Format

Send to

Choose Destination
Ann Allergy Asthma Immunol. 2018 Oct;121(4):434-443.e2. doi: 10.1016/j.anai.2018.05.033. Epub 2018 Jun 8.

Clinical phenotypes of bronchial hyperresponsiveness in school-aged children.

Author information

1
Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
2
Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3
Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea.
4
Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea.
5
Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea.
6
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
7
Department of Pediatrics, Dankuk University Hospital, Cheonan, Korea.
8
Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea.
9
Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: sjhong@amc.seoul.kr.

Abstract

BACKGROUND:

Bronchial hyperresponsiveness (BHR), one of the key features of asthma, has a diverse natural course in school-aged children, but studies on BHR phenotypes are lacking.

OBJECTIVE:

To classify BHR phenotypes according to onset age and persistence in children and investigate the characteristics and factors associated with each phenotype in a longitudinal study.

METHODS:

This study analyzed 1,305 elementary school children from the Children's Health and Environmental Research (CHEER) study, a 4-year, prospective, follow-up study with 2-year intervals starting at a mean age of 7years. Total serum IgE levels and blood eosinophil counts were measured, and allergy workup, including methacholine challenge tests with the International Study of Asthma and Allergies in Childhood questionnaire, was performed at each survey.

RESULTS:

The 4 BHR phenotypes were classified as non-BHR (n = 942 [72.2%]), early-onset transient BHR (n = 201 [15.4%]), late-onset BHR (n = 87 [6.7%]), and early-onset persistent BHR (n = 75 [5.7%]). Early-onset persistent BHR is characterized by an increased eosinophil count, total serum IgE level, sensitization rate, decreased lung function, and increased risk of newly diagnosed asthma during follow-up (adjusted odds ratio, 3.89; 95% confidence interval, 1.70-8.88). The 2 early-onset phenotypes were associated with peripheral airway dysfunction. The late-onset BHR phenotype was related to increased risks of allergic rhinitis symptoms at baseline and later sensitization against inhalant allergens.

CONCLUSION:

The early-onset persistent BHR phenotype in school-aged children is associated with high atopic burden and increased risk of newly diagnosed asthma, whereas the late-onset BHR phenotype related with later sensitization and allergic rhinitis symptoms. Diverse BHR phenotypes in children have specific characteristics that require targeted follow-ups.

PMID:
29886267
DOI:
10.1016/j.anai.2018.05.033
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center