Predictors of late asthmatic response. Logistic regression and classification tree analyses

Am J Respir Crit Care Med. 2000 Jun;161(6):2092-5. doi: 10.1164/ajrccm.161.6.9909056.

Abstract

To identify predictors of the late asthmatic response (LAR), we reviewed data from 60 asthmatic subjects who had undergone allergen challenge over the past 5 yr (33 females, age 31.4 +/- 6.7 yr [mean +/- SD], FEV(1) 90% +/- 14% predicted). Variables considered likely predictors of LAR included baseline FEV(1), PC(20) methacholine (PC(20)), sputum eosinophil percent, and the decrease in FEV(1) within 20 min of allergen challenge. A LAR (FEV(1) >/= 15% fall between 3 and 7 h after challenge) was documented in 57% of subjects. A variety of logistic regression methods revealed a significant inverse association between LAR and PC(20) (odds ratio [OR] = 0.14 [95% CI = 0.03-0.66]) and a positive association between LAR and the decrease in FEV(1) at 20 min (OR = 1.18 [1.04 -1.33]). Classification tree analysis revealed that a threshold of 0.25 mg/ml for PC(20) was most predictive of LAR; LAR developed in 87% of those with PC(20) </= 0.25 mg/ml (n = 23) and in 38% of those with PC(20) > 0.25 mg/ml (n = 37). Notably, in subjects with PC(20) > 0.25 mg/ml, the incidence of LAR increased from 38% to 57% if the allergen-induced decline in FEV(1) at 20 min was >/= 27%. Surprisingly, baseline FEV(1) and percent eosinophils in induced sputum were not significantly associated with LAR. We conclude that a threshold value of 0.25 mg/ml for PC(20) methacholine is a good predictor of LAR. Measuring the PC(20) methacholine may be useful as a screening method to improve the efficiency of identifying asthmatic subjects with a LAR.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Asthma / diagnosis*
  • Asthma / physiopathology
  • Bronchial Hyperreactivity / diagnosis*
  • Bronchial Hyperreactivity / physiopathology
  • Bronchial Provocation Tests* / statistics & numerical data
  • Eosinophils / immunology
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Hypersensitivity, Delayed / diagnosis*
  • Hypersensitivity, Delayed / physiopathology
  • Leukocyte Count
  • Male
  • Predictive Value of Tests
  • Regression Analysis
  • Respiratory Hypersensitivity / diagnosis*
  • Respiratory Hypersensitivity / physiopathology