Published ahead of print on April 17, 2008, doi:10.1164/rccm.200708-1174OC Am. J. Respir. Crit. Care Med., Volume 178, Number 4, August 2008, 325-331 A more recent version of this article appeared on August 15, 2008
Submitted on August 9, 2007 Airway Responsiveness in Mild to Moderate Childhood Asthma: Gender Influences on the Natural HistoryKelan G Tantisira1*,1 Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Pumonary Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, 2 CAMP Coordinating Center, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA, 3 Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA, 4 Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, 5 Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Pumonary Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, 6 Childhood Astma Management Program Research Group, none * To whom correspondence should be addressed. E-mail: kelan.tantisira{at}channing.harvard.edu.
Rationale: Airway responsiveness is a prognostic marker for asthma symptoms in later life.
Objectives: To evaluate characteristics responsible for persistence of airway responsiveness in asthmatic children.
Methods, Measurements, and Main Results: 1041 children initially aged 5-12 with mild to moderate persistent asthma enrolled in the Childhood Asthma Management Program (CAMP) were studied prospectively for 8.6 ± 1.8 years with methacholine challenges yearly. Least squares geometric mean models were fit to determine effects of gender and age on airway responsiveness (provocative concentration producing 20% decrease in FEV1 or PC20). Multiple linear regression analysis was performed to determine factors at baseline and over time which were associated with PC20 at end of follow-up. 7748 methacholine challenges were analyzed. PC20 increased with age, with boys having greater increase after age 11 years than girls (p<0.001). The divergence coincided with the mean age for Tanner stage 2. Post-pubertal girls had greater airway responsiveness, even after adjustment for FEV1 and other potential confounders. While multivariable regression analyses noted a variety of factors that influenced airway responsivness in both genders, a history of hayfever ( Key words: Methacholine, PC20, FEV1, bronchoconstriction, sex
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= -0.30, p=0.005), respiratory allergy (
