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Airway responsiveness to hypertonic saline: dose-response slope or PD15?
G de Meer1, G B Marks, J C de Jongste
1Institute for Risk Assessment Sciences, Environmental and Occupational Health, Utrecht University, P Box 80176, 3508 TD Utrecht, The Netherlands. G.demeer@iras.uu.nl
The European Respiratory Journal
|January 11, 2005
Summary
The dose-response slope (DRS) better reflects asthma risk than PD15 in children. This continuous measure shows a stronger link between airway responsiveness and asthma symptoms, offering a more comprehensive assessment.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Allergy and Immunology
Background:
- Airway hyperresponsiveness is a hallmark of asthma.
- Current methods like PD15 (dose causing 15% fall in FEV1) are censored and may underestimate asthma risk.
- Non-censored measures like the dose-response slope (DRS) may offer a more complete assessment.
Purpose of the Study:
- To evaluate the relationship between airway responsiveness to hypertonic saline (HS), assessed by PD15 and DRS.
- To determine the association of HS airway responsiveness with asthma symptoms and eosinophilic inflammation markers.
- To compare the utility of PD15 versus DRS in assessing asthma risk in children.
Main Methods:
- A cohort of 1,107 children (aged 8-13 years) underwent airway challenge testing with HS.
- Airway responsiveness was measured using PD15 (if applicable) and DRS.
- Asthma symptoms (current wheeze) and markers of eosinophilic inflammation (blood eosinophils, serum ECP) were assessed.
Main Results:
- Children with asthma features exhibited lower PD15 and higher DRS values.
- The DRS showed a more pronounced separation between children with and without asthma features.
- Current wheeze prevalence increased continuously across the range of DRS values.
- Blood eosinophil levels were significantly elevated only at the highest DRS values.
Conclusions:
- The dose-response slope (DRS) provides a continuous and more sensitive measure of airway responsiveness compared to PD15.
- DRS demonstrates a stronger, continuous relationship with asthma symptoms in children.
- Non-censored measures like DRS are favored for evaluating asthma risk and airway responsiveness.