The prevalence of bronchial hyperresponsiveness in elementary school children and its associated factors

Mi Suk Kim; Young Ho Kim; Dong In Suh; Young Yull Koh; Byoung-Ju Kim; Hyo Bin Kim; So Yeon Lee; Dae Jin Song; Woo-Kyung Kim; Gwang Cheon Jang; Jung Yeon Shim; Soo-Jong Hong; Ji-Won Kwon

doi:10.4168/aard.2014.2.3.171

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Kim, Kim, Suh, Koh, Kim, Kim, Lee, Song, Kim, Jang, Shim, Hong, and Kwon: The prevalence of bronchial hyperresponsiveness in elementary school children and its associated factors

Original Article

Allergy, Asthma & Respiratory Disease 2014; 2(3): 171-178.

Published online: 31 July 2014

DOI: https://doi.org/10.4168/aard.2014.2.3.171

The prevalence of bronchial hyperresponsiveness in elementary school children and its associated factors

Mi Suk Kim¹, Young Ho Kim^1,², Dong In Suh¹, Young Yull Koh¹, Byoung-Ju Kim³, Hyo Bin Kim⁴, So Yeon Lee⁵, Dae Jin Song⁶, Woo-Kyung Kim⁷, Gwang Cheon Jang⁸, Jung Yeon Shim⁹, Soo-Jong Hong^10,¹¹, Ji-Won Kwon^1,²

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

²Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

³Department of Pediatrics, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

⁴Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

⁵Department of Pediatrics, Hallym University Secred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

⁶Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

⁷Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

⁸Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

⁹Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

¹⁰Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

¹¹Research Center for Standardization of Allergic Diseases, Seoul, Korea.

Correspondence to: Ji-Won Kwon. Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. Tel: +82-31-787-7296, Fax: +82-31-787-4054, pedas@snubh.org

Received 26 August 2013 Revised 10 October 2013 Accepted 16 October 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

We investigated the prevalence of bronchial hyperresponsiveness (BHR) and its associated factors in population-based elementary school children.

Methods

Methacholine bronchial provocation tests were performed on 1,151 elementary school children and BHR was defined as PC₂₀ (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV₁]) ≤8 mg/mL. We analyzed the prevalence of BHR according to age and sex. The Korean version of International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, skin prick test, pulmonary function test, and blood tests were performed to determine associated factors for BHR.

Results

A total of 1,106 students eligible for provocation tests were included in the analysis. The overall prevalence of PC₂₀ ≤8 mg/mL was 11.5% (95% confidence interval, 10.6-13.4) and BHR decreased with age (P-value for trend <0.001). Younger age (adjusted odds ratio [aOR], 0.860; P=0.032), higher blood eosinophil % (aOR, 1.151; P=0.001), lower predictive % of FEV₁ (aOR, 0.977; P=0.029), fraction of exhaled nitric oxide (FeNO) ≥25 ppb (aOR, 2.118; P=0.025), and sensitization to mites (aOR, 1.705; P=0.034) were associated with BHR. Preterm birth (aOR, 2.056; P=0.068) showed borderline significance. The associated factors for BHR with atopy were lower body mass index (aOR, 0.838; P=0.005), preterm birth (aOR, 4.361; P=0.003), and FeNO ≥25 ppb (aOR, 2.161; P=0.043). Younger age (aOR, 0.810; P=0.037) and higher blood eosinophil % (aOR, 1.296; P<0.001) were associated with BHR without atopy.

Conclusion

The prevalence of BHR decreased with age in elementary school children. Younger age, preterm birth, eosinophilia, sensitization to mites, lower lung function, and higher FeNO level were independently associated with BHR.

Keywords: Bronchial hyperreactivity, Prevalence, Associated factors, Child

Figures and Tables

Fig. 1

Scheme of subject eligibility for the study. Total 1,106 students eligible for provocation tests were included in the analysis (82.7%).

Fig. 2

Prevalence of bronchial hyperresponsiveness (PC₂₀≤8 mg/mL) according to age and sex. The P value for trend was 0.009 in males, 0.001 in females, and <0.001 in total subjects. There were no sex differences in each age; PC₂₀, provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second.

Table 1

Characteristics of the subjects

Values are presented as number (%) or mean±standard deviation.

KRW, Korean Won (the currency of South Korea); IgE, immunoglobulin E; FeNO, fraction of exhaled nitric oxide.

Table 2

Prevalence of wheezing, asthma, and bronchial hyperresponsiveness (BHR)

CI, confidence interval; PC₂₀, provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second.

Table 3

Associated factors for bronchial hyperresponsiveness (PC₂₀≤8 mg/mL) in elementary school children

aOR: adjusted by age, sex, body mass index, personal AD, parental asthma, maternal education, monthly income, environmental tobacco smoke, log IgE, eosinophil percent, predictive % of FEV₁, and atopy on skin prick test.

PC₂₀, provocative concentration of methacholine causing a 20% fall in FEV₁; OR, odds ratio; CI, confidence interval; aOR, adjusted OR; AD, atopic dermatitis; AR, allergic rhinitis; IgE, immunogloulin E; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; FeNO, fraction of exhaled nitric oxide.

Table 4

Associated factors for bronchial hyperresponsiveness (PC₂₀≤8 mg/mL) according to atopy

PC₂₀, provocative concentration of methacholine causing a 20% fall in FEV₁; aOR, adjusted odds ratio; CI, confidence interval; AD, atopic dermatitis; AR, allergic rhinitis; IgE, immunogloulin E; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; FeNO, fraction of exhaled nitric oxide.

Notes

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare, Republic of Korea (A092076).

References

1. Kim YH, Urm SH, Kim WK. Prevalence of allergic diseases and risk factors in preschool children, 2009. Pediatr Allergy Respir Dis. 2011; 21:165–175.

2. Kwon JW, Kim BJ, Song Y, Seo JH, Kim TH, Yu J, et al. Changes in the prevalence of childhood asthma in seoul from 1995 to 2008 and its risk factors. Allergy Asthma Immunol Res. 2011; 3:27–33.

3. Jee HM, Kim KW, Kim CS, Sohn MH, Shin DC, Kim KE. Prevalence of asthma, rhinitis and eczema in Korean children using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. Pediatr Allergy Respir Dis. 2009; 19:165–172.

4. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Korean J Pediatr. 2008; 51:343–350.

5. Lee HB, Shin SA, Oh JW. New patterns of childhood asthma pevalence in six Asian countries: comparison of ISAAC phases I and III. Pediatr Allergy Respir Dis. 2008; 18:70–77.

6. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006; 368:733–743.

7. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet. 1998; 351:1225–1232.

8. Asher MI, Weiland SK. ISAAC Steering Committee. The International Study of Asthma and Allergies in Childhood (ISAAC). Clin Exp Allergy. 1998; 28:Suppl 5. 52–66.

9. Cockcroft DW, Davis BE. Mechanisms of airway hyperresponsiveness. J Allergy Clin Immunol. 2006; 118:551–559.

10. Park JJ, Kim JJ, Kang IJ. The risk factors for persistence of asthma symptoms from late childhood to early adult life: the effects of pulmonary function and bronchial hyperresponsiveness. Pediatr Allergy Respir Dis. 2008; 18:138–147.

11. Roorda RJ, Gerritsen J, van Aalderen WM, Schouten JP, Veltman JC, Weiss ST, et al. Follow-up of asthma from childhood to adulthood: influence of potential childhood risk factors on the outcome of pulmonary function and bronchial responsiveness in adulthood. J Allergy Clin Immunol. 1994; 93:575–584.

12. Arshad SH, Kurukulaaratchy RJ, Fenn M, Matthews S. Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age. Chest. 2005; 127:502–508.

13. Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ. 2009; 181:E181–E190.

14. Wong GW, Leung TF, Fok TF. ISAAC and risk factors for asthma in the Asia-Pacific. Paediatr Respir Rev. 2004; 5:Suppl A. S163–S169.

15. Homer RJ, Elias JA. Airway remodeling in asthma: therapeutic implications of mechanisms. Physiology (Bethesda). 2005; 20:28–35.

16. Schwartz J, Schindler C, Zemp E, Perruchoud AP, Zellweger JP, Wuthrich B, et al. Predictors of methacholine responsiveness in a general population. Chest. 2002; 122:812–820.

17. Kim BS, Jin HS, Kim HB, Lee SY, Kim JH, Kwon JW, et al. Airway hyperresponsiveness is associated with total serum immunoglobulin E and sensitization to aeroallergens in Korean adolescents. Pediatr Pulmonol. 2010; 45:1220–1227.

18. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000; 161:309–329.

19. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005; 26:319–338.

20. Pyun BY, Kim WK, Park YM, Kim JH, Song TW, Kim HH, et al. Pediatric allergy immunology pulmonology. 2nd ed. Seoul: Yeomungak;2013.

21. Mochizuki H, Shigeta M, Kato M, Maeda S, Shimizu T, Mirokawa A. Age-related changes in bronchial hyperreactivity to methacholine in asthmatic children. Am J Respir Crit Care Med. 1995; 152:906–910.

22. Montgomery GL, Tepper RS. Changes in airway reactivity with age in normal infants and young children. Am Rev Respir Dis. 1990; 142(6 Pt 1):1372–1376.

23. Mochizuki H, Arakawa H, Tokuyama K, Morikawa A. Effect of age on bronchial reactivity in children with asthma. J Asthma. 2006; 43:25–29.

24. Lee SI. Prevalence of childhood asthma in Korea: international study of asthma and allergies in childhood. Allergy Asthma Immunol Res. 2010; 2:61–64.

25. Hong SJ. Epidemiology of childhood asthma and allergic diseases. Pediatr Allergy Respir Dis. 2007; 17:S55–S66.

26. Narang I, Baraldi E, Silverman M, Bush A. Airway function measurements and the long-term follow-up of survivors of preterm birth with and without chronic lung disease. Pediatr Pulmonol. 2006; 41:497–508.

27. Halvorsen T, Skadberg BT, Eide GE, Roksund O, Aksnes L, Oymar K. Characteristics of asthma and airway hyper-responsiveness after premature birth. Pediatr Allergy Immunol. 2005; 16:487–494.

28. Kotecha SJ, Watkins WJ, Paranjothy S, Dunstan FD, Henderson AJ, Kotecha S. Effect of late preterm birth on longitudinal lung spirometry in school age children and adolescents. Thorax. 2012; 67:54–61.

29. Nelson HS, Szefler SJ, Jacobs J, Huss K, Shapiro G, Sternberg AL. The relationships among environmental allergen sensitization, allergen exposure, pulmonary function, and bronchial hyperresponsiveness in the Childhood Asthma Management Program. J Allergy Clin Immunol. 1999; 104(4 Pt 1):775–785.

30. Uhm TG, Kim BS, Chung IY. Eosinophil development, regulation of eosinophil-specific genes, and role of eosinophils in the pathogenesis of asthma. Allergy Asthma Immunol Res. 2012; 4:68–79.

31. Jansen DF, Rijcken B, Schouten JP, Kraan J, Weiss ST, Timens W, et al. The relationship of skin test positivity, high serum total IgE levels, and peripheral blood eosinophilia to symptomatic and asymptomatic airway hyperresponsiveness. Am J Respir Crit Care Med. 1999; 159:924–931.

32. Steerenberg PA, Janssen NA, de Meer G, Fischer PH, Nierkens S, van Loveren H, et al. Relationship between exhaled NO, respiratory symptoms, lung function, bronchial hyperresponsiveness, and blood eosinophilia in school children. Thorax. 2003; 58:242–245.

33. Juusela M, Pallasaho P, Sarna S, Piirila P, Lundback B, Sovijarvi A. Bronchial hyperresponsiveness in an adult population in Helsinki: decreased FEV1, the main determinant. Clin Respir J. 2013; 7:34–44.

34. Song YJ, Heo SY, Kang IJ. Relationship between allergen sensitization and frequency of asthma in preschool atopic dermatitis children. Pediatr Allergy Respir Dis. 2006; 16:216–224.

35. Simpson A, Soderstrom L, Ahlstedt S, Murray CS, Woodcock A, Custovic A. IgE antibody quantification and the probability of wheeze in preschool children. J Allergy Clin Immunol. 2005; 116:744–749.

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