Clinical predictors and outcomes of consistent bronchodilator response in the childhood asthma management program.
BACKGROUND
Among asthmatic subjects, bronchodilator response (BDR) to inhaled beta(2)-adrenergic agonists is variable, and the significance of a consistent response over time is unknown.


OBJECTIVE
We assessed baseline clinical variables and determined the clinical outcomes associated with a consistently positive BDR over 4 years in children with mild-to-moderate persistent asthma.


METHODS
In the 1041 participants in the Childhood Asthma Management Program, subjects with a change in FEV(1) of 12% or greater (and 200 mL) after inhaled beta(2)-agonist administration at each of their yearly follow-up visits (consistent BDR) were compared with those who did not have a consistent BDR.


RESULTS
We identified 52 children with consistent BDRs over the 4-year trial. Multivariable logistic regression modeling demonstrated that lower baseline prebronchodilator FEV(1) values (odds ratio, 0.71; P < .0001), higher log10 IgE levels (odds ratio, 1.97; P = .002), and lack of treatment with inhaled corticosteroids (odds ratio, 0.31; P = .009) were associated with a consistent BDR. Individuals who had a consistent BDR had more hospital visits (P = .007), required more prednisone bursts (P = .0007), had increased nocturnal awakenings caused by asthma (P < .0001), and missed more days of school (P = .03) than nonresponders during the 4-year follow-up.


CONCLUSIONS
We have identified predictors of consistent BDR and determined that this phenotype is associated with poor clinical outcomes.
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. ssharma4@partners.org
Sunita
S
Sharma
Augusto A
AA
Litonjua
Kelan G
KG
Tantisira
Anne L
AL
Fuhlbrigge
Stanley J
SJ
Szefler
Robert C
RC
Strunk
Robert S
RS
Zeiger
Amy J
AJ
Murphy
Scott T
ST
Weiss
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D017835:Nedocromil / Q000008:administration & dosage; D013147:Spirometry; D016896:Treatment Outcome; D014797:Vital Capacity
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D017835:Nedocromil; D019819:Budesonide