Chest
Volume 113, Issue 4, April 1998, Pages 973-979
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Clinical Investigations: Asthma
Longitudinal Determinants of Bronchial Responsiveness to Inhaled Histamine

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Background and study objective

The point prevalence of bronchial hyperresponsiveness (BHR) is imperfectly associated with current asthma, possibly due to changes over time in bronchial responsiveness (BR). To evaluate cross-sectional and longitudinal determinants of BR, a population sample comprising 408 children and adolescents, aged 7 to 17 years at enrollment, was examined twice, 6 years apart.

Methods

Case history was obtained by interview and questionnaire. BR to inhaled histamine, pulmonary function, and skin prick test reactivity were measured using standard techniques.

Results

The point prevalence of BHR (the concentration of histamine causing a 20% decline in FEV1 <8 mg/mL) declined from childhood to early adulthood (25% and 6%, respectively; p<0.001); and similarly a decline in histamine dose-response slope was observed. At both surveys, prechallenge FEV1 percent predicted, asthma, and atopy, especially atopy to house dust mite (HDM), were important determinants for the degree of BR. After adjustment for prechallenge FEV1 percent predicted, no male-female difference was observed in degree of BR. Lower FEV1 percent predicted (p=0.003), asthma (p<0.001), higher degree of BR (p=0.003), and atopy to HDM (p=0.007) at enrollment predicted a higher degree of BR at the second survey (degree of BR at second survey adjusted for prechallenge FEV1). Furthermore, new asthma (p<0.001) and/or atopy to HDM (p=0.003) were associated with higher BR at the second survey. Confining the analysis to nonasthmatics showed that subjects with new or persistent atopy to HDM had significantly increased BR compared with nonatopic subjects; and, moreover, prechallenge FEV1 percent predicted was significantly correlated with BR.

Conclusions

BR declines from childhood to early adulthood, possibly reflecting the increase in airway caliber. The level of FEV1 and atopy, especially to HDM, are important determinants for changes over time in level of BR, also in nonasthmatic subjects.

Section snippets

Subjects

A sample of 983 children and adolescents living in the area surrounding Rigshospitalet in the city of Copenhagen was drawn at random from the civil registration list in 1986; all subjects were born in the first week of each month with a mean age of 12 years (range, 7 to 17 years). In 1986 (first survey) and 1992 (second survey), all subjects (n=983) were invited by letter to participate in a study concerning asthma, allergy, and BHR.

Of the 983 subjects, 527 (54%) participated in the first

RESULTS

Complete data were available for 408 subjects, 199 male and 209 female; characteristics of the examined subjects are displayed in Table 1. The proportion of subjects with current asthma increased from 5% at the first survey to 15% at the second survey (Table 2); and likewise did the point prevalence of a positive SPT increase from 26 to 44% (Table 2).

The prevalence of a positive histamine challenge test declined from 25% (n= 102) at the first survey to 6% (n=24) at the second survey, of whom 81

DISCUSSION

The present study showed an overall decline in BR to inhaled histamine from childhood to early adulthood, possibly reflecting the growth-related increase in airway caliber, and furthermore, the level of FEV1 %pred, as an index of airway caliber, and atopy, especially to HDMs, are important determinants for changes over time in degree of histamine responsiveness in both asthmatic and nonasthmatic subjects.

The present population study not only confirmed that prechallenge airway caliber has a

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  • Cited by (0)

    This study was supported by the National Union for the Fight Against Lung Diseases.

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