The outcome after 25 yr was studied for three groups of children classified in a random community survey in 1964 as having asthma (121 subjects), wheeze in the presence of infection (167 subjects), or no respiratory symptoms (167 comparison subjects). Approximately 80% of the subjects in each group, now aged 34 to 40 yr, were successfully traced. Current symptoms and smoking habit were recorded by questionnaire, and ventilatory function, peak flow variability, and bronchial reactivity to inhaled methacholine were measured. Subjects who had asthma in childhood were more likely to wheeze (odds ratio [OR] 14.4) or produce phlegm (OR 3.3) than comparison subjects. They also had significantly lower FEV1 values and greater bronchial reactivity than comparison subjects. Adult FEV1 correlated with childhood FEV1 (both expressed as % of predicted) (r = 0.44, p < 0.01). The prognosis for those children who were classed as having wheeze in the presence of infection in 1964 was better than for those who had asthma. Although they also were more likely to report wheeze (OR 3.8) or phlegm (OR 4.4) than comparison subjects, the wheezy symptoms were unlikely to interfere with activities and the ventilatory function and bronchial reactivity to methacholine did not differ from those of comparison subjects. Smokers were more likely to report wheeze (OR 2.0), cough (OR 7.2), and phlegm (OR 3.1) than never-smokers, and current smokers with current wheezy symptoms had significantly reduced FEV1 values, although smoking was not associated with increased methacholine reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

We have previously demonstrated that the adult outcome of childhood asthma differs from that of wheeze occurring only in the presence of infection. This paper examines the role of atopy in relation to outcome. We investigated the atopic status, current symptoms and bronchial reactivity to methacholine of 235 subjects aged 34-40 yrs, originally classified at age 10-15 yrs as having asthma (asthma group), wheeze only in the presence of infection (wheezy group), or no respiratory symptoms (comparison group). Subjects from the original asthma group were more likely to be atopic as defined by skin test reactivity, total serum immunoglobulin E (IgE) measurement or specific IgE radio allergosorbent test (RAST) measurement than those from the wheezy group. The wheezy group differed significantly from the reference group only in RAST results, when other variables were taken into account. In a logistic regression model, the important independent predictors for adult wheezing symptoms were original group, atopy and current smoking. Methacholine responsiveness was independently associated with original group (the asthma group were more likely to respond positively), atopy and female gender. The results suggest that atopy is an important predictor for wheeze and bronchial hyperreactivity in middle age. However, the difference in outcome for children who had asthma compared to those who had wheeze only in the presence of infection cannot be explained by atopy alone.

Background: Bronchial asthma (BA) is a common chronic inflammatory condition affecting the airways. Bronchial asthma not only affects the lung but also affects other organs including the heart. Right ventricular (RV) hypertrophy and dilation and left ventricular (LV) diastolic dysfunction were observed in severe BA. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been extensively studied before.Purpose: The aim of this study was to evaluate ventricular function in young adult patients with BA. Patients and methods: Fifty patients with bronchial asthma and 30 control subjects (mean ages 28.3 ± 7.0 and 26.8 ± 6.2 years, respectively) participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle (LV). LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). RV function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure.Results: Our results revealed that there were statistically significant differences in the peak E velocity, peak E velocity/peak A velocity ratio and isovolumetric relaxation time between the two groups (p < 0.05). Mean LV MPI in the bronchial asthma group (0.40 ± 0.13) was also significantly higher than that of the controls (0.36 ± 0.11, p < 0.05). On the other hand, there were no significant differ-* Corresponding authors. Address: Alhayah National Hospital, Khames Mushyt, Saudi Arabia. Tel.: +966 507378430/+966 545048673; ences in the mean value of peak A velocity, deceleration time and isovolumetric contraction time between bronchial asthma patients and controls. TFPV was significantly reduced in the bronchial asthma group when compared to controls (37.10 ± 2.13 versus 43.40 ± 3.11, respectively, p = 0.001). We observed no significant difference in the echocardiographic indices of RV performance between the two groups. The mean RV MPI in the bronchial asthma group (0.29 ± 0.11) was not significantly different from that of the controls (0.27 ± 0.08).Conclusion: From this study we concluded that LV diastolic function is impaired in patients with bronchial asthma despite no effect on RV diastolic function.

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