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Am. J. Respir. Crit. Care Med., Volume 162, Number 5, November 2000, 1723-1730

Sex-specific Effects of Asthma on Pulmonary Function in Children

KIROS BERHANE, ROB MCCONNELL, FRANK GILLILAND, TALAT ISLAM, W. JAMES GAUDERMAN, EDWARD AVOL, STEPHANIE J. LONDON, ED RAPPAPORT, HELENE G. MARGOLIS, and JOHN M. PETERS

Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, California; National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina; and California Air Resources Board, Sacramento, California

To evaluate the effects on lung function of asthma, time since diagnosis of asthma, and age at diagnosis of asthma, we examined school children in a cohort of 2,277 fourth- and seventh-graders at least twice during a 4-yr follow-up period. Sex-specific models for each lung function were fitted through mixed-effects models that used regression splines and captured age-dependent trends in the effect of asthma on lung function. In males, a history of asthma was associated with large and statistically significant deficits in maximum midexpiratory flow (MMEF) (-4.89%) and forced expiratory flow at 75% of expired FVC (FEF75) (-6.62%), whereas in females these deficits were smaller (-1.93% and -2.45%, respectively) and were not statistically significant. However, larger deficits were seen in both males and females with longer time since diagnosis. In males with more than 6 yr since diagnosis, there were significant deficits in FEV1 (-3.91%), MMEF (-7.39%), FEF75 (-8.12%), and peak expiratory flow rate (PEFR) (-4.65%) as compared with children with less than 3 yr since diagnosis. There were fewer females with more than 6 yr since diagnosis, but deficits were similar to those of males for FEV1 (-2.52%), MMEF (-9.26%), and FEF75 (-14.28%). Large deficits in flow rates in both large and small airways were observed in males and females for whom asthma was reported to have been diagnosed before age 3 yr. There was little evidence that lung growth in children with asthma "catches up" at older ages. Therefore, because a constant percent deficit in lung function implies an increasingly large absolute deficit in older children with larger lungs, these results are consistent with prior evidence that lung function deficits in children with asthma persist into adulthood. We also suggest that in children, commonly observed differences between sexes in the impact of asthma on lung function may reflect differences in the duration and age of onset of asthma in males and females.




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