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Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 447-454

Bronchodilator Responsiveness in Normal Infants and Young Children

AMY B. GOLDSTEIN, ROBERT G. CASTILE, STEPHANIE D. DAVIS, DAVID A. FILBRUN, ROBERT L. FLUCKE, KAREN S. McCOY, and ROBERT S. TEPPER

Section of Pediatric Pulmonary Medicine, Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; and Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University Medical Center, Indianapolis, Indiana

Several studies have demonstrated that normal infants exhibit bronchoconstriction after inhalation of nonspecific agonists and that the induced airway narrowing can be reversed by the inhalation of a beta -agonist. However, there are very limited data on baseline airway tone and the airway response to a beta -agonist in this subject population. The purpose of our study was to evaluate in normal infants baseline airway responsiveness to the inhaled beta -agonist, albuterol, using changes in maximal expiratory flows. Forty-one healthy infant volunteers with no history of respiratory disease or recurrent wheezing (ages 5.4 to 141.4 wk) were studied. Maximal expiratory flow- volume curves were obtained at baseline and 10 min after inhalation of albuterol (n = 28) or placebo (n = 13) using a metered-dose inhaler with a spacer. The mean percent change was significantly greater (p < 0.05) in the albuterol versus placebo group for FEV0.5 (2.2% versus -1.5%), FEF75% (10.6% versus -3.1%), and FEF85% (12.9% versus 0.5%). Six of 28 albuterol-treated infants demonstrated increases in FEF75% greater than two standard deviations from the mean change in FEF75% seen in the placebo group. These infants were younger and more frequently exposed to maternal smoking during pregnancy. We conclude that normal healthy infants have overall levels of baseline airway tone that are similar to that reported in adults and older children; however, among the infants we evaluated the response to an inhaled bronchodilator was greatest in the youngest infants and in those exposed to tobacco smoking.

Keywords: airway responsiveness; asthma; tobacco smoke; infant pulmonary function; bronchodilator




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