Bronchodilation and bronchoconstriction: predictors of future lung function in childhood asthma.
BACKGROUND
Persistently low levels of lung function are associated with subsequent symptoms in patients with asthma as children.


OBJECTIVE
We hypothesized that objective measures of baseline pulmonary function would be independently associated with future lung function in the Childhood Asthma Management Program and that these associations might vary with treatment.


METHODS
We evaluated the association of FEV1, airway responsiveness, and bronchodilator response at randomization as predictors of longitudinal growth in FEV1 at the 48-month follow-up visit in the 1041 Childhood Asthma Management Program participants.


RESULTS
Baseline levels of airway responsiveness and bronchodilator response were significantly associated with baseline level of lung function. In multivariate models, higher bronchodilator response (beta = 0.22; P < .0001), log PC20 (beta = 1.82; P < .0001), and FEV1 (beta = 0.58; P < .0001) at randomization were each associated with higher levels of prebronchodilator FEV1, as a percent of predicted, after 4 years. Similar associations were noted for prebronchodilator forced vital capacity and FEV1/forced vital capacity ratio. Baseline bronchodilator response was a particularly powerful predictor of lung function improvements while on inhaled corticosteroids, whereas airway responsiveness was a better predictor in subjects not randomized to any controller medications.


CONCLUSIONS
We conclude that baseline bronchodilator response, airway responsiveness, and level of FEV1 are independent predictors of subsequent level of FEV1 in childhood asthma and may have treatment-specific prognostic significance for persistence of symptoms into early adulthood.


CONCLUSIONS
In asthma, bronchodilator and bronchoconstrictor responses are independent predictors of future lung function and should not be used interchangeably; bronchodilator response may indicate good response to inhaled corticosteroids.
Tantisira
Kelan G
KG
Channing Laboratory, Pulmonary Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. kelan.tantisira@channing.harvard.edu
Fuhlbrigge
Anne L
AL
Tonascia
James
J
Van Natta
Mark
M
Zeiger
Robert S
RS
Strunk
Robert C
RC
Szefler
Stanley J
SJ
Weiss
Scott T
ST
D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D016084:Bronchoconstriction / Q000187:drug effects*; D001993:Bronchodilator Agents / Q000494:pharmacology*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D015337:Multicenter Studies as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012129:Respiratory Function Tests
D001993:Bronchodilator Agents