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First published online on November 7, 2007
Chest, doi:10.1378/chest.07-2130
doi:10.1378/chest.07-2130
(Chest. 2008; 133:107-114)
© 2008 American College of Chest Physicians
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Paternal Asthma, Mold Exposure, and Increased Airway Responsiveness Among Children With Asthma in Costa Rica*

Ngoc P. Ly, MD, MPH; Manuel E. Soto-Quirós, MD, PhD; Lydiana Avila, MD; Gary M. Hunninghake, MD, MPH; Benjamin A. Raby, MD, MPH; Daniel Laskey, BS; Jody S. Sylvia, BS and Juan C. Celedón, MD, DrPH, FCCP

* From the Channing Laboratory (Drs. Ly, Hunninghake, Raby, and Celedón, Mr. Laskey, and Ms. Sylvia), Boston, MA; and the Division of Pediatric Pulmonology (Drs. Soto-Quirós and Avila), Hospital Nacional de Niños, San José, Costa Rica.

Correspondence to: Juan C. Celedón, MD, DrPH, Channing Laboratory, 181 Longwood Ave, Boston, MA 02115; e-mail: juan.celedon{at}channing.harvard.edu

Abstract

Background: Little is known about the determinants of airway hyperresponsiveness (AHR) among children with asthma in Hispanic America.

Methods: We examined the relations among selected familial and environmental factors, markers of allergy, spirometric measures of lung function, and AHR in a cross-sectional study of 403 Costa Rican children with asthma between the ages of 6 and 14 years. Study participants completed a protocol that included questionnaires, spirometry, measurements of serum total and allergen-specific IgE, peripheral blood eosinophil count, and body mass index, and the assessment of airway responsiveness to methacholine (ie, a methacholine challenge test [MCT]). AHR to MCT was defined as the provocative dose of methacholine causing a 20% fall in FEV1. Linear regression was used for the univariate and multivariate analyses.

Results: Of the 403 asthmatic children who underwent an MCT, 350 (86.8%) had AHR to methacholine. In a multivariate analysis, paternal asthma (p = 0.004), parental report of mold/mildew in the child’s home (p = 0.04), FEV1/FVC ratio (p < 0.0001), and a positive IgE response to Der p 1 (p = 0.008) were significantly associated with AHR among Costa Rican children with asthma.

Conclusion: Our results suggest that paternal asthma and environmental exposure to mold/mildew are strong determinants of AHR in Costa Rican children with asthma. FEV1/FVC ratio may be a useful measure of AHR (a marker of asthma severity) among Costa Ricans and other Hispanic Americans for whom reference values for FEV1 are not currently available.

Key Words: airway hyperresponsiveness • asthma • FEV1/FVC ratio • Hispanics • mold • paternal asthma






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