Gender- and race-specific effects of asthma and wheeze on level and growth of lung function in children in six U.S. cities.

The gender-and race-specific effects of asthma/wheeze on pulmonary function level and annual growth velocity were studied in a cohort of 10,792 white and 944 black children 6 to 18 yr of age, examined annually between 1974 and 1989 in six U.S. cities. In comparison with white boys who never reported asthma or wheeze, FEV1 levels were 5.7% lower and FEF 25-75 levels were 16.9% lower for white boys with a diagnosis of asthma who reported wheeze symptoms in the past year. White girls with asthma and wheeze had FEV1 levels that were 3.4% lower and FEF25-75 levels that were 13.6% lower than white girls with never-asthma/wheeze. Asthma with wheeze was associated with a greater percent deficit in FEV1 level in boys than in girls (p < 0.01) and, particularly in preadolescence, with a significant percent increment in FVC level (1.6%) for girls but not for boys. The diagnosis of asthma with or without wheeze in the past year was associated with a greater deficit in level of lung function than the reporting of wheeze symptoms in a child without the diagnosis of asthma. The prevalence of asthma and wheeze was higher among blacks, but no race differences were found in the effects of asthma or wheeze on level of FEV1 and FEF25-75. Compared with white adolescent female ever asthmatics with no medication use, FEV1 level was 5.8% lower for those with routine medication use and 7.8% lower for those with routine and additional medication use. Although white girls with wheeze but no diagnosis of asthma had slightly slower growth of FEV1 (0.3% per year) than did white girls without asthma or wheeze, children with asthma did not have slower annual growth in percent terms. In absolute terms, growth of FEV1 was 14.7 ml/yr and FEF25-75 was 47 ml/s/yr slower for asthmatic white boys with wheeze than for those without asthma; for girls with asthma and wheeze growth of FEF25-75 was 29 ml/s/yr slower. We conclude that in absolute terms, but not in percent terms, the pulmonary function deficits associated with asthma and wheeze increase throughout childhood. In the preadolescent and adolescent years, the mechanical properties of the lungs and the inflammatory process in asthmatics may differ by gender, leading to gender differences in their pulmonary function. We also conclude that lung function may not return to normal, even when asthmatics become asymptomatic.