Presentation: Different Phenotypes of Bhr (bronchial hyperresponsiveness) By Natural Course in Children and It's Characteristics ( World Allergy Congress)

Friday, 16 October 2015

Hall D1 Foyer (Floor 3) (Coex Convention Center)

Young-Ho Kim, MD , Department of Pediatrics, Childhood Asthma Atopy Center, Enviromental Health Center, University of Ulsan College of Medicine,, Asan Medical Center, Seoul, South Korea

Eun Lee, MD , Pediatrics, Asan Medical Center, Seoul, South Korea

Song-I Yang, MD , Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, South Korea

Hyun-Ju Cho, MD , Asan Medical Center Seoul Korea, Seoul, South Korea

Hyung Young Kim, MD , Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, South Korea

Ji-Won Kwon, MD , Seoul National University Bundang Hospital, Seongnam, South Korea

Young-Ho Jung, MD , Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, South Korea

Byoung-Ju Kim, MD , Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH

Ju-Hee Seo, MD , Department of Pediatrics, Korea Cancer Center Hospital, Seoul, South Korea

Hyo-Bin Kim, MD, PhD , Department of Pediatrics, Sanggye Paik Hospital, Seoul, South Korea

So-Yeon Lee, MD , Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, South Korea

Ho-Jang Kwon, MD , Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea

Soo Hyun Kim, MD , Department of Pediatrics, Asan Medical Center, Seoul, South Korea

Soo-Jong Hong, MD, PhD , Research Center for Standardization of Allergic Diseases, University of Ulsan College of Medicine, Seoul, South Korea

Purpose: Bronchial hyperresponsiveness (BHR) is a key feature of asthma, but the natural course of BHR is heterogenous. We divided the BHR changing pattern into 4 different phenotypes and investigated the characteristics and the risk factors from the longitudinal study.

Methods: Total 658 (male 342, female 316) elementary school children were included from the CHEER (children's health and environment research)study. The ISSAC questionnaire, serum total IgE level, blood eosinophil percentage, skin prick test, pulmonary function test and methacholine challenge test were done at age 7 for baseline and age 11 years after follow up. BHR was defined as provocative concentration of 20% decrease of FEV1 (PC₂₀) below 16 mg/m. We divided 4 different phenotypes of BHR change pattern (BHR never, BHR remission, BHR new, BHR persistent). Multinomial logistic regression analysis was done to evaluate the risk factors for each type.

Results: Four phenotypes of BHR were composed of 376 (BHR never), 152 (BHR remission), 48 (BHR new), 82 (BHR persistent) respectively. Parental allergic disease (aOR=3.334, 95% CI 1.188-9.358) and asthma (aOR=4.623, 95% CI 1.790-11.944) history at age 7 years were risk factors for BHR remission group. Atopic sensitization (aOR=3.233, 95% CI 1.436-7.279) at age 7 years was a risk factor for BHR new group. Eosinophil percent (aOR=1.280, 95% CI 1.123-1.458), logIgE (aOR=2.757, 95% CI 1.443-5.269), and atopic sensitization (aOR=2.461, 95% CI 1.163-5.208) at age 7 years were risk factors for BHR persistent group. Dp sensitization was a risk factor for for BHR new group at age 7 years (aOR=3.036, 95% CI 1.295-7.118). Dp, Df sensitization were risk factors for BHR persistent group at age 7 years (aOR=2.383, 95% CI 1.120-5.071; aOR=3.084, 95% CI 1.524-6.239). Dfwas a additionally sensitized allergen as a risk factor for BHR new group at 11 years (aOR=3.267, 95% CI 1.388-7.692) and grass pollen for BHR persistent group at 11 years (aOR=6.441, 95% CI 1.239-33.472).

Conclusion: Children with BHR remission were associated with family history of asthma and low sensitization at age 7 years. Children with BHR new showed high sensitization and normal lung function, but low eosinophil at age 7 yrs. Children with BHR persistent were associated with high atopic condition including high eosinophil, high IgE, high sensitization, and low lung function at age 7 yrs. These findings suggest that the natural course of childhood BHR has different phenotypes and we can predict the future prognosis of BHR by these phenotypes.

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