title: Relationship between bronchial hyperresponsiveness and impaired lung function after infantile asthma.
abstract: Wheezing during infancy has been linked to early loss of pulmonary function. We prospectively investigated the relation between bronchial hyperresponsiveness (BHR) and progressive impairment of pulmonary function in a cohort of asthmatic infants followed until age 9 years. We studied 129 infants who had had at least three episodes of wheezing. Physical examinations, baseline lung function tests and methacholine challenge tests were scheduled at ages 16 months and 5, 7 and 9 years. Eighty-three children completed follow-up. Twenty-four (29%) infants had wheezing that persisted at 9 years of age. Clinical outcome at age 9 years was significantly predicted by symptoms at 5 years of age and by parental atopy. Specific airway resistance (sRaw) was altered in persistent wheezers as early as 5 years of age, and did not change thereafter. Ninety-five per cent of the children still responded to methacholine at the end of follow-up. The degree of BHR at 9 years was significantly related to current clinical status, baseline lung function, and parental atopy. BHR at 16 months and 5 years of age did not predict persistent wheezing between 5 and 9 years of age, or the final degree of BHR, but it did predict altered lung function. Wheezing that persists from infancy to 9 years of age is associated with BHR and to impaired lung function. BHR itself is predictive of impaired lung function in children, strongly pointing to early airway remodeling in infantile asthma.
authors.affiliation: Laboratoire d'Explorations Fonctionnelles Respiratoires, Service de Pneumologie et Allergologie Pédiatriques, Hôpital des Enfants Malades, Paris, France. christophe.delacourt@chicreteil.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Delacourt
authors.forename: Marie-Rose
authors.initials: MR
authors.lastname: Benoist
authors.forename: Muriel
authors.initials: M
authors.lastname: Le Bourgeois
authors.forename: Serge
authors.initials: S
authors.lastname: Waernessyckle
authors.forename: Patrick
authors.initials: P
authors.lastname: Rufin
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Brouard
authors.forename: Jacques
authors.initials: J
authors.lastname: de Blic
authors.forename: Pierre
authors.initials: P
authors.lastname: Scheinmann
mesh_terms: D001249:Asthma / Q000503:physiopathology*; D016535:Bronchial Hyperreactivity / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012129:Respiratory Function Tests