miranda van Tilburg, Carlos Velasco-Benítez, Arine Vlieger (Author), Chinese Medical Association Parenteral and Enteral Nutrition Branch Pediatrics Group, The Subspecialty Group of Gastroenterology, The Society of Pediatric, Chinese Medical Association, Gastroenterology Group, Pediatrician Branch, Chinese Medical Doctor Association (Translator). Core interpretation and explanation of Rome Ⅴ diagnostic criteria: lower and biliary disorders of gut-brain interaction in children and adolescents [J]. Journal of Clinical Pediatrics, 2026, 44(7): 609-621.
[10]	LI Xufeng, TANG Haoxun, LI Xingjun, ZHANG Lize, GAO Chenqing, ZHAO Shunying, LIU Jianhua. Clinical characteristics, chest CT imaging phenotypes, and their correlation with prognosis in 76 children with Chlamydia pneumoniae pneumonia [J]. Journal of Clinical Pediatrics, 2026, 44(7): 622-627.
[11]	WANG Zhen, SHAO Jingbo, ZHANG Na, XIA Min, ZHU Jiashi, DU Chengkan, LI Hong. Factors influencing long-term recurrence in pediatric acute lymphoblastic leukemia patients with low-risk disease at initial diagnosis: a five-year follow-up analysis of 254 cases from a single center [J]. Journal of Clinical Pediatrics, 2026, 44(7): 628-635.
[12]	GUO Xuemei, XUE Yao, WANG Yongren, RONG Liucheng, FANG Yongjun, LIN Rufeng. Clinical features and prognosis of childhood acute myeloid leukemia with CBFA2T3::GLIS2 fusion [J]. Journal of Clinical Pediatrics, 2026, 44(7): 636-643.
[13]	YANG Lijun, FU Dongxia, CUI Yan, YANG Junmei, ZHANG Liming. Clinical manifestation and genetic analysis of CHARGE syndrome caused by CHD7 gene variation [J]. Journal of Clinical Pediatrics, 2026, 44(7): 644-650.
[14]	HU Yan, YANG Fan, LIANG Aimin, MAO Meng. Identification and management of faltering growth in children: insights from the 13th International Conference on Nutrition and Growth [J]. Journal of Clinical Pediatrics, 2026, 44(6): 485-488.
[15]	LIU Ziyao, WANG Congying, WANG Hongmao, ZHANG Mingming, XU Yingjie, LAI Jianming, NIU Wenquan, LI Xiaohui. Early differentiation of Kawasaki disease with joint symptoms and systemic juvenile idiopathic arthritis with Kawasaki disease-like symptoms: a single-center retrospective study [J]. Journal of Clinical Pediatrics, 2026, 44(6): 489-498.