Small airway function in predicting asthma control in preschool children

Liangqin Yi, Yan Zhao, Ziyao Guo, Qinyuan Li, Chunlan Qiu, Jingyi Yang, Sha Liu, Fangjun Liu, Ximing Xu, Zhengxiu Luo

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Pediatric Discovery ›› 2024, Vol. 2 ›› Issue (1) : e46. DOI: 10.1002/pdi3.46
RESEARCH ARTICLE

Small airway function in predicting asthma control in preschool children

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Abstract

Asthma control in children is often challenging. This retrospective cohort study aimed to investigate the potential contribution of small airway function in predicting asthma control within a 2- to 3-month period following the initial diagnosis in preschool children with asthma. A total of 219 preschool children diagnosed with asthma were enrolled, and their follow-up was conducted by pediatric pulmonary physicians. Clinical history and lung function results were collected for analysis. To identify risk factors associated with poor asthma control, a multivariable regression model was employed. Sixty-nine of the patients (31.5%) exhibited poor asthma control. Poor adherence to therapy (14.5% vs. 6.0%, p = 0.038) and the presence of severe airway hyperresponsiveness (AHR) (20.6% vs. 1.6%, p < 0.001) were more prevalent in the group with poor control. Additionally, baseline forced expiratory volume in 1 s in predicting (94.5% vs. 101.4%, p = 0.001), forced expiratory flows (FEF)50% (66.1% vs. 86.0%, p < 0.001), FEF75% (60.9% vs. 75.3%, p = 0.001), and FEF25–75% (70.9% vs. 86.0%, p < 0.001) were significantly lower in the poorly-controlled group than those of well-controlled group. There was no significant difference in forced vital capacity in predicting (FVC%) between the two groups (92.4% vs. 96.7%, p = 0.093). Multivariable regression model unveiled initial severe AHR (OR 8.595, 95%CI 1.241–59.537, p = 0.021) and decreased FEF50% (OR 0.971, 95%CI 0.949–0.994, p = 0.012) were significantly associated with short-term poor asthma control. Preschool children with asthma who exhibites initial severe AHR and/or decreased FEF50% faces an elevated risk of encountering poor asthma control during the subsequent 2–3 months.

Keywords

asthma control / FEF50 / preschool children / small airway function

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Liangqin Yi, Yan Zhao, Ziyao Guo, Qinyuan Li, Chunlan Qiu, Jingyi Yang, Sha Liu, Fangjun Liu, Ximing Xu, Zhengxiu Luo. Small airway function in predicting asthma control in preschool children. Pediatric Discovery, 2024, 2(1): e46 https://doi.org/10.1002/pdi3.46

References

[1]
Report A. Premium Times. November 1, 2022. Accessed May 5, 2021. https://www.premiumtimesng.com/news/top-news/459514-world-asthma-day-339-million-people-affected-globally-expert.html#.Y2pxApbQSC4.link
[2]
Bateman ED, Boushey HF, Bousquet J, et al. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control study. Am J Respir Crit Care Med. 2004;170(8), 836-844.
[3]
Papwijitsil R, Pacharn P, Areegarnlert N, et al. Risk factors associated with poor controlled pediatric asthma in a university hospital. Asian Pac J Allergy Immunol. 2013;31(3):253.
[4]
Bao Y, Chen Z, Liu E, Xiang L, Zhao D, Hong J. Risk factors in preschool children for predicting asthma during the preschool age and the early school age: a systematic review and meta-analysis. Curr Allergy Asthma Rep.2017;17(12):85.
[5]
Green RJ, Klein M, Becker P, et al. Disagreement among common measures of asthma control in children. Chest. 2013;143(1):117-122.
[6]
Asthma GIf. Global Strategy for Asthma Management and Prevention. 2018. www.ginasthma.org
[7]
Turner SW, Craig LC, Harbour PJ, et al. Spirometry in 5-year-olds—validation of current guidelines and the relation with asthma. Pediatr Pulmonol. 2007;42(12):1144-1151.
[8]
McFadden E. Jr, Linden DA. A reduction in maximum mid-expiratory flow rate. A spirographic manifestation of small airway disease. Am J Med. 1972;52(6):725-737.
[9]
Takeda T, Oga T, Niimi A, et al. Relationship between small airway function and health status, dyspnea and disease control in asthma. Respiration. 2010;80(2):120-126.
[10]
Shi Y, Aledia AS, Galant SP, George SC. Peripheral airway impairment measured by oscillometry predicts loss of asthma control in children. J Allergy Clin Immunol. 2013;131(3):718-723.
[11]
Robroeks CM, van Vliet D, Jöbsis Q, et al. Prediction of asthma exacerbations in children: results of a one-year prospective study. Clin Exp Allergy. 2012;42(5):792-798.
[12]
Postma DS, Brightling C, Baldi S, et al. Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. Lancet Respir Med. 2019;7(5):402-416.
[13]
Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-338.
[14]
Knihtilä H, Kotaniemi-Syrjänen A, Pelkonen AS, Mäkelä MJ, Malmberg LP. Small airway function in children with mild to moderate asthmatic symptoms. Ann Allergy Asthma Immunol. 2018;121(4):451-457.
[15]
Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481-1490.
CrossRef Google scholar
[16]
Yuan H. Exploratory the Establishment of Improved Method in Bronchial Provocation Tests for Infants and the Clinical Application. Master. Chongqing Medical University; 2007. http://kns.cnki.net.forest.vpn358.com/KCMS/detail/detail.aspx?dbname=CMFD2008&filename=2007218528.nh
[17]
Gudmund R, Iversen MG, Xizhi W. Statistics. China Higher Education Press/Springer Verlag; 2000.
[18]
Braido F, Scichilone N, Lavorini F, et al. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association – GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA(2)LEN). World Allergy Organ J. 2016;9:1-6.
[19]
Bonser LR, Erle DA-O. Airway mucus and asthma: the role of MUC5AC and MUC5B. J Clin Med. 2017;6(12):112.
[20]
Tirakitsoontorn P, Crookes M, Fregeau W, et al. Recognition of the peripheral airway impairment phenotype in children with well-controlled asthma. Ann Allergy Asthma Immunol. 2018;121(6):692-698.
[21]
Kraft M, Cairns C, Ellison MC, Pak J, Irvin C, Wenzel S. Improvements in distal lung function correlate with asthma symptoms after treatment with oral montelukast. Chest. 2006;130(6):1726-1732.
[22]
Komarow HD, Skinner J, Young M, et al. A study of the use of impulse oscillometry in the evaluation of children with asthma: analysis of lung parameters, order effect, and utility compared with spirometry. Pediatr Pulmonol. 2012;47(1):18-26.
[23]
Dosman J, Bode F, Urbanetti J, Martin R, Macklem PT. The use of a helium-oxygen mixture during maximum expiratory flow to demonstrate obstruction in small airways in smokers. J Clin Invest. 1975;55(5):1090-1099.
[24]
Murray AB, Ferguson AC. A comparison of spirometric measurements in allergen bronchial challenge testing. Clin Exp Allergy. 1981;11(1):87-93.
[25]
Lutfi M, My S. Reliability of spirometric measurements in assessing asthma severity. Khartoum Med J. 2010;3:433-439.
[26]
Leiria-Pinto P, Carreiro-Martins P, Peralta I, et al. Factors associated with asthma control in 121 preschool children. J Investig Allergol Clin Immunol. 2021;31(6):471-480.
[27]
Scott L, Morphew T, Bollinger ME, et al. Achieving and maintaining asthma control in inner-city children. J Allergy Clin Immunol. 2011;128(1):56-63.
[28]
Gruchalla RS, Sampson HA, Matsui E, et al. Asthma morbidity among inner-city adolescents receiving guidelines-based therapy: role of predictors in the setting of high adherence. J Allergy Clin Immunol. 2009;124(2):213-221.
[29]
Lötvall J, Inman M, O'Byrne P. Measurement of airway hyperresponsiveness: new considerations. Thorax. 1998;53(5):419-424.
[30]
Brutsche MH, Downs SH, Schindler C, et al. Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA cohort study. Thorax. 2006;61(8):671-677.
[31]
Palmer LJ, Rye PJ, Gibson NA, Burton PR, Landau LI, Lesouëf PN. Airway responsiveness in early infancy predicts asthma, lung function, and respiratory symptoms by school age. Am J Respir Crit Care Med. 2001;163(1):37-42.
[32]
Martin RJ. Therapeutic significance of distal airway inflammation in asthma. J Allergy Clin Immunol. 2002;109(2 Suppl):S447-S460.
[33]
Abdo M, Watz H, Veith V, et al. Small airway dysfunction as predictor and marker for clinical response to biological therapy in severe eosinophilic asthma: a longitudinal observational study. Respir Res. 2020;21(1):278.

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