Allergy Asthma Immunol Res.  2018 Sep;10(5):466-477. 10.4168/aair.2018.10.5.466.

Prevalence, Risk Factors and Cutoff Values for Bronchial Hyperresponsiveness to Provocholine in 7-Year-Old Children

Affiliations
  • 1Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sjhong@amc.seoul.kr
  • 2Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University Hospital, Incheon, Korea.
  • 4Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 5Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 6Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 7Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
  • 8Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea.
  • 9Department of Pediatrics, The Catholic University of Korea College of Medicine, Daejeon, Korea.
  • 10Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea.
  • 11Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
  • 12Department of Pediatrics, Gwangju Veterans Hospital, Gwangju, Korea.
  • 13Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea.
  • 14Department of Pediatrics, Ulsan University Hospital, Ulsan, Korea.
  • 15Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 16Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea.
  • 17Department of Pediatrics, Health Science Institute, Gyeongsang National University College of Medicine, Jinju, Korea.

Abstract

BACKGROUND
A US Food and Drug Administration (FDA)-approved drug methacholine chloride (Provocholine®) was recently introduced to Korea where it is now widely used in clinical practice. We aimed to evaluate the prevalence, risk factors and cutoff value of bronchial hyperresponsiveness (BHR) to Provocholine in 7-year-old children.
METHODS
Six hundred and thirty-three children from the Panel Study on Korean Children who visited 16 regional hospitals were evaluated. Skin prick tests, spirometry and bronchial provocation tests for Provocholine as well as a detailed history and physical examinations were performed. The bronchial provocation test was reliably performed on 559 of these children.
RESULTS
The prevalence of ever-diagnosed asthma via medical records was 7.7%, and that of current asthma (wheezy episode in the last 12 months + diagnosed asthma by physicians) was 3.2%. The prevalence of BHR to Provocholine was 17.2% and 25.8%, respectively, for a PC20 < 8 and < 16 mg/mL. The risk factors for BHR (PC20 < 16 mg/mL) were atopic dermatitis diagnosis and current dog ownership, whereas those for current asthma were allergy rhinitis diagnosis, a history of bronchiolitis before the age of 3, recent use of analgesics/antipyretics and maternal history of asthma. The BHR prevalence trend showed an increase along with the increased immunoglobulin E (IgE) quartile. The cutoff value of PC20 for the diagnosis of current asthma in children at age 7 was 5.8 mg/mL (sensitivity: 47.1%, specificity: 87.4%).
CONCLUSIONS
BHR to Provocholine (PC20 < 8 mg/mL) was observed in 17.2% of 7-year-olds children from the general population and the cutoff value of PC20 for the diagnosis of current asthma was 5.8 mg/mL in this age group. The risk factors for BHR and current asthma showed discrepancies suggesting different underlying mechanisms. Bronchial provocation testing with Provocholine will be a useful clinical tool in the future.

Keyword

Bronchial hyperreactivity; asthma; risk factors; prevalence; ROC curve

MeSH Terms

Animals
Asthma
Bronchial Hyperreactivity
Bronchial Provocation Tests
Bronchiolitis
Child*
Dermatitis, Atopic
Diagnosis
Dogs
Humans
Hypersensitivity
Immunoglobulin E
Immunoglobulins
Korea
Medical Records
Methacholine Chloride*
Ownership
Physical Examination
Prevalence*
Rhinitis
Risk Factors*
ROC Curve
Sensitivity and Specificity
Skin
Spirometry
United States Food and Drug Administration
Immunoglobulin E
Immunoglobulins
Methacholine Chloride

Figure

  • Fig. 1 Flow chart of the study subjects. PSKC, Panel Study on Korean Children; PFT, pulmonary function test.

  • Fig. 2 ROC curve evaluation of the BHR cutoff used to diagnose current asthma in 7-year-old children. ROC, receiver-operating-characteristic; BHR, bronchial hyperresponsiveness; AUC, area under the ROC curve; PC20, provocative concentration of Provocholine that caused a 20% decrease in the baseline FEV1; FEV1, forced expiratory volume in 1 second. *Cutoff values for Provocholine PC20 provided the best combination of diagnostic sensitivity and specificity; †Provocative concentration causing 20% fall in FEV1.

  • Fig. 3 BHR severity across the IgE quartiles. BHR, bronchial hyperresponsiveness; IgE, immunoglobulin E; PC20, provocative concentration of Provocholine that caused a 20% decrease in the baseline FEV1; FEV1, forced expiratory volume in 1 second.


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Allergy Asthma Immunol Res. 2020;12(1):72-85.    doi: 10.4168/aair.2020.12.1.72.

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Reference

1. Nair P, Martin JG, Cockcroft DC, Dolovich M, Lemiere C, Boulet LP, et al. Airway hyperresponsiveness in asthma: measurement and clinical relevance. J Allergy Clin Immunol Pract. 2017; 5:649–659.e2.
Article
2. Kim SW, Han DH, Lee SJ, Lee CH, Rhee CS. Bronchial hyperresponsiveness in pediatric rhinitis patients: the difference between allergic and nonallergic rhinitis. Am J Rhinol Allergy. 2013; 27:e63–e68.
Article
3. Lee E, Lee SH, Kwon JW, Kim YH, Yoon J, Cho HJ, et al. Persistent asthma phenotype related with late-onset, high atopy, and low socioeconomic status in school-aged Korean children. BMC Pulm Med. 2017; 17:45.
Article
4. Kim YH, Lee E, Cho HJ, Yang SI, Jung YH, Kim HY, et al. Association between menarche and increased bronchial hyper-responsiveness during puberty in female children and adolescents. Pediatr Pulmonol. 2016; 51:1040–1047.
Article
5. Thomas AO, Jackson DJ, Evans MD, Rajamanickam V, Gangnon RE, Fain SB, et al. Sex-related differences in pulmonary physiologic outcome measures in a high-risk birth cohort. J Allergy Clin Immunol. 2015; 136:282–287.
Article
6. Harmsen L, Ulrik CS, Porsbjerg C, Thomsen SF, Holst C, Backer V. Airway hyperresponsiveness and development of lung function in adolescence and adulthood. Respir Med. 2014; 108:752–757.
Article
7. Jayet PY, Schindler C, Künzli N, Zellweger JP, Brändli O, Perruchoud AP, et al. Reference values for methacholine reactivity (SAPALDIA study). Respir Res. 2005; 6:131.
Article
8. Joseph-Bowen J, de Klerk NH, Firth MJ, Kendall GE, Holt PG, Sly PD. Lung function, bronchial responsiveness, and asthma in a community cohort of 6-year-old children. Am J Respir Crit Care Med. 2004; 169:850–854.
Article
9. Leynaert B, Bousquet J, Henry C, Liard R, Neukirch F. Is bronchial hyperresponsiveness more frequent in women than in men? A population-based study. Am J Respir Crit Care Med. 1997; 156:1413–1420.
10. Sears MR, Burrows B, Flannery EM, Herbison GP, Hewitt CJ, Holdaway MD. Relation between airway responsiveness and serum IgE in children with asthma and in apparently normal children. N Engl J Med. 1991; 325:1067–1071.
Article
11. Brutsche MH, Downs SH, Schindler C, Gerbase MW, Schwartz J, Frey M, et al. Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA cohort study. Thorax. 2006; 61:671–677.
Article
12. 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.
Article
13. Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ. 2009; 181:E181–E190.
Article
14. Homer RJ, Elias JA. Airway remodeling in asthma: therapeutic implications of mechanisms. Physiology (Bethesda). 2005; 20:28–35.
Article
15. Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD. Tucson Children's Respiratory Study: 1980 to present. J Allergy Clin Immunol. 2003; 111:661–675.
Article
16. Bahk J, Yun SC, Kim YM, Khang YH. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth. 2015; 15:85.
Article
17. 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.
18. Lee SI. Prevalence of childhood asthma in Korea: international study of asthma and allergies in childhood. Allergy Asthma Immunol Res. 2010; 2:61–64.
Article
19. Ahn K, Kim J, Kwon HJ, Chae Y, Hahm MI, Lee KJ, et al. The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: nationwide cross-sectional survey using complex sampling design. J Korean Med Assoc. 2011; 54:769–778.
Article
20. 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.
Article
21. 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.
Article
22. D'Amato G, Pawankar R, Vitale C, Lanza M, Molino A, Stanziola A, et al. Climate change and air pollution: effects on respiratory allergy. Allergy Asthma Immunol Res. 2016; 8:391–395.
23. Kim MS, Kim YH, Suh DI, Koh YY, Kim BJ, Kim HB, et al. The prevalence of bronchial hyperresponsiveness in elementary school children and its associated factors. Allergy Asthma Respir Dis. 2014; 2:171–178.
Article
24. 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.
Article
25. Schwartz J, Schindler C, Zemp E, Perruchoud AP, Zellweger JP, Wüthrich B, et al. Predictors of methacholine responsiveness in a general population. Chest. 2002; 122:812–820.
Article
26. Futrakul S, Deerojanawong J, Prapphal N. Risk factors of bronchial hyperresponsiveness in children with wheezing-associated respiratory infection. Pediatr Pulmonol. 2005; 40:81–87.
Article
27. Ernst P, Ghezzo H, Becklake MR. Risk factors for bronchial hyperresponsiveness in late childhood and early adolescence. Eur Respir J. 2002; 20:635–639.
Article
28. Polgar G, Weng TR. The functional development of the respiratory system from the period of gestation to adulthood. Am Rev Respir Dis. 1979; 120:625–695.
29. Busse WW. The contribution of viral respiratory infections to the pathogenesis of airway hyperreactivity. Chest. 1988; 93:1076–1082.
Article
30. Zhong NS, Chen RC, Yang MO, Wu ZY, Zheng JP, Li YF. Is asymptomatic bronchial hyperresponsiveness an indication of potential asthma? A two-year follow-up of young students with bronchial hyperresponsiveness. Chest. 1992; 102:1104–1109.
31. Lee E, Kim YH, Han S, Yang SI, Jung YH, Seo JH, et al. Different cutoff values of methacholine bronchial provocation test depending on age in children with asthma. World J Pediatr. 2017; 13:439–445.
Article
32. Mitchell EA, Beasley R, Keil U, Montefort S, Odhiambo J; ISAAC Phase Three Study Group. The association between tobacco and the risk of asthma, rhinoconjunctivitis and eczema in children and adolescents: analyses from Phase Three of the ISAAC programme. Thorax. 2012; 67:941–949.
Article
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