Clinical predictors and outcomes of consistent bronchodilator response in the childhood asthma management program

• Published in: Journal of allergy and clinical immunology Vol. 122; no. 5; pp. 921 - 928.e4
• Main Authors: Sharma, Sunita, Litonjua, Augusto A., Tantisira, Kelan G., Fuhlbrigge, Anne L., Szefler, Stanley J., Strunk, Robert C., Zeiger, Robert S., Murphy, Amy J., Weiss, Scott T.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2008; Elsevier; Elsevier Limited
• Subjects: Administration, Inhalation; Adrenergic beta-Agonists - administration & dosage; Allergy and Immunology; Asthma; Asthma - diagnosis; Asthma - drug therapy; Asthma - physiopathology; Biological and medical sciences; Bronchodilator Agents - administration & dosage; Budesonide - administration & dosage; Child; consistent bronchodilator response; Double-Blind Method; Drug therapy; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Genotype & phenotype; Hospitalization; Humans; Logistics; Male; Medical sciences; Nedocromil - administration & dosage; outcomes; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Spirometry; Statistical analysis; Statistical methods; Studies; Treatment Outcome; Values; Vital Capacity; ATS; BDR; FVC; outcomes; consistent bronchodilator response; CAMP; Asthma; American Thoracic Society; Childhood Asthma Management Program; Forced vital capacity; Bronchodilator response; Human; Lung disease; Immunopathology; Program; Prognosis; Respiratory disease; Bronchodilator; Prediction; Clinical management; Immunology; Bronchus disease; Evolution; Obstructive pulmonary disease; Predictive factor; Child
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2008.09.004

Among asthmatic subjects, bronchodilator response (BDR) to inhaled β 2-adrenergic agonists is variable, and the significance of a consistent response over time is unknown. 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. 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 β 2-agonist administration at each of their yearly follow-up visits (consistent BDR) were compared with those who did not have a consistent BDR. 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. We have identified predictors of consistent BDR and determined that this phenotype is associated with poor clinical outcomes.