Dröge, T. (Tijmen) A. (2013) Response to bronchodilator predicts lung function decline in childhood asthma. thesis, Medicine.
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Abstract
Introduction: Lung function in asthmatic children gradually declines with age and airway remodeling leading to irreversible airflow limitation may play a crucial role. Within asthmatic children, there is variation in the extent to which lung function declines over time. Apart from the immunological pathway of remodeling, mechanical stress of lung tissue seems to induce remodeling as well. In this study, this process was investigated by trying to predict lung function over 2-3 years, based on the maximum response to a bronchodilator. Methods: Data from two large clinical trials of asthmatic children as well as follow up data 2-3 years post-trial was analyzed with maximum response to a bronchodilator at baseline as predictor and post-bronchodilator FEV1 (% of predicted) over time as primary outcome. Oneway ANOVA, regression analysis and Chi2-test of proportions were used. There were 464 total children enrolled in the two trials, of whom 213 participated in the extension study. Data consisted of spirometry data, questionnaires and peripheral blood samples. Results: Exhaled nitric oxide, serum IgE and asthma control were strongly associated with maximum bronchodilator response at baseline and were corrected for in the regression analysis. The model proved to significantly predict FEV1 (% of predicted) over a period of 2-3 years to be 0.25% lower per percent of response to a bronchodilator at baseline (p=0.014). When a cut off value for maximum bronchodilator response of 18.53% (top 10% of children) was used, a difference was found in post bronchodilator % predicted FEV1 of 104.6% [95% CI 102.7,106.5] versus 97.5% [91.1,103.8] (p=0.022). Conclusion: Response to a bronchodilator can successfully predict future lung function outcome. The mechanical cause of airway remodeling seems to coexist with the allergic cause of this process.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Brand Paul L.P. MD |
| Supervisor name: | External supervisor: and Martinez Fernando D. MD and Daily supervisor: and Stern, Debra A. and BIO5 & Arizona Respiratory Center, University Medical Hospit |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2291 |
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