Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1996 Mar;51(3):272–276. doi: 10.1136/thx.51.3.272

Atopy, bronchial hyperresponsiveness, and peak flow variability in children with mild occasional wheezing.

H Roizin 1, A Reshef 1, I Katz 1, S Benzaray 1, M Lison 1, R J Shiner 1
PMCID: PMC1090638  PMID: 8779130

Abstract

BACKGROUND: Children who suffer from recurrent wheezy episodes are often promptly classified as asthmatic. The aim of this study was to evaluate a population of mild wheezy children with repeatedly normal spirometric tests at rest for atopy, bronchial hyperresponsiveness, and peak expiratory flow variability. METHODS: Thirty nine children aged 6-16 years with 1-12 wheezy attacks during the previous year were recruited from a community paediatric primary health care clinic serving an urban Israeli population. The conditions for inclusion were a physician-diagnosed wheeze on auscultation and normal spirometric tests at rest on at least three occasions. Evaluation included skin prick tests for atopy and a physician-completed questionnaire. In addition, two tests of bronchial hyperresponsiveness (BHR) were performed--namely, exercise-induced bronchospasm and inhaled methacholine hyperresponsiveness--as well as diurnal variability of peak expiratory flow (PV). RESULTS: One or more tests of BHR/PV were positive in 27 (69%) but repeatedly negative in 12 (31%). In terms of frequency of wheezing attacks, atopy, and questionnaire responses, there were no differences between BHR/PV and non-BHR/PV children, with the exception of a history of chest radiography proven pneumonia (only noted in the BHR/PV group). Overall, evidence of atopy (mainly indoor allergens) was noted in 21 (56%) of those tested and parental smoking in 29 (74%) of households. Thirty-two (82%) of the children complained of an exercise-related wheeze, yet exercise-induced bronchospasm was only demonstrated in nine (23%). CONCLUSIONS: This selected group of wheezy children appears to be intermediate between a normal and clearly asthmatic population and, despite the recurrent wheezy attacks, some should probably not be classified as asthmatic by conventional criteria. Important aetiological factors in the symptomatology of these children may include parental smoking and atopy as well as other elements such as viral infections.

Full text

PDF
272

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson S. D., Silverman M., König P., Godfrey S. Exercise-induced asthma. Br J Dis Chest. 1975 Jan;69(1):1–39. doi: 10.1016/0007-0971(75)90053-4. [DOI] [PubMed] [Google Scholar]
  2. Burr M. L., Butland B. K., King S., Vaughan-Williams E. Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child. 1989 Oct;64(10):1452–1456. doi: 10.1136/adc.64.10.1452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Clifford R. D., Radford M., Howell J. B., Holgate S. T. Prevalence of atopy and range of bronchial response to methacholine in 7 and 11 year old schoolchildren. Arch Dis Child. 1989 Aug;64(8):1126–1132. doi: 10.1136/adc.64.8.1126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Clough J. B., Williams J. D., Holgate S. T. Effect of atopy on the natural history of symptoms, peak expiratory flow, and bronchial responsiveness in 7- and 8-year-old children with cough and wheeze. A 12-month longitudinal study [published errarum appears in Am Rev Respir Dis 1992 Aug;146(2):540]. Am Rev Respir Dis. 1991 Apr;143(4 Pt 1):755–760. doi: 10.1164/ajrccm/143.4_Pt_1.755. [DOI] [PubMed] [Google Scholar]
  5. Cockcroft D. W., Killian D. N., Mellon J. J., Hargreave F. E. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977 May;7(3):235–243. doi: 10.1111/j.1365-2222.1977.tb01448.x. [DOI] [PubMed] [Google Scholar]
  6. Dodge R., Burrows B., Lebowitz M. D., Cline M. G. Antecedent features of children in whom asthma develops during the second decade of life. J Allergy Clin Immunol. 1993 Nov;92(5):744–749. doi: 10.1016/0091-6749(93)90018-b. [DOI] [PubMed] [Google Scholar]
  7. Gelber L. E., Seltzer L. H., Bouzoukis J. K., Pollart S. M., Chapman M. D., Platts-Mills T. A. Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. Am Rev Respir Dis. 1993 Mar;147(3):573–578. doi: 10.1164/ajrccm/147.3.573. [DOI] [PubMed] [Google Scholar]
  8. Godfrey R. C., Griffiths M. The prevalence of immediate positive skin tests to Dermatophagoides pteronyssinus and grass pollen in schoolchildren. Clin Allergy. 1976 Jan;6(1):79–82. doi: 10.1111/j.1365-2222.1976.tb01415.x. [DOI] [PubMed] [Google Scholar]
  9. Godfrey S., Bar-Yishay E. Exercised-induced asthma revisited. Respir Med. 1993 Jul;87(5):331–344. doi: 10.1016/0954-6111(93)90046-3. [DOI] [PubMed] [Google Scholar]
  10. Hill R., Williams J., Tattersfield A., Britton J. Change in use of asthma as a diagnostic label for wheezing illness in schoolchildren. BMJ. 1989 Oct 7;299(6704):898–898. doi: 10.1136/bmj.299.6704.898. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hopp R. J., Bewtra A. K., Nair N. M., Watt G. D., Townley R. G. Methacholine inhalation challenge studies in a selected pediatric population. Am Rev Respir Dis. 1986 Nov;134(5):994–998. doi: 10.1164/arrd.1986.134.5.994. [DOI] [PubMed] [Google Scholar]
  12. Johnston S. L., Sanderson G., Pattemore P. K., Smith S., Bardin P. G., Bruce C. B., Lambden P. R., Tyrrell D. A., Holgate S. T. Use of polymerase chain reaction for diagnosis of picornavirus infection in subjects with and without respiratory symptoms. J Clin Microbiol. 1993 Jan;31(1):111–117. doi: 10.1128/jcm.31.1.111-117.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lebowitz M. D., Sherrill D., Holberg C. J. Effects of passive smoking on lung growth in children. Pediatr Pulmonol. 1992 Jan;12(1):37–42. doi: 10.1002/ppul.1950120109. [DOI] [PubMed] [Google Scholar]
  14. Ninan T. K., Russell G. Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart. BMJ. 1992 Apr 4;304(6831):873–875. doi: 10.1136/bmj.304.6831.873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Roizin H., Szeinberg A., Tabachnik E., Molho M., Benzaray S., Augarten A., Har-Even D., Barzilay Z., Yahav J. Ethnic differences in lung function in Israeli children. Thorax. 1993 Sep;48(9):906–910. doi: 10.1136/thx.48.9.906. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Salome C. M., Peat J. K., Britton W. J., Woolcock A. J. Bronchial hyperresponsiveness in two populations of Australian schoolchildren. I. Relation to respiratory symptoms and diagnosed asthma. Clin Allergy. 1987 Jul;17(4):271–281. doi: 10.1111/j.1365-2222.1987.tb02015.x. [DOI] [PubMed] [Google Scholar]
  17. Sherrill D., Holberg C. J., Lebowitz M. D. Differential rates of lung growth as measured longitudinally by pulmonary function in children and adolescents. Pediatr Pulmonol. 1990;8(3):145–154. doi: 10.1002/ppul.1950080304. [DOI] [PubMed] [Google Scholar]
  18. Sherrill D., Sears M. R., Lebowitz M. D., Holdaway M. D., Hewitt C. J., Flannery E. M., Herbison G. P., Silva P. A. The effects of airway hyperresponsiveness, wheezing, and atopy on longitudinal pulmonary function in children: a 6-year follow-up study. Pediatr Pulmonol. 1992 Jun;13(2):78–85. doi: 10.1002/ppul.1950130204. [DOI] [PubMed] [Google Scholar]
  19. Sporik R., Holgate S. T., Platts-Mills T. A., Cogswell J. J. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med. 1990 Aug 23;323(8):502–507. doi: 10.1056/NEJM199008233230802. [DOI] [PubMed] [Google Scholar]
  20. Strachan D. P., Anderson H. R. Trends in hospital admission rates for asthma in children. BMJ. 1992 Mar 28;304(6830):819–820. doi: 10.1136/bmj.304.6830.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Toelle B. G., Peat J. K., Salome C. M., Mellis C. M., Woolcock A. J. Toward a definition of asthma for epidemiology. Am Rev Respir Dis. 1992 Sep;146(3):633–637. doi: 10.1164/ajrccm/146.3.633. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES