Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary

Hopp, Russell J.; Pasha, M. Asghar

doi:10.1007/s12016-020-08818-1

Cited by 16 publications

(19 citation statements)

References 134 publications

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“… 23 However, it is difficult to perform spirometry in preschool children. 26 , 27 , 45 , 46 Body plethysmography and the impulse oscillometry system are necessary for evaluating lung function in infants and preschool children. 26 , 27 Our cohort study found that the number (%) of children who underwent spirometry at the ages < 4 years, 4 years, and 5 years were 0 (0%), 6 (1.2%), and 28 (5.4%), respectively.…”

Section: Discussionmentioning

confidence: 99%

Poor Asthma Control in Schoolchildren May Lead to Lower Lung Function Trajectory from Childhood to Early Adulthood: A Japanese Cohort Study

Tsuneyoshi¹,

Kawayama²,

Sasaki³

et al. 2022

JAA

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Purpose Although childhood asthma is a risk factor for adult lung function disorders, the correlation between childhood asthma control level and lung function growth remains unclear in Japan. The correlation between childhood asthma control and early adulthood lung function growth was investigated in this study. Patients and Methods We included 505 children with asthma from the Omuta City Air Pollution-Related Health Damage Cohort Program. The characteristics and lung function of girls and boys aged 6–11 years and 12–17 years were compared between poor and good asthma control groups. Results Among the 505 children, 214 (42.4%) showed poor asthma control. The mean percentage forced expiratory volume in 1 second predicted for girls and boys aged 6–11 years (80.2% and 79.2%, respectively) and 12–17 years (80.0% and 81.1%, respectively) in the poor control group was significantly lower than those of girls and boys aged 6–11 years (87.9% and 87.3%, respectively) and 12–17 years (88.1% and 87.8%, respectively) in the good control group. However, a linear regression model did not reveal between-group differences in the slopes of lung function growth for both sexes. Girls (24.6%, P < 0.0001) and boys (24.4%, P = 0.0026) in the poor control group had a significantly higher proportion of young adults with obstructive ventilatory patterns than girls (1.4%) and boys (8.1%) in the good control group. Conclusion Our findings revealed that poor childhood asthma control leaded to lung function disorders, which suggest the importance of early asthma control in school children.

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Section: Discussionmentioning

confidence: 99%

Poor Asthma Control in Schoolchildren May Lead to Lower Lung Function Trajectory from Childhood to Early Adulthood: A Japanese Cohort Study

Tsuneyoshi¹,

Kawayama²,

Sasaki³

et al. 2022

JAA

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“…Small airway dysfunction has not been well studied in childhood asthma. Small airway obstruction can be found in asthma patients without clinical symptoms (1)(2)(3). There is evidence to support the concept that small airway dysfunction is associated with a risk factor for asthma exacerbations, asthma severity, AHR, and loss of lung function (10,11).…”

Section: Introductionmentioning

confidence: 97%

“…Asthma is a chronic airway inflammatory disorder characterized by airway hypersensitivity (AHR) and reversible airflow obstruction (1,2). Persistent airway inflammation contributes to airway remodeling and asthma progression (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…There is evidence to support the concept that small airway dysfunction is associated with a risk factor for asthma exacerbations, asthma severity, AHR, and loss of lung function (10,11). Thus, early assessment, recognition, and monitoring of small airway obstruction may reduce the frequency of asthma exacerbations (2,12). The spirometry of FEF 25−75% is a marker of early small airway obstruction associated with lung function impairment in early adulthood (4).…”

Section: Introductionmentioning

confidence: 99%

“…The IOS-defined small airway dysfunction parameters, R5-R20, X5, and AX (reactance area), are found to be correlated with poor asthma control (8,13,14). However, some evidence shows that spirometry measures are poorly associated with a validated asthma control questionnaire, and thus, the routine use of these small-airway dysfunction markers to detect asthma control is still debated (2,15,16).…”

Section: Introductionmentioning

confidence: 99%

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Small Airway Dysfunction Measured by Impulse Oscillometry and Fractional Exhaled Nitric Oxide Is Associated With Asthma Control in Children

et al. 2022

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BackgroundImpulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) are sensitive and non-invasive methods to measure airway resistance and inflammation, although there are limited population-based studies using IOS and FeNO to predict asthma control.ObjectiveThis study aimed to investigate the utility of IOS and FeNO for assessing childhood asthma control in terms of small airway dysfunction and airway inflammation.MethodsThis prospective observational cohort study enrolled 5,018 school children (aged 6–12 years), including 560 asthmatic children and 140 normal participants. FeNO, spirometry, IOS, bronchial dilation test, total IgE, and childhood asthma control test (C-ACT) were measured. FeNO, IOS, spirometry, and C-ACT results were correlated with childhood asthma with and without control.ResultsUncontrolled asthmatic children had abnormal FeNO, IOS, and spirometric values compared with control subjects (P < 0.05). IOS parameters with R5, R5-R20, X5, Ax, △R5, and FeNO can predict lower C-ACT scales by the areas under receiver operating characteristic curves (AUCs) (0.616, 0.625, 0.609, 0.622, 0.625, and 0.714). A combination of FeNO (>20 ppb) with IOS measure significantly increased the specificity for predicting uncontrolled asthma patients compared with FeNO alone (P < 0.01). A multiple regression model showed that small airway parameter (R5-R20) was the strongest risk factor [OR (95% CI): 87.26 (7.67–993.31)] for uncontrolled asthma patients. Poor control with lower C-ACT scales correlated with high FeNO (r = −0.394), R5 (r = −0.106), and R5-R20 (r = −0.129) in asthmatic children (P < 0.05).ConclusionA combined use of FeNO and IOS measurements strongly predicts childhood asthma with or without control.

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A positive effect of a short period stay in Alpine environment on lung function in asthmatic children

Cogo¹,

Piazza

Costella³

et al. 2022

Pediatric Pulmonology

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Lung function is a central issue in diagnosis and determination of asthma severity and asthma control has been previously reported to improve after a stay in mountain environment for at least 2 weeks. No data are available for shorter periods of stay, in particular for small airways during a stay at altitude. The aim of this study is to focus on changes in respiratory function, regarding both the central airways and the peripheral airways in the first 2 weeks of stay in a mountain environment in asthmatic children. In this study, 66 asthmatic children (age: 14 ± 2.8 years) were evaluated through spirometric and oscillometric tests at the time of arrival at the Istituto Pio XII, Misurina (BL), Italy, 1756 m above sea level (T0), after 24 h (T1), and 168 h (T2) of stay. FEV1%, FEF25%–75%, and FEV1/FVC increased significantly from T0 value both at T1 and T2 (respectively, p = 0.0002, p < 0.0001, p = 0.0002). Oscillometry showed a significant improvement in R5, R20, and R5–20 at both T1 and T2 as compared to T0 (respectively, p = 0.0001, p = 0.0002, and p = 0.049). Reactance at 5 Hz (X5) improved significantly at T2 versus T0, p = 0.0022. The area under reactance curve between Fres and 5 Hz (AX) was significantly reduced (p = 0.0001) both at T1 and T2 as compared to T0. This study shows an improvement in respiratory indices as soon as after 24 h of stay at altitude, persisting in the following week.

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Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary

Cited by 16 publications

References 134 publications

Poor Asthma Control in Schoolchildren May Lead to Lower Lung Function Trajectory from Childhood to Early Adulthood: A Japanese Cohort Study

Poor Asthma Control in Schoolchildren May Lead to Lower Lung Function Trajectory from Childhood to Early Adulthood: A Japanese Cohort Study

Small Airway Dysfunction Measured by Impulse Oscillometry and Fractional Exhaled Nitric Oxide Is Associated With Asthma Control in Children

A positive effect of a short period stay in Alpine environment on lung function in asthmatic children

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