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Randomized Controlled Trial
. 2008 Nov;122(5):921-928.e4.
doi: 10.1016/j.jaci.2008.09.004. Epub 2008 Oct 10.

Clinical predictors and outcomes of consistent bronchodilator response in the childhood asthma management program

Sunita Sharma  1 , Augusto A Litonjua, Kelan G Tantisira, Anne L Fuhlbrigge, Stanley J Szefler, Robert C Strunk, Robert S Zeiger, Amy J Murphy, Scott T Weiss; Childhood Asthma Management Program Research Group
Collaborators, Affiliations
Randomized Controlled Trial

Clinical predictors and outcomes of consistent bronchodilator response in the childhood asthma management program

Sunita Sharma et al. J Allergy Clin Immunol. 2008 Nov.

Abstract

Background: Among asthmatic subjects, bronchodilator response (BDR) to inhaled beta(2)-adrenergic agonists is variable, and the significance of a consistent response over time is unknown.

Objective: We assessed baseline clinical variables and determined the clinical outcomes associated with a consistently positive BDR over 4 years in children with mild-to-moderate persistent asthma.

Methods: In the 1041 participants in the Childhood Asthma Management Program, subjects with a change in FEV(1) of 12% or greater (and 200 mL) after inhaled beta(2)-agonist administration at each of their yearly follow-up visits (consistent BDR) were compared with those who did not have a consistent BDR.

Results: We identified 52 children with consistent BDRs over the 4-year trial. Multivariable logistic regression modeling demonstrated that lower baseline prebronchodilator FEV(1) values (odds ratio, 0.71; P < .0001), higher log10 IgE levels (odds ratio, 1.97; P = .002), and lack of treatment with inhaled corticosteroids (odds ratio, 0.31; P = .009) were associated with a consistent BDR. Individuals who had a consistent BDR had more hospital visits (P = .007), required more prednisone bursts (P = .0007), had increased nocturnal awakenings caused by asthma (P < .0001), and missed more days of school (P = .03) than nonresponders during the 4-year follow-up.

Conclusions: We have identified predictors of consistent BDR and determined that this phenotype is associated with poor clinical outcomes.

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Figures

Figure 1
Figure 1. Distribution of Baseline Bronchodilator Response in CAMP
A histogram demonstrating the distribution of bronchodilator response at randomization of the 1,041 children participating in the Childhood Asthma Management Program.
Figure 2
Figure 2. Number of Subjects with Bronchodilator Response at Each Yearly Follow-Up Visit
A graph demonstrating the number of subjects that had a positive bronchodilator response at each yearly follow-up visit. Non-responders (black) had less than a 12% and 200mLs improvement in FEV1 following inhaled bronchodilator. Responders (white) had a BDR>12% and 200mLs.
Figure 3
Figure 3. Mean Bronchodilator Response at Yearly Visits in Responders and Non-responders
Graph showing the mean bronchodilator response as the percent change in FEV1 in consistent responders (solid line) versus non-responders (dashed line) at each of the yearly follow-up visits in the trial
See this image and copyright information in PMC

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