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First published online on November 7, 2007
Chest, doi:10.1378/chest.07-2130
A more recent version of this article appeared on January 1, 2008
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Paternal Asthma, Mold Exposure, and Increased Airway Responsiveness among Children with Asthma in Costa Rica

Ngoc P. Ly, MD, MPH1,3,4; Manuel E. Soto-Quirós, MD, PhD5; Lydiana Avila, MD5; Gary M. Hunninghake, MD, MPH1,2,4; Benjamin A. Raby, MD, MPH1,2,4; Daniel Laskey1; Jody S. Sylvia1 and Juan C. Celedón, MD, Dr.P.H., F.C.C.P1,2,4

1Channing Laboratory and 2Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital 3Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital 4Harvard Medical School, Boston, Massachusetts; and 5Division of Pediatric Pulmonology, Hospital Nacional de Niños, San José, Costa Rica

juan.celedon{at}channing.harvard.edu

Abstract

BackgroundLittle is known about determinants of airway hyper-responsiveness (AHR) among children with asthma in Hispanic America.

MethodsWe examined the relation 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 ages 6 to 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 (BMI); and assessment of airway responsiveness to methacholine (MCT). AHR to methacholine was defined as the provocative dose of methacholine causing a 20% reduction in FEV1 (PD20). Linear regression was used for the univariate and multivariate analyses.

ResultsOf the 403 asthmatic children with 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 (p<0.0001), and a positive IgE to dust mite (p=0.008) were significantly associated with AHR among Costa Rican children with asthma.

ConclusionOur results suggest that paternal asthma and environmental exposure to mold/mildew are strong determinants of AHR in Costa Rican children with asthma. FEV1/FVC 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: paternal asthma • mold • AHR • Hispanics • asthma • FEV1/FVC






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