Pediatr Allergy Respir Dis.  2012 Dec;22(4):364-373.

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

• Lee JK
• Lee EJ
• Song JH
• Suh DI
• Koh YY

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)< or =8 mg/mL. MBCT was performed at the school age with spirometric method. Positive BHR was defined as PC20< or =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.

Keyword

Asthma; Bronchial hyperresponsiveness; Children; Cough; Development; Methacholine; Preschool

MeSH Terms

Aged
Asthma
Auscultation
Bronchial Provocation Tests
Child
Child, Preschool
Cough
Follow-Up Studies
Humans
Medical Records
Methacholine Chloride
Oxygen
Phosphorylcholine
Prevalence
Respiratory Sounds
Methacholine Chloride
Oxygen
Phosphorylcholine

Figure

• 

  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).

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