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Published ahead of print on March 17, 2004, doi:10.1164/rccm.200308-1174OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 3, August 2004, 234-241

A more recent version of this article appeared on August 1, 2004
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Submitted on September 3, 2003
Accepted on March 15, 2004

Progression of Asthma Measured by Lung Function in the Childhood Asthma Management Program

Ronina A Covar1, Joseph D Spahn1, James R Murphy2, and Stanley J Szefler1*

1 Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology, National Jewish Medical and Research Center, Denver, CO, USA; Division of Allergy-Clinical Immunology and Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO, USA, 2 Division of Biostatistics, National Jewish Medical and Research Center, Denver, CO, USA

* To whom correspondence should be addressed. E-mail: szeflers{at}njc.org.

From the Childhood Asthma Management Program cohort who were randomly assigned to receive budesonide, nedocromil, or placebo for 4-6 years, we determined the prevalence of and factors associated with at least 1%/ year loss in post-bronchodilator FEV1 % predicted. SRP, which refers to participants who had a significant reduction in post-bronchodilator FEV1 % predicted, comprised 25.7% of the cohort (n=990). Using logistic regression, predictors of SRP at baseline were younger age (p= 0.0005), male gender (p<0.0001), clinic (p= 0.02), and higher post-bronchodilator FEV1 % predicted (p= 0.02). Examination of the SRP indicated that the effect of baseline lung function was such that the higher the lung function, the less steep the reduction in post-bronchodilator FEV1 % predicted (p<0.0001). A similar proportion of SRP was found in each treatment group. Among the SRP, the rate of reduction in post-bronchodilator FEV1 % predicted was similar in all treatment groups. At a single site where biomarker assessment was performed, SRP also had more prominent eosinophilic inflammation during the washout period. The course and mechanisms of lung function reduction or slow lung growth velocity in children with asthma must be defined.
Key words: Asthma progression, Markers of inflammation, Airway inflammation




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