A general practice based survey of bronchial hyperresponsiveness and its relation to symptoms, sex, age, atopy, and smoking.

Trigg, C.J.; Bennett, John B.; Tooley, M; Sibbald, Bonnie; D'Souza, M.F.; Davies, Robert J.

doi:10.1136/thx.45.11.866

Cited by 70 publications

(62 citation statements)

References 28 publications

(8 reference statements)

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“…The sensitivity of mean slope to variation in baseline lung function and smoking between centres was investigated, as several authors have found that PD20 is dependent on baseline lung function [17][18][19][20][21] and related to smoking [21][22][23][24][25]. The average within-centre relationship of slope to baseline FEV1 and FEV1 % pred was used, and resulted in little change to the conclusions.…”

Section: Discussionmentioning

confidence: 99%

Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS)

et al. 1997

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Attempts to compare bronchial responsiveness between populations have been hampered by between-study differences in the pharmacological agent of provocation, the method of administration and the summary statistic employed. The European Community Respiratory Health Survey used methacholine challenge delivered by Mefar dosimeter according to a standardized protocol used in 35 centres in 16 countries.Data were obtained from 13,161 men and women, aged 20-44 yrs at the start of the study. The dose of methacholine producing a 20% fall in forced expiratory volume in one second (FEV1) (PD20) and the regression coefficient of percentage decline in FEV1 with log dose, were calculated ("slope", after transformation), with and without calibration of nebulizers by weight and adjustment for nonresponse bias. Standardization for baseline lung function and variation in smoking prevalence was applied to slope.Results were robust to whichever summary measure was used, and to the various adjustments. Responsiveness was low in Iceland and Switzerland, and in most centres in Sweden, Italy and Spain, and high in New Zealand, Australia, the USA, Britain, France, Denmark and Germany.Bronchial responsiveness varies considerably in Europe, and high levels are not confined to the English-speaking world. Eur Respir J 1997; 10: 2495-2501 Bronchial challenge has been used for over 20 yrs, and there have been several epidemiological studies of risk factors for bronchial responsiveness. However, there are relatively few prevalence studies in the general population, and most of these have been in Englishspeaking countries. NEUKIRCH and CARTIER [1] identified 12 studies, eight using histamine challenge, three methacholine and one cold air, with a variety of cut-off points to define reactivity, and differing age ranges. Two comparative studies in children have been published [2,3], one involving four countries and one involving two, but to date no comparative data on adults from different countries have been reported.The European Community Respiratory Health Survey (ECRHS) is a multicentre study of the variation in the prevalence, risk factors and management of asthma throughout the European Union and elsewhere [4], and includes measurement of bronchial response to methacholine challenge. Results are reported here from 35 centres in 16 countries which have provided usable data. Methods SamplingThe protocol for the ECRHS has been described in detail elsewhere [4,5]. Briefly, participating centres selected an area defined by pre-existing administrative boundaries, with a population of at least 150,000 people. Where possible an up-to-date sampling frame was used to select randomly at least 1,500 men and 1,500 women aged 20-44 yrs. In stage 1 subjects were sent a questionnaire enquiring about respiratory symptoms and attacks of asthma in the last 12 months, current use of asthma medication and nasal allergies including hayfever. A random sample of subjects were selected to take part in stage 2. Those who had already responded to stage 1 wer...

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Section: Discussionmentioning

confidence: 99%

Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS)

et al. 1997

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“…TRIGG et al [36] investigated the role of age in airway responsiveness in a general practice population of 318 subjects (aged 18-75 yrs); again, airway hyperresponsiveness was not associated with increasing age, although it could be argued that the proportion of subjects showing airway hyperresponsiveness was higher in the oldest group (.30% in those aged 65-75 yrs versus f25% in the other study groups). The study also showed a strong negative association between airway hyperresponsiveness and baseline lung function.…”

Section: Airway Responsiveness and Age N Scichilone Et Almentioning

confidence: 99%

Airway hyperresponsiveness in the elderly: prevalence and clinical implications

Scichilone¹

2005

European Respiratory Journal

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Airway hyperresponsiveness is associated with an increased risk of developing respiratory symptoms. The assessment of airway hyperresponsiveness can provide valuable information regarding the natural course of respiratory diseases. However, little information is available for populations of more advanced age, and data are conflicting.It was assessed whether age influences the occurrence of airway hyperresponsiveness by reviewing those studies that specifically addressed this issue, and attempting to identify the factors responsible for discrepancies between studies.Eighteen studies, published between 1983 and 2002, are included in this review. Overall, the results of the analysis are in favour of a positive association between age and airway hyperresponsiveness, the prevalence of which appears to increase in the elderly. The most important determinants were reduced lung function, probably due to geometric factors, and a history of smoking, primarily because of the length of exposure, although acute effects were also demonstrated. Atopy should also be considered as an independent determinant of airway hyperresponsiveness in the elderly population. In addition, inflammatory and neuronal mechanisms could be involved. Finally, the role of sex requires further investigation.Assessing the impact of age on the occurrence of airway hyperresponsiveness has important implications: the age-associated alterations to the lung provide a model for evaluating the contribution of structural changes to the pathogenesis of airway hyperresponsiveness. From a clinical standpoint, evaluation of the magnitude of airway hyperresponsiveness could permit the early identification of individuals who are at risk, even at more advanced age. Assessment of airway hyperresponsiveness in the aged should be considered as an additional tool in the diagnostic work-up in the subset of elderly subjects with long-term smoking exposure and/or documented atopy.

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“…Measuring peak expiratory flow (PEF) variability has often been promoted as a good alternative for challenge testing [8]. Associations between PEF variability and bronchial responsiveness have been observed both in asthmatic and COPD patients [9][10][11][12], although the two phenomena are not interchangeable [9].…”

mentioning

confidence: 99%

Distribution of peak expiratory flow variability by age, gender and smoking habits in a random population sample aged 20-70 yrs

Boezen

Schouten²,

Postma³

et al. 1994

Eur Respir J

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D Di is st tr ri ib bu ut ti io on n oof f p pe ea ak k e ex xp pi ir ra at to or ry y f fl lo ow w v va ar ri ia ab bi il li it ty y b by y a ag ge e, , g ge en nd de er r a an nd d s sm mo ok ki in ng g h ha ab bi it ts s i in n a a r ra an nd do om m p po op pu ul la at ti io on n s sa am mp pl le e a ag ge ed d 2 20 0--7 70 0 y yr rs s A training effect was found, absolute PEF values on the first measurement day being significantly lower. Females had greater PEF variability (adjusted for age, height and pack-years) and lower absolute PEFs than males. The mean within-day variation (amplitude % mean) was 3.66% (SD 2.03%), whereas the mean day-today variation was relatively small: 0.08% (SD 1.53%). Absolute PEFs were lower and amplitude % mean were significantly higher in older age groups. Smoking was significantly associated with lower mean PEFs and greater amplitude % mean. We observed lower mean values of the amplitude % mean than other investigators, possibly related to lower frequency of PEF recording (twice daily).We conclude that PEF and PEF variability have a normal or log-normal distribution. When studying PEF variability, age, gender and smoking habits should be taken into account.

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A general practice based survey of bronchial hyperresponsiveness and its relation to symptoms, sex, age, atopy, and smoking.

Abstract: The prevalence and associations of bronchial hyperresponsiveness were investigated in a general practice population.

Cited by 70 publications

References 28 publications

Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS)

Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS)

Airway hyperresponsiveness in the elderly: prevalence and clinical implications

Distribution of peak expiratory flow variability by age, gender and smoking habits in a random population sample aged 20-70 yrs

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