The relationship of the bronchodilator response phenotype to poor asthma control in children with normal spirometry

J Pediatr. 2011 Jun;158(6):953-959.e1. doi: 10.1016/j.jpeds.2010.11.029. Epub 2011 Jan 13.

Abstract

Objective: To determine the relationship of poor asthma control to bronchodilator response (BDR) phenotypes in children with normal spirometry.

Study design: Children with asthma were assessed for clinical indexes of poorly controlled asthma. Pre- and post-bronchodilator spirometry were performed, and the percent BDR was determined. Multivariate logistic regression assessed the relationship of the clinical indices to BDR at ≥ 8%, ≥ 10%, and ≥ 12% BDR thresholds.

Results: There were 510 controller naïve children and 169 on controller medication. In the controller naïve population the mean age (± 1 SD) was 9.5 (3.4); 57.1% were male, 85.7% Hispanic. Demographics were similar in both populations. In the adjusted profile, significant clinical relationships were found particularly to positive BDR phenotypes ≥ 10% and ≥ 12% versus negative responses including younger age, (OR 2.0, 2.5; P < .05), atopy (OR 1.9, 2.6; P < .01), nocturnal symptoms in females (OR 3.4, 3.8; P < .01); β₂ agonist use (OR 1.7, 2.8; P < .01); and exercise limitation (OR 2.2, 2.5; P < .01) only in the controller naïve population.

Conclusions: The BDR phenotype ≥ 10% is significantly related to poor asthma control, providing a potentially useful objective tool in controller naïve children even when the pre-bronchodilator spirometry result is normal.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / pharmacology
  • Asthma / therapy*
  • Bronchodilator Agents / pharmacology*
  • Child
  • Exhalation
  • Female
  • Forced Expiratory Volume
  • Humans
  • Male
  • Nitric Oxide / metabolism
  • Odds Ratio
  • Pulmonary Medicine / methods
  • Regression Analysis
  • Spirometry / methods*

Substances

  • Adrenal Cortex Hormones
  • Bronchodilator Agents
  • Nitric Oxide