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Relationship between duration of disease and bronchial responsiveness in 6-8 year old children with asthma
Abstracts S217
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
of a PD10 to identify athletes with exercise-induced bronchoconstriction was 96%. There was a significant relationship between mannitol PD10 and the response to exercise, (rp=-0.71) eucapnic hyperpnea, (rp=0.60) cold air, (rp=0.62) histamine, (rp=0.73) and methacholine (rp=0.50, adults, rp=0.73 in children). CONCLUSIONS: The conclusions of the published studies were unchanged when PD10 rather than PD15 was used to express sensitivity to mannitol. Funding: National Health & Medical Research Council of Australia
between months 0 and 1 (p=0.009). In analyzing the increase in FEV1 between month 1 with months 3, 6, and 12 respectively, we observed a trend of increasing significance, i.e. month 1 v. month 3 (p=0.173), month 1 v. month 6 (p=0.058), month 1 v. month 12 (p=0.036). CONCLUSIONS: We conclude that PFTs do not reflect improvement in lung function in the first year following bilateral lung transplantation. This observation suggests that transplanted lungs may need to time to mature within its adult recipient before providing improved function. Funding: Washington University School of Medicine
Comparison of the Administration of Methacholine by Hand Held Nebulisers and by Dosimeter to Assess Bronchial Hyper-Responsiveness in Schoolchildren Aged 15 to 17 Years M. Levin; Paediatric Allergy, Red Cross Childrens Hospital, Cape Town, SOUTH AFRICA. RATIONALE: Labour intensive and expensive techniques for performing methacholine challenge tests make the technique impractical and unaffordable in resource-limitted settings. A cheap, easy to administer and quick alternative method of administration of methacholine was studied. PRIMARY AIMS: To validate / assess the correlation between two different methods of administering methacholine in the assessment of bronchial hyper-responsiveness. To ascertain the cost savings of such a protocol in the setting of a community based survey. METHODS: 30 schoolchildren in the Western Cape Province of South Africa underwent methacholine challenge by hand-held De-Vilbiss glass nebulisers (experimental method), and by Sensormedics dosimeter method (conventional method). 22 subjects had various degrees of bronchial hyper-responsiveness and 8 had no hyper-responsiveness. The order of administration of methacholine challenges was randomised. The time period between methacholine challenges was greater than two days, and did not exceed 10 days. RESULTS: Preliminary results show agreement between the two methods. Statistical correlation will be completed by November 2004. Unpaired t-tests and Spearman rank order analysis will be used to compare PC20 and PD20 results obtained by the two methods. The per cent agreement and kappa statistic for agreement will be calculated for cut off points of both methods. Costs of the tests will be compared. CONCLUSIONS: Validation of a safe, rapid and accurate field method for assessing bronchial hyper-reactivity will make this test appropriate to a resource-limited setting. Funding: ALLSA/UCB
864
Adjustment Period in Lung Function Parameters Following Bilateral Lung Transplantation S. Park1, P. Win1, M. Amin2, I. Hussain3; 1Internal Medicine, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, MO, 2Renal/Critical Care, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, MO, 3Allergy and Immunology, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, MO. RATIONALE: Adults with terminal lung disease should have immediate recovery of lung function following bilateral lung transplantation. We examined the pulmonary function status of 5 patients who underwent bilateral lung transplantation up to one year post-operatively. METHODS: We reviewed 5 patients in the Lung Transplant Center who had undergone bilateral lung transplantation from 1994 to 2002. For all patients, PFTs were done pre-operatively (month 0), and at 1, 3, 6 and approximately 12 months after transplantation. FEV1 was examined to demonstrate lung function. The shortest duration of follow-up was 11 months, while the longest was 10 years. RESULTS: There were 2 female and 3 male patients. Ages ranged from 33 to 56 years old. Two patients had severe COPD, 1 had lymphangioleimyomatosis, and 2 had cystic fibrosis. The mean FEV1 at 0, 1, 3, 6, and 12 months was 20% ± 13%; 72% ± 22%; 90% ± 30%; 109%± 33%; 111%± 32%. As expected, there was significant improvement in FEV1
863
ROC Curve Analysis of IgE Antibodies Values to Predict Clinical Allergy to Cat Dander in Asthmatic Subjects R. Cárdenas, C. Fernández, M. Garcimartin, S. Romero, A. Gómez de la Cámara, D. Martín, P. Casasnovas, R. Vives; Servicio de alergia, Hospital 12 de Octubre, Madrid, SPAIN. RATIONALE: Asthmatic patients can be sensitized to cat allergens without clinical allergy symptoms. The aim of this work has been to find an optimal cutoff value for specific IgE predictive of a positive specific bronchial response to cat dander in adult asthmatic patients. METHODS: We performed a bronchial provocation test (BPT) with cat dander (following ATS guidelines) in 72 asthmatic patients (mean age 28.21±10.7, female/male 1.3) with a positive skin prick-test (cat dander 100 BU, ALK-Abelló) and/or detectable cat allergen specific serum IgE (CAP System FEIA). Statistical analyses of results were performed by logistic regression analysis and Receiver Operating Characteristics (ROC) curve. RESULTS: Cat dander BPT was positive in 31 subjects (43%). The area under the ROC curve for CAP values, was 0.838. The optimal cutoff point was 1.6 KU/L (80.6% sensitivity and 72.5% specificity). CAP values of 6.44, 8.26 and 11.75 KU/L showed 90%, 95% and 97.5% specificity, respectively. CONCLUSIONS: In patients with asthma and allergy to cat dander, the determination of specific serum IgE by CAP system is a proper diagnostic test. Quantitative specific IgE levels could be useful to predict clinical allergy.
Relationship Between Duration of Disease and Bronchial Responsiveness in 6-8 Year Old Children With Asthma J. Yu, Y. Yoo, D. Kim, Y. Koh; Pediatrics, College of Medicine, Seoul National University, Seoul, REPUBLIC OF KOREA. RATIONALE: Bronchial hyperresponsiveness is considered a hallmark of asthma. The duration of asthma was demonstrated to be associated with bronchial responsiveness, expressed as methacholine PC20. We investigated the relationship between duration of asthma and percentage fall in FVC at PC20 (∆FVC%), another index of bronchial responsiveness, which reflects excessive bronchoconstriction. METHODS: Six to 8-year-old children with asthma underwent methacholine inhalation test. The PC20 and ∆FVC% were calculated for each individual. The subjects were classified into those with wheezing onset in the first three years of life (early-onset asthma: EA, n=65) and those with wheezing onset from three years onwards (late-onset asthma: LA, n=97). RESULTS: From the time of wheezing onset, duration of asthma ranged from 0.1 to 8.3 years. The mean duration of asthma in patients with EA was 5.6 years (SD, 1.3 years), significantly longer compared with 2.4 years (SD, 1.4 years) in the patients with LA. Patients with EA had a significantly lower FEV1 (% predicted) than did those with LA (90.5±13.9% vs. 95.4±15.7%, p<0.05). The ∆FVC% was significantly higher in patients with EA than in those with LA (19.5±5.2% vs. 17.2±4.9%, p<0.01), but PC20 was not different between the two groups. In total subjects, asthma duration correlated significantly with ∆FVC% (r=0.243, p<0.01), but not with PC20. CONCLUSIONS: These data suggest that disease progression may be associated with worsening of airways responsiveness among children with asthma, and such an association may be reflected primarily by ∆FVC% rather than PC20.
865
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862
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
of a PD10 to identify athletes with exercise-induced bronchoconstriction was 96%. There was a significant relationship between mannitol PD10 and the response to exercise, (rp=-0.71) eucapnic hyperpnea, (rp=0.60) cold air, (rp=0.62) histamine, (rp=0.73) and methacholine (rp=0.50, adults, rp=0.73 in children). CONCLUSIONS: The conclusions of the published studies were unchanged when PD10 rather than PD15 was used to express sensitivity to mannitol. Funding: National Health & Medical Research Council of Australia
between months 0 and 1 (p=0.009). In analyzing the increase in FEV1 between month 1 with months 3, 6, and 12 respectively, we observed a trend of increasing significance, i.e. month 1 v. month 3 (p=0.173), month 1 v. month 6 (p=0.058), month 1 v. month 12 (p=0.036). CONCLUSIONS: We conclude that PFTs do not reflect improvement in lung function in the first year following bilateral lung transplantation. This observation suggests that transplanted lungs may need to time to mature within its adult recipient before providing improved function. Funding: Washington University School of Medicine
Comparison of the Administration of Methacholine by Hand Held Nebulisers and by Dosimeter to Assess Bronchial Hyper-Responsiveness in Schoolchildren Aged 15 to 17 Years M. Levin; Paediatric Allergy, Red Cross Childrens Hospital, Cape Town, SOUTH AFRICA. RATIONALE: Labour intensive and expensive techniques for performing methacholine challenge tests make the technique impractical and unaffordable in resource-limitted settings. A cheap, easy to administer and quick alternative method of administration of methacholine was studied. PRIMARY AIMS: To validate / assess the correlation between two different methods of administering methacholine in the assessment of bronchial hyper-responsiveness. To ascertain the cost savings of such a protocol in the setting of a community based survey. METHODS: 30 schoolchildren in the Western Cape Province of South Africa underwent methacholine challenge by hand-held De-Vilbiss glass nebulisers (experimental method), and by Sensormedics dosimeter method (conventional method). 22 subjects had various degrees of bronchial hyper-responsiveness and 8 had no hyper-responsiveness. The order of administration of methacholine challenges was randomised. The time period between methacholine challenges was greater than two days, and did not exceed 10 days. RESULTS: Preliminary results show agreement between the two methods. Statistical correlation will be completed by November 2004. Unpaired t-tests and Spearman rank order analysis will be used to compare PC20 and PD20 results obtained by the two methods. The per cent agreement and kappa statistic for agreement will be calculated for cut off points of both methods. Costs of the tests will be compared. CONCLUSIONS: Validation of a safe, rapid and accurate field method for assessing bronchial hyper-reactivity will make this test appropriate to a resource-limited setting. Funding: ALLSA/UCB
864
Adjustment Period in Lung Function Parameters Following Bilateral Lung Transplantation S. Park1, P. Win1, M. Amin2, I. Hussain3; 1Internal Medicine, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, MO, 2Renal/Critical Care, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, MO, 3Allergy and Immunology, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, MO. RATIONALE: Adults with terminal lung disease should have immediate recovery of lung function following bilateral lung transplantation. We examined the pulmonary function status of 5 patients who underwent bilateral lung transplantation up to one year post-operatively. METHODS: We reviewed 5 patients in the Lung Transplant Center who had undergone bilateral lung transplantation from 1994 to 2002. For all patients, PFTs were done pre-operatively (month 0), and at 1, 3, 6 and approximately 12 months after transplantation. FEV1 was examined to demonstrate lung function. The shortest duration of follow-up was 11 months, while the longest was 10 years. RESULTS: There were 2 female and 3 male patients. Ages ranged from 33 to 56 years old. Two patients had severe COPD, 1 had lymphangioleimyomatosis, and 2 had cystic fibrosis. The mean FEV1 at 0, 1, 3, 6, and 12 months was 20% ± 13%; 72% ± 22%; 90% ± 30%; 109%± 33%; 111%± 32%. As expected, there was significant improvement in FEV1
863
ROC Curve Analysis of IgE Antibodies Values to Predict Clinical Allergy to Cat Dander in Asthmatic Subjects R. Cárdenas, C. Fernández, M. Garcimartin, S. Romero, A. Gómez de la Cámara, D. Martín, P. Casasnovas, R. Vives; Servicio de alergia, Hospital 12 de Octubre, Madrid, SPAIN. RATIONALE: Asthmatic patients can be sensitized to cat allergens without clinical allergy symptoms. The aim of this work has been to find an optimal cutoff value for specific IgE predictive of a positive specific bronchial response to cat dander in adult asthmatic patients. METHODS: We performed a bronchial provocation test (BPT) with cat dander (following ATS guidelines) in 72 asthmatic patients (mean age 28.21±10.7, female/male 1.3) with a positive skin prick-test (cat dander 100 BU, ALK-Abelló) and/or detectable cat allergen specific serum IgE (CAP System FEIA). Statistical analyses of results were performed by logistic regression analysis and Receiver Operating Characteristics (ROC) curve. RESULTS: Cat dander BPT was positive in 31 subjects (43%). The area under the ROC curve for CAP values, was 0.838. The optimal cutoff point was 1.6 KU/L (80.6% sensitivity and 72.5% specificity). CAP values of 6.44, 8.26 and 11.75 KU/L showed 90%, 95% and 97.5% specificity, respectively. CONCLUSIONS: In patients with asthma and allergy to cat dander, the determination of specific serum IgE by CAP system is a proper diagnostic test. Quantitative specific IgE levels could be useful to predict clinical allergy.
Relationship Between Duration of Disease and Bronchial Responsiveness in 6-8 Year Old Children With Asthma J. Yu, Y. Yoo, D. Kim, Y. Koh; Pediatrics, College of Medicine, Seoul National University, Seoul, REPUBLIC OF KOREA. RATIONALE: Bronchial hyperresponsiveness is considered a hallmark of asthma. The duration of asthma was demonstrated to be associated with bronchial responsiveness, expressed as methacholine PC20. We investigated the relationship between duration of asthma and percentage fall in FVC at PC20 (∆FVC%), another index of bronchial responsiveness, which reflects excessive bronchoconstriction. METHODS: Six to 8-year-old children with asthma underwent methacholine inhalation test. The PC20 and ∆FVC% were calculated for each individual. The subjects were classified into those with wheezing onset in the first three years of life (early-onset asthma: EA, n=65) and those with wheezing onset from three years onwards (late-onset asthma: LA, n=97). RESULTS: From the time of wheezing onset, duration of asthma ranged from 0.1 to 8.3 years. The mean duration of asthma in patients with EA was 5.6 years (SD, 1.3 years), significantly longer compared with 2.4 years (SD, 1.4 years) in the patients with LA. Patients with EA had a significantly lower FEV1 (% predicted) than did those with LA (90.5±13.9% vs. 95.4±15.7%, p<0.05). The ∆FVC% was significantly higher in patients with EA than in those with LA (19.5±5.2% vs. 17.2±4.9%, p<0.01), but PC20 was not different between the two groups. In total subjects, asthma duration correlated significantly with ∆FVC% (r=0.243, p<0.01), but not with PC20. CONCLUSIONS: These data suggest that disease progression may be associated with worsening of airways responsiveness among children with asthma, and such an association may be reflected primarily by ∆FVC% rather than PC20.
865
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