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.
Sharma
Sunita
S
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. ssharma4@partners.org
Litonjua
Augusto A
AA
Tantisira
Kelan G
KG
Fuhlbrigge
Anne L
AL
Szefler
Stanley J
SJ
Strunk
Robert C
RC
Zeiger
Robert S
RS
Murphy
Amy J
AJ
Weiss
Scott T
ST
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