Published ahead of print on January 23, 2004, doi:10.1164/rccm.200304-556OC
Am. J. Respir. Crit. Care Med., Volume 169, Number 7, April 2004, 850-854
A more recent version of this article appeared on April 1, 2004
Submitted on April 22, 2003
Accepted on January 15, 2004
Lung Function, Bronchial Responsiveness and Asthma in a Community Cohort of 6 year-old Children
Jacqui Joseph-Bowen1, Nicholas H de Klerk2, Martin J Firth2, Garth E Kendall3, Patrick G Holt4, and Peter D Sly1*
1 Clinical Sciences, University of Western Australia, Telethon Institute for Child Health Research and Centre for Child Health Research, Perth, Western Australia, Australia,
2 Biostatistics and Genetic Epidemiology, University of Western Australia, Telethon Institute for Child Health Research and Centre for Child Health Research, Perth, Western Australia, Australia,
3 Population Sciences, University of Western Australia, Telethon Institute for Child Health Research and Centre for Child Health Research, Perth, Western Australia, Australia,
4 Cell Biology, University of Western Australia, Telethon Institute for Child Health Research, Perth, Western Australia, Australia
* To whom correspondence should be addressed. E-mail: peters{at}ichr.uwa.edu.au.
Children as young as 6 years old can perform spirometry, yet the relationship between current asthma, lung function and bronchial responsiveness has not been described at this age. 2537 children from a community-based birth cohort were assessed at 6 years of age, with history (n=2141), physical examination (n=1995), standard spirometry (n=1735) and a random sample (n=711) offered methacholine challenge. Males had greater values of FVC and FEV1 but not of FEF25-75 or FEV1/FVC than females. The greatest influences on lung function at 6 years were height, sex, birth weight and wheezing in the first year of life. Children with current asthma had small but significant deficits in lung function and were more sensitive to methacholine. The optimal cut-point for determining heightened bronchial responsiveness was found to be a 15% fall in FEV1 at a dose of 1.8 mg/ml. A negative test could be useful in excluding a diagnosis of asthma (negative predictive value 92%). Lung function testing, including methacholine challenge, is feasible in five to seven year-old children and has the potential to contribute to clinical management of children with asthma.
Key words: birth cohort, spirometry, forced expiration, methacholine challenge
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