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

• Jung S
• Suh DI
• Lee SY
• Yoon J
• Cho HJ
• Kim YH
• Yang SI
• Kwon JW
• Jang GC
• Sun YH
• Woo SI
• Youn YS
• Park KS
• Cho HJ
• Kook MH
• Yi HR
• Chung HL
• Kim JH
• Kim HY
• Jung JA
• Woo HO
• Hong SJ

• KMID: 2418045
• DOI: http://doi.org/10.4168/aair.2018.10.5.466

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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