Trajectories of Lung Function during Childhood

Abstract

Rationale: Developmental patterns of lung function during childhood may have major implications for our understanding of the pathogenesis of respiratory disease throughout life.Objectives: To explore longitudinal trajectories of lung function during childhood and factors associated with lung function decline.Methods: In a population-based birth cohort, specific airway resistance (sRaw) was assessed at age 3 (n = 560), 5 (n = 829), 8 (n = 786), and 11 years (n = 644). Based on prospective data (questionnaires, skin tests, IgE), children were assigned to wheeze phenotypes (no wheezing, transient, late-onset, and persistent) and atopy phenotypes (no atopy, dust mite, non-dust mite, multiple early, and multiple late). We used longitudinal linear mixed models to determine predictors of change in sRaw over time.Measurements and Main Results: Contrary to the assumption that sRaw is independent of age and sex, boys had higher sRaw than girls (mean difference, 0.080; 95% confidence interval [CI], 0.049-0.111; P , 0.001) and a higher rate of increase over time. For girls, sRaw increased by 0.017 kPa $ s 21 per year (95% CI, 0.011-0.023). In boys this increase was significantly greater (P = 0.012; mean betweensex difference, 0.011 kPa $ s 21; 95% CI, 0.003-0.019). Children with persistent wheeze (but not other wheeze phenotypes) had a significantly greater rate of deterioration in sRaw over time compared with never wheezers (P = 0.009). Similarly, children with multiple early, but not other atopy phenotypes had significantly poorer lung function than those without atopy (mean difference, 0.116 kPa $ s 21 ; 95% CI, 0.065-0.168; P , 0.001). sRaw increased progressively with the increasing number of asthma exacerbations.Conclusions: Children with persistent wheeze, frequent asthma exacerbations, and multiple early atopy have diminished lung function throughout childhood, and are at risk of a progressive loss of lung function from age 3 to 11 years. These effects are more marked in boys.

Allergy in severe asthma

“…Importantly, the risk of asthma was increased more than 20-fold among children belonging to one of these subgroups (those sensitized to multiple allergens in early life -comprising less than one-third of the sensitized children), but not among those in other classes (14,28). Striking similarities were observed in the association between different subgroups of atopic sensitization in these two cohorts in relation to asthma severity, with children in the subgroup of sensitization characterized by IgE responses to multiple allergens in early life having higher FeNO levels, more hyper-reactive airways and increased risk of severe asthma exacerbations, having significantly diminished lung function, compared to all other classes (14,28,29). It is of note, however, that such subtypes (clusters/classes) of sensitization can only be identified using statistical inference on longitudinal data (14,28) and that differentiation between different clusters at any single cross-sectional point is not yet possible (30).…”

Relationship between cytokine expression patterns and clinical outcomes: two population‐based birth cohorts

“…We studied two population‐based birth cohorts, the Manchester Asthma and Allergy Study (MAAS; ISRCTN72673620) 17, 18, 19 and the Western Australia Pregnancy Cohort (Raine) Study 20. Both studies were approved by local research ethics committees.…”

Recurrent bronchial obstruction and asthma in children during the first five years of life

“…Выявление у пациентов специфических IgE к экзогенным неинфекционным аллергенам и/или положительных кожных тестов подтвержда-ет аллергическую этиологию бронхиальной астмы. Подтверждение сенсибилизации в раннем детстве является доказанным фактором риска прогрессиро-вания заболевания и снижения показателей функции внешнего дыхания (чаще у мальчиков) в возрасте от 3 до 11 лет [24].…”