Severe airway hyperresponsiveness was not predictable with the use of current tools in asthmatic children in general practice.
OBJECTIVE
To evaluate whether moderate to severe airway hyperresponsiveness (AHR) could be suspected with the use of routinely available clinical and environmental information.


METHODS
Cross-sectional study of asthma in 526 asthmatics aged 7-17 years and treated in general practice.


RESULTS
Moderate to severe AHR was present in 48% (n=253) of the participants. The presence of inhalation allergy, nocturnal symptoms, and usage of beta2-mimetics were significantly associated with moderate to severe AHR. If all three factors were present, the probability of the presence of moderate to severe and severe AHR was 76% and 36%, respectively. If all three were absent, the probability decreased to 11% and 5%, respectively. In 319 subjects (64%) AHR could not be adequately predicted with routinely available information.


CONCLUSIONS
Moderate and severe AHR could not be suspected with the use of routinely available clinical and environmental information in the majority of children. Except for a subgroup of children, our models were not helpful in deciding in which child an inhaled corticosteroid should be started or whether the dose should be increased or decreased. We recommend measuring the severity of AHR in these children by means of an inhalation challenge test.
Hagmolen Of Ten Have
W
W
Flevohospital, Department of Pediatrics, Almere, The Netherlands. wandahoth@hotmail.com
van den Berg
N J
NJ
van der Palen
J
J
van Aalderen
W M C
WM
Bindels
P J E
PJ
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D001985:Bronchial Provocation Tests; D002648:Child; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D005194:Family Practice; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D018579:Patient Selection; D010366:Peak Expiratory Flow Rate; D012307:Risk Factors; D012720:Severity of Illness Index
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids