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New evidence for the Dutch hypothesis?
  1. D Shaw
  1. Clinical Research Fellow, Glenfield Hospital, Groby Road, Leicester, UK; Dominic.Shawuhl-tr.nhs.uk

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This study, designed to evaluate risk factors for the persistence and relapse of asthma, followed children born in Dunedin, New Zealand between April 1972 and March 1973. A total of 613 subjects (51.4% of the total study population) underwent spirometry, bronchial provocation, allergy testing, and questionnaires at roughly 2 year intervals between the ages of 9 and 26. Overall, one in four had persistent or relapsing wheeze at the age of 26. Wheezing was reported at some point by 72.6% of the population. The risk of persistent/relapsing wheeze was increased by the presence of airway hyperresponsiveness and house dust mite allergy; female subjects were more likely to have persistent wheeze. The chance of relapsing wheeze was greater, the earlier its onset. Compared with the rest of the population, in male subjects with persistent wheeze the fall in the FEV1/FVC ratio was, on average, 6.8% and in female subjects it was 4.7%. However, the slopes of the decline in lung function were similar for all groups, indicating that impairment in lung function existed before the first measurement at the age of 9.

Given this longitudinal decline in lung function, these findings may be considered to support the “Dutch hypothesis” that falling lung function is due to endogenous factors such as airway hyperresponsiveness leading to airway remodelling and the development of COPD. However, data for FEV1 as a percentage of predicted was not presented, and only 51.4% of subjects attended all the visits. Clearly, more long term data are needed in this interesting area of study.

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