New application of point-of-care lung ultrasound in pediatric asthma exacerbations

Aim: Regarding the persistent difficulty of accurately diagnosing asthma exacerbations in children, the assessment of Lung ultrasound (LUS) might be a particularly exciting option. Our aim was to assess the comparative accuracy of LUS and spirometry in the diagnosis of asthma exacerbation. Materials and Methods: Seventy eligible patients, 5-18 years of age, admitted to an asthma outpatient clinic and fifty controls were included in our cross-sectional study. Information on asthma symptoms was obtained by an asthma questionnaire. LUS and spirometry were applied to all participants. We evaluated the performance of both tests by calculating specificity, sensibility, negative predictive value (NPV), positive predictive value (PPV), and accuracy and their corresponding 95% Confidence Intervals (95% CI). Results: LUS was positive in 54 asthmatics (83,1%), of whom 81.5% presented multiple B lines, 51.9% micro-consolidation, 18.5% macro-consolidation, 44.4% pleural thickening and 35.2% pleural effusion. The presence of asthma exacerbation was correctly identified by spirometry in 40% of the cases. LUS had a significantly higher accuracy (0.90 vs 0.65, p<0.0001 with McNemar test) sensitivity (0.83, 95%CI 0.75-0.91 vs 0.40, 95% 0.32-0.50), and NPV (0.81, 95% IC 0.78-0.89 vs 0.54, 95% IC 0.45-0.63) than spirometry for diagnosing asthma exacerbation in all participants. Conclusions: LUS is much more useful in excluding a diagnosis of asthma than in establishing one because its NPV is greater than its PPV. We believe that in clinical practice LUS in combination with clinical findings and spirometry might have the important potential to improve the diagnosis and the management of asthma in children.