Allergy Asthma Immunol Res.  2018 Sep;10(5):466-477. 10.4168/aair.2018.10.5.466.

Prevalence, Risk Factors and Cutoff Values for Bronchial Hyperresponsiveness to Provocholine in 7-Year-Old Children

Affiliations
  • 1Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sjhong@amc.seoul.kr
  • 2Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University Hospital, Incheon, Korea.
  • 4Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 5Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 6Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 7Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
  • 8Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea.
  • 9Department of Pediatrics, The Catholic University of Korea College of Medicine, Daejeon, Korea.
  • 10Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea.
  • 11Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
  • 12Department of Pediatrics, Gwangju Veterans Hospital, Gwangju, Korea.
  • 13Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea.
  • 14Department of Pediatrics, Ulsan University Hospital, Ulsan, Korea.
  • 15Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 16Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea.
  • 17Department of Pediatrics, Health Science Institute, Gyeongsang National University College of Medicine, Jinju, Korea.

Abstract

BACKGROUND
A US Food and Drug Administration (FDA)-approved drug methacholine chloride (Provocholine®) was recently introduced to Korea where it is now widely used in clinical practice. We aimed to evaluate the prevalence, risk factors and cutoff value of bronchial hyperresponsiveness (BHR) to Provocholine in 7-year-old children.
METHODS
Six hundred and thirty-three children from the Panel Study on Korean Children who visited 16 regional hospitals were evaluated. Skin prick tests, spirometry and bronchial provocation tests for Provocholine as well as a detailed history and physical examinations were performed. The bronchial provocation test was reliably performed on 559 of these children.
RESULTS
The prevalence of ever-diagnosed asthma via medical records was 7.7%, and that of current asthma (wheezy episode in the last 12 months + diagnosed asthma by physicians) was 3.2%. The prevalence of BHR to Provocholine was 17.2% and 25.8%, respectively, for a PC20 < 8 and < 16 mg/mL. The risk factors for BHR (PC20 < 16 mg/mL) were atopic dermatitis diagnosis and current dog ownership, whereas those for current asthma were allergy rhinitis diagnosis, a history of bronchiolitis before the age of 3, recent use of analgesics/antipyretics and maternal history of asthma. The BHR prevalence trend showed an increase along with the increased immunoglobulin E (IgE) quartile. The cutoff value of PC20 for the diagnosis of current asthma in children at age 7 was 5.8 mg/mL (sensitivity: 47.1%, specificity: 87.4%).
CONCLUSIONS
BHR to Provocholine (PC20 < 8 mg/mL) was observed in 17.2% of 7-year-olds children from the general population and the cutoff value of PC20 for the diagnosis of current asthma was 5.8 mg/mL in this age group. The risk factors for BHR and current asthma showed discrepancies suggesting different underlying mechanisms. Bronchial provocation testing with Provocholine will be a useful clinical tool in the future.

Keyword

Bronchial hyperreactivity; asthma; risk factors; prevalence; ROC curve
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