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Clinical Investigations |

Association of Airway Responsiveness With Asthma and Persistent Wheeze in a Chinese Population*

Xiping Xu, MD, PhD; Tianhua Niu, ScD; Changzhong Chen, MD; Binyan Wang, MD, PhD; Yontong Jin, MD; Jianhua Yang, MD; Scott T. Weiss, MD, FCCP
Author and Funding Information

*From the Program of Population Genetics (Drs. Xu, Niu, Chen, and Wang), Harvard School of Public Health, Boston, MA; Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital (Dr. Weiss), Harvard Medical School, Boston, MA; Anhui Meizhong Institute for Biomedical Science and Environmental Health (Dr. Yang), Anqing, Anhui, China; and Anhui Medical University Center for Ecogenetics and Disease Control (Dr. Jin), Hefei, Anhui, China.

Correspondence to: Xiping Xu, MD, Associate Professor, Program for Population Genetics FXB-101, 665 Huntington Ave, Boston, MA 02115; e-mail: xxu@ppg.harvard.edu



Chest. 2001;119(3):691-700. doi:10.1378/chest.119.3.691
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Study objectives: Data from a cross-sectional study were analyzed to examine the association of increased airway responsiveness with physician-diagnosed asthma and persistent wheeze.

Design: Two methods for calculating the provocative dose that decreases the airflow rate by 20% (PD20) were used as indexes for increased airway responsiveness: (1) a 20% drop in FEV1 calculated from baseline FEV1 (PD20b), and (2) a 20% drop in FEV1 from FEV1 measurements after inhalation of saline solution (PD20s). Both PD20b and PD20s were measured through induction by varying doses of methacholine.

Setting: Anqing, Anhui Province, China.

Participants: Study subjects were 8 to 74 years of age and were classified into four groups: children (< 15 years old), young adults (15 to 29 years old), adults (30 to 44 years old), and older adults (≥ 45 years old).

Interventions: The differences in estimated odds ratios of airway hyperresponsiveness with asthma and wheeze, sensitivity and specificity, and coefficients of variation were compared between PD20b and PD20s. The sample for analysis consisted of 10,284 subjects from 2,663 nuclear families with complete data on wheeze, asthma, and major potential confounding factors.

Measurements and results: The prevalence of asthma in this sample was lowest in subjects with no demonstrable PD20 and had a reverse dose-response relationship with PD20 across all age groups. Using the receiver operating characteristic, the sensitivity and specificity of the PD20s or PD20b were found to be almost identical. A similar trend was found for persistent wheeze, although the estimated odds ratios for persistent wheeze appeared slightly smaller than those for physician-diagnosed asthma.

Conclusions: This study demonstrates a dose-response relationship between increased airway responsiveness and asthma and wheeze in this Chinese population. PD20s or PD20b yielded virtually indistinguishable results, which indicated that either of the two tests could serve as an index of airway hyperresponsiveness.

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