Relationship between Bronchial Hyperresponsiveness and Development of Asthma in Preschool Children with Cough Variant Asthma

Ju Kyung Lee; Eui Jun Lee; Jun Hyuk Song; Dong In Suh; Young Yull Koh

doi:10.7581/pard.2012.22.4.364

Journal List > Pediatr Allergy Respir Dis > v.22(4) > 1033195

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Lee, Lee, Song, Suh, and Koh: Relationship between Bronchial Hyperresponsiveness and Development of Asthma in Preschool Children with Cough Variant Asthma

Original Article

Pediatric Allergy and Respiratory Disease

Pediatric Allergy and Respiratory Disease 2012; 22(4): 364-373.

Published online: 31 December 2012

DOI: https://doi.org/10.7581/pard.2012.22.4.364

Relationship between Bronchial Hyperresponsiveness and Development of Asthma in Preschool Children with Cough Variant Asthma

Ju Kyung Lee, MD, Eui Jun Lee, MD, Jun Hyuk Song, MD, Dong In Suh, MD, Young Yull Koh, MD, PhD

Department of Pediatrics, Seoul National University College of medicine, Seoul, Korea.

Corresponding author (kohyy@plaza.snu.ac.kr)

Received 3 August 2012 Revised 21 August 2012 Accepted 6 October 2012

Abstract

Purpose

A significant proportion of patients with cough variant asthma (CVA) eventually develops asthma. The aim of this study was to investigate the relationship between bronchial hyperresponsiveness (BHR) and development of asthma in preschool children with CVA.

Methods

We reviewed the medical records of children aged 5 to 7 years who presented with chronic cough and had regular check-up by the school age. All children had methacholine bronchial challenge test (MBCT) at preschool age with a modified auscultation method. The end-point was defined as the appearance of wheezing and/or oxygen desaturation. Positive BHR was defined as end-point concentration (EPC)≤8 mg/mL. MBCT was performed at the school age with spirometric method. Positive BHR was defined as PC₂₀≤8 mg/mL. We collected information on the development of wheezing or dyspnoea from the medical records.

Results

Thirty-six children with CVA were analyzed. During follow-up (2.1±0.9 years), 9/36 children developed wheezing or dyspnoea (group A), and 27/36 children did not (group B). EPC (geometric mean, 95% confidence interval) was significantly lower in group A than group B (1.59 mg/mL, 0.93 to 2.70 mg/mL vs. 3.43 mg/mL, 2.34 to 5.03 mg/mL; P=0.02, respectively). The prevalence of positive BHR at school age was significantly higher in group A than group B (77.8% vs. 22.2%, P<0.01).

Conclusion

These results suggest that the increase and the persistence of BHR may have an important role in the development of asthma during the course of CVA in preschool children.

Keywords: Asthma, Bronchial hyperresponsiveness, Children, Cough, Development, Methacholine, Preschool

Figures and Tables

Fig. 1

Frequency of development of asthma according to the level of methacholine endpoint concentration (EPC) at the preschool age. The patients who developed asthma during the course of follow-up period were listed as group A; those who did not were listed as group B. The development of asthma was significantly associated with the level of EPC (chi-square test for linear trend, P=0.02).

Fig. 2

Individual values of end point concentration (EPC) and methacholine provocative concentration of methacholine inducing a 20% fall in forced expiratory volume in 1 second (PC₂₀). The patients who developed asthma during the course of follow up period were listed as group A; those patients who did not were listed as group B. Censored value were included as 200 mg/mL (▵). Positive bronchial hyperresponsivenss (BHR) indicated by horizontal and vertical dotted line. There was no significant correlation between end-point concentration (EPC) and PC₂₀. (P=0.50) However, Group A showed significantly lower EPC and significantly higher prevalence of positive BHR at school age than group B (P=0.02, P<0.01, respectively).

Table 1

Demographic Characteristics of the Two Groups

Data are presented as absolute numbers, mean±standard deviation, or geometric mean (95% confidence interval).

The patients who developed asthma during the course of follow-up period were listed as group A; those who did not were listed as group B.

ECP, eosinophil cationic protein; IgE, immunoglobulin E.

Table 2

Results of Bronchoprovocation Test in the Two Groups

Data are presented as geometric mean (95% confidence interval) or mean±standard deviation.

The patients who developed asthma during the course of follow-up period were listed as group A; those who did not were listed as group B.

EPC, end-point concentration; PC20, provocative concentration of methacholine inducing a 20% fall in forced expiratory volume in 1 second; BHR, bronchial hyperresponsiveness; FEV₁, forced expiratory volume in 1 second.

Table 3

Odds Ratios of Risk Factors for Asthma Development in School Age

CI, confidence interval; EPC, end-point concentration; BHR, bronchial hyperresponsivenss.

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