Asthmatic risk factors and bronchial reactivity in non-diagnosed asthmatic adults

Specific respiratory signs and symptoms are thought to occur prior to diagnoses of asthma as part of the natural history. These signs and symptoms include: high IgE, a history of wheezing symptoms, and/or excessive declines in lung function. The first two are thought to distinguish asthma from other airway obstructive diseases (AOD). To predict subsequent AOD, twelve years of follow-up (1972-84) data from the Tucson longitudinal epidemiological study of AOD in a community population were evaluated on 687 subjects aged 19-70 years on entry. To determine the likelihood that non-asthmatics that have these specific risk factors would have marked or intermediate bronchial reactivity to methacholine, an experimental study was performed. This was done in 1984-85 in a robust, efficient post-hoc stratified sample of male subjects ages 30-55 from the population followed from 1972. They were subsequently followed through 1991. Persistent symptoms best predicted final pulmonary function and new diagnosed AOD in subjects in the population. Previously diagnosed AOD also predicted lower pulmonary function. The experimental results indicate that predisposition to reactivity appears likely without the presence of diagnosed asthma. Further, the experimental subjects with high risk had increased symptomatology and decreased lung function when tested at follow-up; not all of the reactivity was explained by these factors. An attempt to predict reactivity by physician evaluation and special questionnaire was not fruitful. In addition, wheeze per se often disappeared without later evidence of asthma (or AOD) diagnosis, questioning some international tendencies to label all wheeze as asthma. Thus, high IgE significantly predicted bronchial responsiveness, but high IgE and symptoms are neither necessary nor sufficient. Also, both preclinical and clinical asthma predict eventual low lung function.