Does Bronchial Hyperresponsiveness in Childhood Predict Active Asthma in Adolescence?

• Published in: American journal of respiratory and critical care medicine Vol. 186; no. 6; pp. 493 - 500
• Main Authors: RIISERE, Amund, HOVLAND, Vegard, CARLSEN, Kai-Hakon, MOWINCKEL, Petter, LØDRUP CARLSEN, Karin C
• Format: Journal Article
• Language: English
• Published: New York, NY American Thoracic Society 15-09-2012
• Subjects: Adolescent; Age; Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Asthma; Asthma - diagnosis; Asthma - drug therapy; Asthma - epidemiology; Asthma, Exercise-Induced - diagnosis; Asthma, Exercise-Induced - drug therapy; Asthma, Exercise-Induced - epidemiology; Biological and medical sciences; Bronchial Hyperreactivity - diagnosis; Bronchial Hyperreactivity - drug therapy; Bronchial Hyperreactivity - epidemiology; Bronchial Provocation Tests - methods; Child; Chronic obstructive pulmonary disease, asthma; Cohort Studies; Disease Progression; Drug dosages; Exercise Test - methods; Female; Fitness equipment; Follow-Up Studies; Humans; Intensive care medicine; Kaplan-Meier Estimate; Male; Medical sciences; Methacholine Chloride; Multivariate Analysis; Odds Ratio; Pneumology; Predictive Value of Tests; Prevalence; Prospective Studies; Respiratory Function Tests; Risk Assessment; ROC Curve; Sex Factors; Surveys and Questionnaires; Time Factors; Human; Lung disease; Intensive care; Respiratory disease; children; Bronchus disease; Obstructive pulmonary disease; bronchial hyperresponsiveness; Child; Resuscitation; Asthma
• DOI: 10.1164/rccm.201112-2235OC
• EISSN: 1535-4970
• ISSN: 1073-449X

Bronchial hyperresponsiveness (BHR) is an important, but not specific, asthma characteristic.
We aimed to assess the predictive value of BHR tested by methacholine and exercise challenge at age 10 years for active asthma 6 years later.
From a Norwegian birth cohort, 530 children underwent methacholine challenge and exercise-induced bronchoconstriction (EIB) test (n = 478) at 10 years and structured interview and clinical examination at age 16 years. The methacholine dose causing 20% reduction in FEV(1) (PD(20)) and the reduction in FEV(1) (%) after a standardized treadmill test were used for BHR assessment. Active asthma was defined with at least two criteria positive: doctor's diagnosis of asthma, symptoms of asthma, and/or treatment for asthma in the last year.
PD(20) and EIB at 10 years of age increased the risk of asthma (β = 0.94 [95% confidence interval (CI), 0.92-0.96] per μmol methacholine and β = 1.10 [95% CI, 1.06-1.15] per %, respectively). Separately the tests explained 10 and 7%, respectively, and together 14% of the variation in active asthma 6 years later. The predicted probability for active asthma at the age of 16 years increased with decreasing PD(20) and increasing EIB. The area under the curve (receiver operating characteristic curves) was larger for PD(20) (0.69; 95% CI, 0.62-0.75) than for EIB (0.60; 95% CI, 0.53-0.67).
BHR at 10 years was a significant but modest predictor of active asthma 6 years later, with methacholine challenge being superior to exercise test.