Allergy Asthma Respir Dis.  2014 Mar;2(1):23-29. 10.4168/aard.2014.2.1.23.

Relationship between duration of disease and bronchial responsiveness in 6-8 years old children with asthma

• Shim E
• Yu J

• KMID: 2168568
• DOI: http://doi.org/10.4168/aard.2014.2.1.23

Abstract

PURPOSE
Bronchial hyperresponsiveness is considered as a hallmark of asthma. The duration of asthma was demonstrated to be associated with bronchial responsiveness, expressed as methacholine PC20. We investigated the relationship between duration of asthma and percentage fall in forced vital capacity (FVC) at PC20 (DeltaFVC), another index of bronchial responsiveness, which reflects excessive bronchoconstriction.
METHODS
Six- to 8-year-old children with asthma underwent methacholine inhalation test. The PC20 and DeltaFVC were calculated for each individual. The subjects were classified into those with wheezing onset in the first three years of life (early-onset asthma [EA], n=63) and those with wheezing onset from three years onwards (late-onset asthma [LA], n=99).
RESULTS
From the time of wheezing onset, duration of asthma ranged from 0.2 to 8.3 years. The mean duration of asthma in patients with EA was 5.6 years (standard deviation [SD], 1.2 years), compared with 2.2 years (SD, 1.3 years) in the patients with LA. Patients with EA had a significantly lower forced expiratory volume in 1 second/FVC than did those with LA (84.6%+/-5.9% vs. 86.8%+/-5.1%, P<0.05). The DeltaFVC was significantly higher in patients with EA than in those with LA (19.4%+/-5.1% vs. 17.0%+/-4.5%, P<0.01), but PC20 was not different between the two groups. In total subjects, asthma duration correlated significantly with DeltaFVC (r=0.222, P<0.01), but not with PC20.
CONCLUSION
These data suggest that prolonged asthma is associated with worsened bronchial responsiveness during childhood, and such an association may be reflected primarily by DeltaFVC rather than PC20.

Keyword

Asthma duration; Bronchial hyperreactivity; FVC; PC20

MeSH Terms

Asthma*
Bronchial Hyperreactivity
Bronchoconstriction
Child*
Forced Expiratory Volume
Humans
Inhalation
Methacholine Chloride
Respiratory Sounds
Vital Capacity
Methacholine Chloride

Figure

• 

  Fig. 1 Correlation between duration of asthma and ΔFVC (r=0.222, P<0.05). ΔFVC, forced vital capacity at PC20.

Reference

1. Brannan JD, Lougheed MD. Airway hyperresponsiveness in asthma: mechanisms, clinical significance, and treatment. Front Physiol. 2012; 3:460.

2. Hargreave FE, Dolovich J, O'Byrne PM, Ramsdale EH, Daniel EE. The origin of airway hyperresponsiveness. J Allergy Clin Immunol. 1986; 78(5 Pt 1):825–832.

3. Cockcroft DW, Killian DN, Mellon JJ, Hargreave FE. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977; 7:235–243.

4. Sterk PJ, Bel EH. Bronchial hyperresponsiveness: the need for a distinction between hypersensitivity and excessive airway narrowing. Eur Respir J. 1989; 2:267–274.

5. Gibbons WJ, Sharma A, Lougheed D, Macklem PT. Detection of excessive bronchoconstriction in asthma. Am J Respir Crit Care Med. 1996; 153:582–589.

6. Zeiger RS, Dawson C, Weiss S. Relationships between duration of asthma and asthma severity among children in the Childhood Asthma Management Program (CAMP). J Allergy Clin Immunol. 1999; 103(3 Pt 1):376–387.

7. Cassino C, Berger KI, Goldring RM, Norman RG, Kammerman S, Ciotoli C, et al. Duration of asthma and physiologic outcomes in elderly nonsmokers. Am J Respir Crit Care Med. 2000; 162(4 Pt 1):1423–1428.

8. Hudon C, Turcotte H, Laviolette M, Carrier G, Boulet LP. Characteristics of bronchial asthma with incomplete reversibility of airflow obstruction. Ann Allergy Asthma Immunol. 1997; 78:195–202.

9. Little SA, MacLeod KJ, Chalmers GW, Love JG, McSharry C, Thomson NC. Association of forced expiratory volume with disease duration and sputum neutrophils in chronic asthma. Am J Med. 2002; 112:446–452.

10. Olaguibel Rivera JM, Alvarez-Puebla MJ, Puy Uribe San Martín M, Tallens Armand ML. Duration of asthma and lung function in life-long nonsmoking adults. J Investig Allergol Clin Immunol. 2007; 17:236–241.

11. Agertoft L, Pedersen S. Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med. 1994; 88:373–381.

12. Porpodis K, Papakosta D, Manika K, Kontakiotis T, Gaga M, Sichletidis L, et al. Long-term prognosis of asthma is good--a 12-year follow-up study. Influence of treatment. J Asthma. 2009; 46:625–631.

13. Dompeling E, van Schayck CP, van Grunsven PM, van Herwaarden CL, Akkermans R, Molema J, et al. Slowing the deterioration of asthma and chronic obstructive pulmonary disease observed during bronchodilator therapy by adding inhaled corticosteroids. A 4-year prospective study. Ann Intern Med. 1993; 118:770–778.

14. Limb SL, Brown KC, Wood RA, Wise RA, Eggleston PA, Tonascia J, et al. Irreversible lung function deficits in young adults with a history of childhood asthma. J Allergy Clin Immunol. 2005; 116:1213–1219.

15. Obase Y, Shimoda T, Kawano T, Saeki S, Tomari S, Izaki K, et al. Bronchial hyperresponsiveness and airway inflammation in adolescents with asymptomatic childhood asthma. Allergy. 2003; 58:213–220.

16. Boulet LP, Turcotte H, Laviolette M, Naud F, Bernier MC, Martel S, et al. Airway hyperresponsiveness, inflammation, and subepithelial collagen deposition in recently diagnosed versus long-standing mild asthma. Influence of inhaled corticosteroids. Am J Respir Crit Care Med. 2000; 162(4 Pt 1):1308–1313.

17. Urbano FL. Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. J Manag Care Pharm. 2008; 14:41–49.

18. Chai H, Farr RS, Froehlich LA, Mathison DA, McLean JA, Rosenthal RR, et al. Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol. 1975; 56:323–327.

19. American Thoracic Society. Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med. 1995; 152:1107–1136.

20. Yoon KA, Lim HS, Koh YY, Kim H. Normal predicted values of pulmonary function test in Korean school-aged children. J Korean Pediatr Soc. 1993; 36:25–37.

21. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. The Group Health Medical Associates. Asthma and wheezing in the first six years of life. N Engl J Med. 1995; 332:133–138.

22. Kupczyk M, Kuprys I, Gorski P, Kuna P. Long-term deterioration of lung function in asthmatic outpatients. Respiration. 2004; 71:233–240.

23. Weiss ST, Van Natta ML, Zeiger RS. Relationship between increased airway responsiveness and asthma severity in the childhood asthma management program. Am J Respir Crit Care Med. 2000; 162:50–56.

24. Lee P, Abisheganaden J, Chee CB, Wang YT. A new asthma severity index: a predictor of near-fatal asthma? Eur Respir J. 2001; 18:272–278.

25. Abisheganaden J, Chan CC, Chee CB, Wang YT. Methacholine-induced fall in forced vital capacity as a marker of asthma severity. Respir Med. 1999; 93:277–282.

26. Oga T, Nishimura K, Tsukino M, Hajiro T, Ikeda A. Changes in indices of airway hyperresponsiveness during one year of treatment with inhaled corticosteroids in patients with asthma. J Asthma. 2001; 38:133–139.

27. Cuttitta G, Cibella F, Bellia V, Grassi V, Cossi S, Bucchieri S, et al. Changes in FVC during methacholine-induced bronchoconstriction in elderly patients with asthma: bronchial hyperresponsiveness and aging. Chest. 2001; 119:1685–1690.

28. Zapletal A, Paul T, Samanek M. Pulmonary elasticity in children and adolescents. J Appl Physiol. 1976; 40:953–961.

29. Lim TK, Ang SM. Excessive bronchoconstriction induced by histamine and effects of volume history in patients with bronchial asthma. Respirology. 1997; 2:107–112.

30. Lambert RK, Wiggs BR, Kuwano K, Hogg JC, Pare PD. Functional significance of increased airway smooth muscle in asthma and COPD. J Appl Physiol (1985). 1993; 74:2771–2781.

31. James AL, Pare PD, Hogg JC. The mechanics of airway narrowing in asthma. Am Rev Respir Dis. 1989; 139:242–246.

32. Kimura K, Inoue H, Ichinose M, Miura M, Katsumata U, Takahashi T, et al. Bradykinin causes airway hyperresponsiveness and enhances maximal airway narrowing. Role of microvascular leakage and airway edema. Am Rev Respir Dis. 1992; 146(5 Pt 1):1301–1305.

33. Busse W, Elias J, Sheppard D, Banks-Schlegel S. Airway remodeling and repair. Am J Respir Crit Care Med. 1999; 160:1035–1042.

34. Wiggs BR, Moreno R, Hogg JC, Hilliam C, Pare PD. A model of the mechanics of airway narrowing. J Appl Physiol (1985). 1990; 69:849–860.

35. Paré PD, Roberts CR, Bai TR, Wiggs BJ. The functional consequences of airway remodeling in asthma. Monaldi Arch Chest Dis. 1997; 52:589–596.

36. Rasmussen F, Taylor DR, Flannery EM, Cowan JO, Greene JM, Herbison GP, et al. Risk factors for airway remodeling in asthma manifested by a low postbronchodilator FEV1/vital capacity ratio: a longitudinal population study from childhood to adulthood. Am J Respir Crit Care Med. 2002; 165:1480–1488.

37. Niimi A, Matsumoto H, Amitani R, Nakano Y, Mishima M, Minakuchi M, et al. Airway wall thickness in asthma assessed by computed tomography. Relation to clinical indices. Am J Respir Crit Care Med. 2000; 162(4 Pt 1):1518–1523.

38. Bai TR, Cooper J, Koelmeyer T, Pare PD, Weir TD. The effect of age and duration of disease on airway structure in fatal asthma. Am J Respir Crit Care Med. 2000; 162(2 Pt 1):663–669.

39. Macklem PT. A theoretical analysis of the effect of airway smooth muscle load on airway narrowing. Am J Respir Crit Care Med. 1996; 153:83–89.

40. Ding DJ, Martin JG, Macklem PT. Effects of lung volume on maximal methacholine-induced bronchoconstriction in normal humans. J Appl Physiol (1985). 1987; 62:1324–1330.