ASTHMA

Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age

C S Devulapalli^1,2, K C L Carlsen^1,3, G Håland¹, M C Munthe-Kaas^1,3, M Pettersen², P Mowinckel¹, K-H Carlsen^2,3

¹ Department of Paediatrics, Division of Woman and Child, Ullevål University Hospital, Oslo, Norway
² Voksentoppen, Department of Paediatrics, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway
³ The Medical Faculty, University of Oslo, Oslo, Norway

Dr K-H Carlsen, Voksentoppen, Department of Paediatrics, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, University of Oslo, NO-0791 Oslo, Norway; k.h.carlsen{at}medisin.uio.no

Background: Predicting school-age asthma from obstructive airways disease (OAD) in early life is difficult, even when parental and children’s atopic manifestations are taken into consideration.

Objective: To assess if the severity of OAD in the first 2 years of life predicts asthma at 10 years of age.

Methods: From a nested case control study within the Environment and Childhood Asthma study, 233 2-year-old subjects with recurrent (2 episodes) bronchial obstruction (rBO+) and 216 subjects without bronchial obstruction (rBO–) underwent clinical examination, parental interview, treadmill test and metacholine bronchial hyperresponsiveness (BHR) measurement at 10 years. A severity score at 2 years was calculated by frequency, persistence of bronchial obstruction and hospital admissions because of OAD.

Main outcomes: Current asthma at 10 years (asthma with symptoms and/or asthma medication during the past year and/or positive treadmill test). Secondary outcome was metacholine BHR at 10 years.

Results: Compared with rBO– subjects, adjusted odds ratio (95% CI) of current asthma among rBO+ was 7.9 (4.1, 15.3), and among rBO+ with a severity score of >5, 20.2 (9.9, 41.3). In receiver operated characteristic analysis, positive and negative predictive values demonstrated the applicability and value of the score, with an optimal cut-off at severity score 5. Children with severity score >5 had severe BHR more often (PD₂₀ metacholine <1 µmol) than children with a lower or 0 score (p = 0.0041).

Conclusion: Using a simple scoring system, a high severity score of OAD by 2 years of age is a strong risk factor for, and may predict, current asthma at 10 years of age.

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