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(Chest. 2004;126:1060-1065.)
© 2004 American College of Chest Physicians

Adenosine Bronchial Provocation With Computerized Wheeze Detection in Young Infants With Prolonged Cough*

Correlation With Long-term Follow-up

Lea Bentur, MD; Raphael Beck, MD, FCCP; Drora Berkowitz, MD; Jamal Hasanin, MD; Irit Berger, MD; Nael Elias, MD and Noam Gavriely, MD, DSc

* From the Pediatric Pulmonology Unit (Drs. Bentur, Beck, Hasanin, Berger, and Elias) and the Gastroenterology Unit (Dr. Berkowitz), Department of Pediatrics, Meyer Children’s Hospital, Rambam Medical Center, Haifa, Israel; and the Department of Physiology and Biophysics (Dr. Gavriely), the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Correspondence to: Lea Bentur, MD, Director, Pediatric Pulmonary Unit, Rambam Medical Center, PO Box 9602, Haifa, Israel 31096; e-mail: l_bentur{at}rambam.health.gov.il

Background: Chronic cough in babies is often associated with bronchial hyperreactivity (BHR). The objective documentation of BHR in babies is difficult, and acoustic methods have been described (provocative concentration of a substance causing wheeze) for conducting bronchial provocation tests (BPTs). We conducted a study to evaluate automatic computerized wheeze detection (CWD) in determining BHR in young infants with prolonged cough, and its correlation with the subsequent development of wheezing.

Methods: Infants aged < 24 months with prolonged cough (ie, > 2 months) underwent acoustic BPTs with the response determined by CWD and auscultation by a physician. Telephone interviews with parents were conducted after 1 month and yearly for the next 3 years.

Results: A total of 28 infants who were 4 to 24 months old with prolonged cough were included in the study. Twenty of these infants (71.4%) had BHR as determined by a positive acoustic BPT result. In 11 of these 20 tests, the CWD occurred earlier, and in 9 tests it occurred at the same step as auscultation by a physician. Rhonchi or whistles often preceded wheezes. Seventeen of the 20 patients with BHR completed 3 years of follow-up. Of these, 14 had recurrent episodes of wheezing and shortness of breath, and 3 were well. Six of the eight adenosine-negative patients completed 3 years of follow-up and had no symptoms of BHR.

Conclusions: Acoustic BPT is a technically feasible test for the detection of BHR in young infants. CWD provides an earlier detection of wheeze than stethoscope auscultation. In our group of infants, a positive acoustic BPT result had high correlation with symptoms compatible with BHR over the next 3 years.

Key Words: adenosine • bronchial provocation • chronic cough • computerized wheeze detection • infants






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