Is Asymptomatic Bronchial Hyperresponsiveness an Indication of Potential Asthma?: A Two-Year Follow-up of Young Students with Bronchial Hyperresponsiveness

To determine the possibility that asymptomatic bronchial hyperresponsiveness (BHR) develops into symptomatic asthma, a two-year follow-up study was conducted in 81 students (48 male, 33 female; 11 to 17 years) who were found to have BHR in a 3,067 population survey (BHR group). Eighty-eight age-matched students (48 male, 40 female) with normal bronchial responsiveness served as control subjects. Daily symptom cards were recorded. Peak expiratory flow rate was measured for 24 h when symptoms occurred. Histamine inhalation tests were performed at the beginning of the study and at the end of the first and the second year. In the BHR group, 58 students remained bronchial hyperresponsive at the end of follow-up. Nine of 31 students with initially diagnosed bronchial asthma had their symptoms relieved entirely, but ten asymptomatic students developed asthma. The incidence of newly diagnosed asthma (12.5 percent in the BHR group or 20 percent in the asymptomatic BHR group) and the total percentage of diagnosed asthma (39.5 percent) in the BHR group were significantly higher than those (2.27 percent, 2.27 percent) in the control group. FVC and FEV 1 showed no significant difference between two groups. PD20 FEV 1 values in newly diagnosed asthmatics were significantly lower than those in asymptomatic students both at the beginning (3.05 ±1.56 µmol vs 6.14±1.60 µmol, p 1 was undetectable within the cumulative dose of 7.8 µmol of histamine in three students and rose from 4.58 ± 1.85 µmol to 7.62 ± 1.02 µmol in the remaining six. The higher the BHR, the more likely the students developed asthma. About 45 percent of asymptomatic students with PD20 ≤3.2 µmol developed asthma in the following two years and 80 percent of them had a history of early respiratory illness, suggesting that they may have subclinical or potential asthma.