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American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 340-345, (2002)
© 2002 American Thoracic Society

Original Article

Improvement in Bronchial Hyperresponsiveness with Inhaled Corticosteroids in Children with Asthma

Importance of Family History of Bronchial Hyperresponsiveness

Young Yull Koh, Myung Hyun Lee, Yong Han Sun, Yang Park and Chang Keun Kim

Department of Pediatrics and Clinical Research Institute, Seoul National University Hospital; and Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea

Correspondence and requests for reprints should be addressed to Dr. Young Yull Koh, Department of Pediatrics, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea. E-mail: kohyy{at}plaza.snu.ac.kr

The extent of improvement in bronchial hyperresponsiveness (BHR) with corticosteroids varies considerably among patients with asthma, although predictive factors for improvement are largely unknown. We tested the hypothesis that the improvement may vary according to family history of BHR. Children with atopic asthma (n = 121) received inhaled budesonide (800 µg per day) regularly for 6 months. Methacholine provocative concentration causing a 20% fall in FEV1 was measured before treatment and again after 3 and 6 months of treatment. A methacholine challenge test was also performed in each patient's parents, and the results were analyzed with regard to their children's response to corticosteroid therapy. When the children were classified into large (n = 40) and small (n = 40) improvement groups after 6 months of treatment, the prevalence of BHR and the bronchial responsiveness index were higher in parents of the small improvement group (28.8%, 1.145 ± 0.104) than in parents of the large improvement group (6.3%, 1.095 ± 0.064; both, p < 0.01). The magnitude of improvement in BHR at 6 months was lower in children with at least one parent with BHR (n = 45; 1.666 ± 1.244 doubling doses) than in children with non-BHR parents (n = 76; 2.531 ± 1.726, p < 0.01). Our results suggest that a family history of BHR may be an important factor in the sensitivity of BHR of individuals with asthma to inhaled corticosteroids.

Key Words: bronchial hyperreactivity • corticosteroids • familial predisposition




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