The relationship of airways responsiveness to cold air, cigarette smoking, and atopy to respiratory symptoms and pulmonary function in adults

The response to eucapnic hyperventilation with subfreezing air was studied in a population based sample of 171 adults, all of whom also completed a respiratory questionnaire, spirometry, and skin testing. A positive response to the cold air challenge was defined as ((initial FEV₁-postchallenge FEV₁)/initial FVC) x 100) greater than or equal to 9%. Cigarette smoking was associated with a positive cold air response: 12 of 128 current and ex-smokers (9.4%) versus 1 of 43 nonsmokers (2.3%) (p = 0.095). Among current and ex-smokers, a positive response to the cold air challenge was significantly associated with asthma (p = 0.046). Using a logistic regression model, both current smoking and response to cold air were significant predictors of the presence of 'persistent wheeze' or asthma. A positive skin test to any of the 4 environmental antigens used (ragweed, housedust, trees, and grasses) was significantly associated with cigarette smoking (p = 0.018) and hay fever (p = 0.003 among current and ex-smokers) but not with wheezing or asthma. Though not statistically significant, cold air responders had a lower percentage of positive skin test reactivity than nonreactors. The findings of this cross-sectional analysis suggest that in adults, both airways responsiveness and cigarette smoking are important predictors of wheezing and asthma. Furthermore, the data suggest that airway hyperresponsiveness and atopy are independent traits. However, in adults, these traits are associated with cigarette smoking, a common environmental exposure.