Severity of obstructive airways disease by two years predicts asthma at 10 years of age

Chandra Sekhar Devulapalli, Karin C. Lødrup Carlsen, Geir Håland, Monica Cheng Munthe-Kaas, Morten Pettersen, Petter Mowinckel and Kai Håkon Carlsen

Predicting school-age asthma from obstructive airways disease (OAD) in early life is difficult, even considering parental and children's atopic manifestations. The purpose of this study was to assess if severity of OAD in the first two years of life can predict asthma at 10 years of age.

From a nested case control study within the Environment and Childhood Asthma study, 233 two year oldsubjects with recurrent (two episodes) of bronchial obstruction (BO)(rBO+) and 216 subjects without BO(rBO-) underwent clinical examination, parental interview, treadmill test and metacholine bronchial hyperresponsiveness (BHR) measurement at 10 years. A severity score at two years was calculated by frequency, persistence of bronchial obstruction and hospital admissions due to OAD.

Current asthma at 10 years (asthma with symptoms and/or asthma medication during the last yearand/or positive treadmill test). Secondary outcome; metacholine BHR at 10 years. Compared to rBO- subjects; adjusted odds ratio (95 % confidence intervals) of current asthma among rBO+ was 7.9 (4.1, 15.3), among rBO+with severity score >5: 20.2 (9.9, 41.3). In analysis, both positive and negative predictive values demonstratedthe applicability and value of the score with optimal cut off at severity score 5. Children with severity score >5 had more often severe BHR (PD20-metacholine < 1 µmol) than children with a lower or 0 score (p=0.0041).

In conclusion, the authors found that a high severity score of OAD by two years of age is a strong risk factor for

and a strong predictor of asthma at 10 years of age.

Thorax 2007, Advanced publication available online from 5th July.

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