| Title | Clinical predictors and outcomes of consistent bronchodilator response in the childhood asthma management program. | | Author(s) | Sharma S, Litonjua AA, Tantisira KG, Fuhlbrigge AL, Szefler SJ, Strunk RC, Zeiger RS, Murphy AJ, Weiss ST, Childhood Asthma Management Program Research Group | | Institution | Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass; Center for Genomic Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass. | | Source | J Allergy Clin Immunol 2008 Nov; 122(5):921-928.e4. | | Abstract | BACKGROUND: Among asthmatic subjects, bronchodilator response (BDR) to inhaled beta(2)-adrenergic agonists is variable, and the significance of a consistent response over time is unknown.
OBJECTIVE: We assessed baseline clinical variables and determined the clinical outcomes associated with a consistently positive BDR over 4 years in children with mild-to-moderate persistent asthma.
METHODS: In the 1041 participants in the Childhood Asthma Management Program, subjects with a change in FEV(1) of 12% or greater (and 200 mL) after inhaled beta(2)-agonist administration at each of their yearly follow-up visits (consistent BDR) were compared with those who did not have a consistent BDR.
RESULTS: We identified 52 children with consistent BDRs over the 4-year trial. Multivariable logistic regression modeling demonstrated that lower baseline prebronchodilator FEV(1) values (odds ratio, 0.71; P < .0001), higher log10 IgE levels (odds ratio, 1.97; P = .002), and lack of treatment with inhaled corticosteroids (odds ratio, 0.31; P = .009) were associated with a consistent BDR. Individuals who had a consistent BDR had more hospital visits (P = .007), required more prednisone bursts (P = .0007), had increased nocturnal awakenings caused by asthma (P < .0001), and missed more days of school (P = .03) than nonresponders during the 4-year follow-up.
CONCLUSIONS: We have identified predictors of consistent BDR and determined that this phenotype is associated with poor clinical outcomes. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 18848350 |
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