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

J Allergy Clin Immunol. 2008 Nov;122(5):921-928.e4. doi: 10.1016/j.jaci.2008.09.004. Epub 2008 Oct 10.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-Agonists / administration & dosage*
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Asthma / physiopathology*
  • Bronchodilator Agents / administration & dosage*
  • Budesonide / administration & dosage
  • Child
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Nedocromil / administration & dosage
  • Spirometry
  • Treatment Outcome
  • Vital Capacity


  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Nedocromil
  • Budesonide