HM Boezen, DS Postma, JP Schouten, HA Kerstjens and B Rijcken
Department of Epidemiology, University of Groningen, The Netherlands.

We investigated the coherence of bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability in their relation to allergy markers and respiratory symptoms in 399 subjects (20-70 yr). Bronchial hyperresponsiveness to methacholine was defined by both the provocative dose causing a fall in FEV1 of 20%, and the dose-response slope. PEF variability was determined as diurnal PEF variation (amplitude percent mean) and between-day PEF variation. Skin tests positivity, serum total IgE, and specific IgE (RAST) for house-dust mite (HDM), cat, timothy grass, and birch ("pollen") were determined, as well as the number of peripheral blood eosinophils. Wheeze and nocturnal dyspnea were defined as asthma-like symptoms; dyspnea > or = grade 3, cough and phlegm as chronic obstructive pulmonary disease (COPD)-like symptoms. The reciprocal of the dose-response slope and PEF variability were significantly correlated (r = -0.39). Subjects with a positive skin test for HDM (odds ratio [OR] = 3.9), cat (OR = 8.3), or pollen (OR = 3.6), or specific IgE for HDM (OR = 2.3), cat (OR = 3.4), or pollen (OR = 1.9) had increased risk of BHR compared with the reference group (all p values < 0.05). Higher levels of serum total IgE were significantly associated with higher odds for BHR (OR = 2.5 per log unit). There was no significant association between skin test positivity, serum total IgE, or presence of specific IgE and PEF variability. Neither BHR nor PEF variability were associated with higher numbers of peripheral blood eosinophils. There are different associations of BHR and PEF variability with allergy markers. Although BHR and PEF variability are significantly correlated, they cannot be used interchangeably in epidemiologic settings.

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