Predictors of late asthmatic response. Logistic regression and classification tree analyses.
To identify predictors of the late asthmatic response (LAR), we reviewed data from 60 asthmatic subjects who had undergone allergen challenge over the past 5 yr (33 females, age 31.4 +/- 6.7 yr [mean +/- SD], FEV(1) 90% +/- 14% predicted). Variables considered likely predictors of LAR included baseline FEV(1), PC(20) methacholine (PC(20)), sputum eosinophil percent, and the decrease in FEV(1) within 20 min of allergen challenge. A LAR (FEV(1) >/= 15% fall between 3 and 7 h after challenge) was documented in 57% of subjects. A variety of logistic regression methods revealed a significant inverse association between LAR and PC(20) (odds ratio [OR] = 0.14 [95% CI = 0.03-0.66]) and a positive association between LAR and the decrease in FEV(1) at 20 min (OR = 1.18 [1.04 -1.33]). Classification tree analysis revealed that a threshold of 0.25 mg/ml for PC(20) was most predictive of LAR; LAR developed in 87% of those with PC(20) </= 0.25 mg/ml (n = 23) and in 38% of those with PC(20) > 0.25 mg/ml (n = 37). Notably, in subjects with PC(20) > 0.25 mg/ml, the incidence of LAR increased from 38% to 57% if the allergen-induced decline in FEV(1) at 20 min was >/= 27%. Surprisingly, baseline FEV(1) and percent eosinophils in induced sputum were not significantly associated with LAR. We conclude that a threshold value of 0.25 mg/ml for PC(20) methacholine is a good predictor of LAR. Measuring the PC(20) methacholine may be useful as a screening method to improve the efficiency of identifying asthmatic subjects with a LAR.
Avila
P C
PC
Cardiovascular Research Institute, Department of Medicine, University of California at San Francisco, San Francisco, California 94143-0111, USA.
Segal
M R
MR
Wong
H H
HH
Boushey
H A
HA
Fahy
J V
JV
D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis* / Q000503:physiopathology; D001985:Bronchial Provocation Tests / Q000706:statistics & numerical data; D004804:Eosinophils / Q000276:immunology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis* / Q000503:physiopathology; D007958:Leukocyte Count; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012130:Respiratory Hypersensitivity / Q000175:diagnosis* / Q000503:physiopathology