The importance of maximal airway response to methacholine in the prediction of asthma development in patients with allergic rhinitis

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Koh, Y. Y.; Kang, E. K.; Min, Y-G.; Kim, C. K.
Issue Date
Blackwell Publishing
Clin Exp Allergy 2002; 32:921-7
allergic rhinitisasthmaairway hyper-responsivenessmethacholinemaximal airway responsePC20
BACKGROUND: Allergic rhinitis is a known predictor and correlate of asthma incidence. However, it is not clear which patients with allergic rhinitis are at greater risk of the development of asthma. OBJECTIVE: The aim of this study was to investigate whether airway hypersensitivity and/or increased maximal response on the dose-response curve to methacholine would predict the development of asthma in subjects with allergic rhinitis. METHODS: One hundred and forty-one children with allergic rhinitis were prospectively studied for 7 years. At the initiation of the study, bronchial provocation test with methacholine using a stepwise increasing concentration technique was performed to measure PC(20) (provocative concentration causing a 20% fall in FEV(1)) and maximal response. Each subject was evaluated at least every 6 months and details of asthmatic symptoms or signs experienced during the intervening period were taken. RESULTS: Twenty of 122 subjects available for the follow-up developed asthma. Nine (19.6%) of 46 hypersensitive (PC(20) < 18 mg/mL) subjects developed asthma, compared with 11 (14.5%) of 76 normosensitive subjects (P = 0.462). Eight (32%) of 25 subjects without maximal response plateau developed asthma, compared with 12 (12.4%) of 97 subjects with maximal response plateau (P = 0.018). Score test for trend revealed a significant association between the level of maximal response (P = 0.007), but not the degree of methacholine PC(20) (P = 0.123), and the future development of asthma. CONCLUSION: An increased maximal airway response to methacholine is shown to be a better predictor for the future development of asthma in patients with allergic rhinitis, than airway hypersensitivity to methacholine.
0954-7894 (Print)
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College of Medicine/School of Medicine (의과대학/대학원)Pediatrics (소아과학전공)Journal Papers (저널논문_소아과학전공)
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