bachelorThesis
Exactitud diagnostica de la prueba de provocación bronquial con metacolina y la clínica del paciente, en la confirmación de asma en niños
Fecha
2018Autor
Mancera González, Sandra Milena
Dueñas, Elida
Giraldo Cadavid, Luis Fernando
Aguirre Franco, Carlos Eduardo
Institución
Resumen
Introduction: Asthma is considered one of the most frequent chronic diseases in childhood and can continue into adulthood. Its diagnosis is fundamentally clinical and pulmonary function tests confirm it; However, in a high percentage of children, spirometry is normal and in them the bronchial provocation tests, such as methacholine can establish, in conjunction with the clinic, the probability of presenting the disease. Objective: To determine the diagnostic accuracy of the bronchial provocation test with methacholine and the patient`s clinic, to confirm the diagnosis of asthma in a cohort of children between 6 and 15 years of age. Method: A Phase III study of Diagnostic Test was carried out, in which a cohort of pediatric patients at risk of having asthma assessed by Pediatric Pulmonology was taken, who had undergone the Methacholine test from July 2013 to December. 2016 Results: We analyzed the determinant variables of the clinical diagnosis of asthma, finding that cough is the most prevalent symptom with 82. 3%. It was complemented with the therapeutic response to the controller treatment (48. 2%) during the follow-up. Of the total sample, 116 patients met criteria for clinical diagnosis of asthma and this was severe in 18. 4% of cases; moderate in 36. 2% and mild in the rest. The result of the methacholine examination showed that 89 patients of the total have positive bronchial hyperresponsiveness. 24. 8% showed mild bronchial hyperresponsiveness, followed by borderline bronchial hyperresponsiveness and moderate to severe with 22. 0% and 16. 3% respectively. Diagnostic performance curves (ROC curves) were constructed: the area under the curve (AUC-ROC) was calculated for PC20, the percentage of fall of FEV1 and the response to the inhaled bronchodilator; all three variables showed a significant difference with an acceptable AUC-ROC for PC20 (AUC-ROC: 0. 7, 95% CI: 0. 59-0. 82, P < 0. 001), percent drop in FEV1 (AUC-ROC: 0. 77, 95% CI : 0. 66-0. 87; P < 0. 001), response of FEV1 to the bronchodilator (AUC-ROC: 0. 7, 95% CI: 0. 61-0. 84, P < 0. 001). Conclusions: The methacholine test has an acceptable diagnostic capacity for pediatric patients with suspected asthma and it becomes an important tool to analyze the correlation between clinical and functional parameters; which optimizes the accuracy of the diagnosis and therefore the response to the controller treatment. From the variables analyzed and to optimize their diagnostic performance, it is important to consider PC20 together, the percentage of fall of FEV1 and the response to the inhaled bronchodilator.