Bronchodilation and bronchoconstriction: Predictors of future lung function in childhood asthma - 20/08/11
, Anne L. Fuhlbrigge, MD, MS a, b, James Tonascia, PhD d, Mark Van Natta, MHS d, Robert S. Zeiger, MD, PhD e, f, Robert C. Strunk, MD g, Stanley J. Szefler, MD h, Scott T. Weiss, MD, MS afor the Childhood Asthma Management Program Research Group
Reprint requests: Kelan Tantisira, MD, MPH, Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115.Boston, Mass, Baltimore, Md, San Diego and La Jolla, Calif, St Louis, Mo, and Denver, Colo
Abstract |
Background |
Persistently low levels of lung function are associated with subsequent symptoms in patients with asthma as children.
Objectives |
We hypothesized that objective measures of baseline pulmonary function would be independently associated with future lung function in the Childhood Asthma Management Program and that these associations might vary with treatment.
Methods |
We evaluated the association of FEV1, airway responsiveness, and bronchodilator response at randomization as predictors of longitudinal growth in FEV1 at the 48-month follow-up visit in the 1041 Childhood Asthma Management Program participants.
Results |
Baseline levels of airway responsiveness and bronchodilator response were significantly associated with baseline level of lung function. In multivariate models, higher bronchodilator response (β = 0.22; P < .0001), log PC20 (β = 1.82; P < .0001), and FEV1 (β = 0.58; P < .0001) at randomization were each associated with higher levels of prebronchodilator FEV1, as a percent of predicted, after 4 years. Similar associations were noted for prebronchodilator forced vital capacity and FEV1/forced vital capacity ratio. Baseline bronchodilator response was a particularly powerful predictor of lung function improvements while on inhaled corticosteroids, whereas airway responsiveness was a better predictor in subjects not randomized to any controller medications.
Conclusion |
We conclude that baseline bronchodilator response, airway responsiveness, and level of FEV1 are independent predictors of subsequent level of FEV1 in childhood asthma and may have treatment-specific prognostic significance for persistence of symptoms into early adulthood.
Clinical implications |
In asthma, bronchodilator and bronchoconstrictor responses are independent predictors of future lung function and should not be used interchangeably; bronchodilator response may indicate good response to inhaled corticosteroids.
Le texte complet de cet article est disponible en PDF.Key words : FEV1, PC20, methacholine, bronchodilator, corticosteroid, asthma, natural history
Abbreviations used : BD, CAMP, FVC, lnPC20
Plan
| The CAMP is supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051, M01RR0099718-24, M01RR02719-14, and RR00036 from the National Center for Research Resources. This work was supported by U01 HL65899: The Pharmacogenetics of Asthma Treatment and P01 HL67664: The CAMP Genetics Ancillary Study from the National Heart, Lung, and Blood Institute. This study was performed in part in the General Clinical Research Centers at Washington University School of Medicine (M01 RR00036) and National Jewish Medical and Research Center (M01 RR00051). Disclosure of potential conflict of interest: A. Fuhlbrigge has consultant arrangements with GlaxoSmithKline and has served on their advisory board, and has received grants from Boehringer Ingelheim, and Sepracor served on the Data Safety Monitoring Board for a clinical trial. R. Zeiger has consultant arrangements with Aerocrine, AstraZeneca, Genentech, GlaxoSmithKline, and Novartis, and has received grants from AstraZeneca, the National Heart, Lung, and Blood Institute, GlaxoSmithKline, Merck, and Sanofi-Aventis. S. Szefler has consultant arrangements with AstraZeneca, Aventis, GlaxoSmithKline, and Merck, and has received grants from the National Institutes of Health, the National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases, and Ross Pharmaceuticals. S. Weiss has consultant arrangements with Glaxo-Wellcome, Roche Pharmaceuticals, Millennium Pharmaceuticals, Genentech, Schering-Plough, Variagenics, Genome Therapeutics, and Merck Frost; has received grants from Glaxo-Wellcome, AstraZeneca, and Pfizer; and is on The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens Board with Genentech. The rest of the authors have declared that they have no conflict of interest. |
Vol 117 - N° 6
P. 1264-1271 - juin 2006 Retour au numéro
Article précédent
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