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Fain SB, McIntosh MJ. A new approach to computed tomography measurement of airway remodelling in paediatric asthma. ERJ Open Res 2024; 10:00763-2023. [PMID: 38226062 PMCID: PMC10789253 DOI: 10.1183/23120541.00763-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 01/17/2024] Open
Abstract
Internal normalisation to reference structures on quantitative chest CT imaging (e.g. lung airway dimensions to adjacent vascular dimensions) provides a potential way to standardise image measurements to population characteristics https://bit.ly/3Rh9pnW.
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Affiliation(s)
- Sean B. Fain
- Department of Radiology, University of Iowa, Iowa City, IA, USA
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2
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Sarikloglou E, Fouzas S, Paraskakis E. Prediction of Asthma Exacerbations in Children. J Pers Med 2023; 14:20. [PMID: 38248721 PMCID: PMC10820562 DOI: 10.3390/jpm14010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.
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Affiliation(s)
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras Medical School, 26504 Patras, Greece;
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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3
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Betancor D, Villalobos-Vilda C, Olaguibel JM, Rodrigo-Muñoz JM, Puebla MJA, Arismendi E, Barranco P, Barroso B, Bobolea I, Cárdaba B, Cruz MJ, Curto E, Pozo VD, Domínguez-Ortega J, González-Barcala FJ, Luna-Porta JA, Martínez-Rivera C, Mullol J, Muñoz X, Picado C, Plaza V, Quirce S, Rial MJ, Soto-Retes L, Valero A, Valverde-Monge M, Sastre J. The New ERS/ATS 2022 Bronchodilator Response Recommendation: Comparison With the Previous Version in an Asthma Cohort. Arch Bronconeumol 2023; 59:608-611. [PMID: 37331901 DOI: 10.1016/j.arbres.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Diana Betancor
- Servicio de Alergología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | | | - José María Olaguibel
- Servicio de Alergología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - José Manuel Rodrigo-Muñoz
- Servicio de Inmunología, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - María Jose Alvarez Puebla
- Servicio de Alergología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ebymar Arismendi
- Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pilar Barranco
- Servicio de Alergia, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Blanca Barroso
- Servicio de Alergología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Irina Bobolea
- Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Blanca Cárdaba
- Servicio de Inmunología, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - María Jesús Cruz
- Departamento de Biología Celular, Fisiología e Inmunología, Universitat Autónoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Elena Curto
- Servicio de Neumologia y Alergia, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Departamento de Medicina, Barcelona, Spain
| | - Victoria Del Pozo
- Servicio de Inmunología, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Javier Domínguez-Ortega
- Servicio de Alergia, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Juan Alberto Luna-Porta
- Servicio de Alergia, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Carlos Martínez-Rivera
- Servicio de Neumología, Hospital Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Clinical and Experimental Respiratory Immunoallergy (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Xavier Muñoz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Cesar Picado
- Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Vicente Plaza
- Servicio de Neumologia y Alergia, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Departamento de Medicina, Barcelona, Spain
| | - Santiago Quirce
- Servicio de Alergia, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Jorge Rial
- Servicio de Alergología, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Lorena Soto-Retes
- Servicio de Neumologia y Alergia, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Departamento de Medicina, Barcelona, Spain
| | - Antonio Valero
- Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Marcela Valverde-Monge
- Servicio de Alergología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joaquín Sastre
- Servicio de Alergología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Kuang L, Ren C, Liao X, Zhang X, Zhou X. Percent Recovery Index Predicts Poor Asthma Control and Exacerbation in Adults. J Asthma Allergy 2023; 16:711-722. [PMID: 37465370 PMCID: PMC10351680 DOI: 10.2147/jaa.s414164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Background Previous studies indicate that the percent recovery index (PRI: the percentage increase from the maximally reduced FEV1 after bronchodilator inhalation), one of the indexes of methacholine bronchial provocation, may predict acute asthma exacerbations in childhood and elderly asthmatics. It is known that childhood (<12) and elder (>60) asthmatics may be different to adult patients in many aspect including prognosis. However, in adults, a research for predicting value of PRI to exacerbation is still absence. Besides exacerbation, predicting value of PRI to poor asthma control is also unknown. We try to detect whether PRI can predict poor asthma control and exacerbation in adults in this research. Meanwhile, we try to detect whether treatment can influence PRI. Methods In 61 adults with asthma, baseline PRI was measured during enrollment. And then baseline PRI was evaluated as a predictor of exacerbation or poor asthma control at an upcoming 3-month follow-up. The covariates included age, sex, BMI, previous exacerbation, smoking status and baseline lung function. After treatment for 3 months, PRI was measured again and compared with baseline PRI. Results After the 3-month follow-up, we found that baseline PRI was significantly related to asthma exacerbation (P = 0.023), poor asthma control (ACT at 3 months, P = 0.014), decreased quality of life (decrease of MiniAQLQ, P = 0.010) and cumulative number of EDHO at 3 months (P = 0.039). Meanwhile, no significant correlation was observed between baseline PRI and inflammation factors (FENO, CaNO, and EOS). Finally, PRI was dramatically reduced after standard treatment for 3 months. Conclusion PRI is efficient in the prediction of poor asthma control and exacerbation in adults. The predictive value of PRI may rely on the inherent property of asthmatic airway smooth muscle (ASM) independent of inflammation factors. Effective treatment can alleviate PRI dramatically and that indicate PRI may also be valuable in evaluation of curative effect.
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Affiliation(s)
- Lisha Kuang
- Department of Health Management Center, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Cheng Ren
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xiuqing Liao
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xiaobin Zhang
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xuegang Zhou
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
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Miller RL, Schuh H, Chandran A, Aris IM, Bendixsen C, Blossom J, Breton C, Camargo CA, Canino G, Carroll KN, Commodore S, Cordero JF, Dabelea DM, Ferrara A, Fry RC, Ganiban JM, Gern JE, Gilliland FD, Gold DR, Habre R, Hare ME, Harte RN, Hartert T, Hasegawa K, Khurana Hershey GK, Jackson DJ, Joseph C, Kerver JM, Kim H, Litonjua AA, Marsit CJ, McEvoy C, Mendonça EA, Moore PE, Nkoy FL, O'Connor TG, Oken E, Ownby D, Perzanowski M, Rivera-Spoljaric K, Ryan PH, Singh AM, Stanford JB, Wright RJ, Wright RO, Zanobetti A, Zoratti E, Johnson CC. Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program. J Allergy Clin Immunol 2023; 152:84-93. [PMID: 36972767 PMCID: PMC10330473 DOI: 10.1016/j.jaci.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Descriptive epidemiological data on incidence rates (IRs) of asthma with recurrent exacerbations (ARE) are sparse. OBJECTIVES This study hypothesized that IRs for ARE would vary by time, geography, age, and race and ethnicity, irrespective of parental asthma history. METHODS The investigators leveraged data from 17,246 children born after 1990 enrolled in 59 US with 1 Puerto Rican cohort in the Environmental Influences on Child Health Outcomes (ECHO) consortium to estimate IRs for ARE. RESULTS The overall crude IR for ARE was 6.07 per 1000 person-years (95% CI: 5.63-6.51) and was highest for children aged 2-4 years, for Hispanic Black and non-Hispanic Black children, and for those with a parental history of asthma. ARE IRs were higher for 2- to 4-year-olds in each race and ethnicity category and for both sexes. Multivariable analysis confirmed higher adjusted ARE IRs (aIRRs) for children born 2000-2009 compared with those born 1990-1999 and 2010-2017, 2-4 versus 10-19 years old (aIRR = 15.36; 95% CI: 12.09-19.52), and for males versus females (aIRR = 1.34; 95% CI 1.16-1.55). Black children (non-Hispanic and Hispanic) had higher rates than non-Hispanic White children (aIRR = 2.51; 95% CI 2.10-2.99; and aIRR = 2.04; 95% CI: 1.22-3.39, respectively). Children born in the Midwest, Northeast and South had higher rates than those born in the West (P < .01 for each comparison). Children with a parental history of asthma had rates nearly 3 times higher than those without such history (aIRR = 2.90; 95% CI: 2.43-3.46). CONCLUSIONS Factors associated with time, geography, age, race and ethnicity, sex, and parental history appear to influence the inception of ARE among children and adolescents.
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Affiliation(s)
| | - Holly Schuh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Izzuddin M Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass
| | | | - Jeffrey Blossom
- Harvard University Center for Geographic Analysis, Cambridge, Mass
| | - Carrie Breton
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Carlos A Camargo
- Department of Epidemiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Glorisa Canino
- University of Puerto Rico Behavioral Sciences Research Institute, San Juan, Puerto Rico
| | | | | | - José F Cordero
- University of Georgia College of Public Health, Athens, Ga
| | - Dana M Dabelea
- University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, Calif
| | - Rebecca C Fry
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - James E Gern
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | - Frank D Gilliland
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Diane R Gold
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Rima Habre
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Marion E Hare
- University of Tennessee Health Science Center, Memphis, Tenn
| | | | - Tina Hartert
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Gurjit K Khurana Hershey
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | | | - Jean M Kerver
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Mich
| | | | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Carmen J Marsit
- Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Cindy McEvoy
- Oregon Health and Science University, Portland, Ore
| | - Eneida A Mendonça
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul E Moore
- Vanderbilt University School of Medicine, Nashville, Tenn
| | | | - Thomas G O'Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass
| | | | | | | | - Patrick H Ryan
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne Marie Singh
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | | | | | | | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
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Domínguez-Martín C, Cano A, Díez-Monge N. Clinical performance of spirometry and respiratory oscillometry for prediction of severe exacerbations in schoolchildren with asthma. An Pediatr (Barc) 2023:S2341-2879(23)00109-6. [PMID: 37246048 DOI: 10.1016/j.anpede.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/04/2023] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To determine the performance of spirometry and respiratory oscillometry (RO) in the prediction of severe asthma exacerbations (SAEs) in children. METHODS In a prospective study, 148 children (age 6-14 years) with asthma were assessed with RO, spirometry and a bronchodilator (BD) test. Based on the findings of spirometry and the BD test, they were classified into three phenotypes: air trapping (AT), airflow limitation (AFL) and normal. Twelve weeks later, they were re-evaluated in relation to the occurrence of SAEs. We analysed the performance of RO, spirometry and AT/AFL phenotypes for prediction of SAEs by means of positive and negative likelihood ratios, ROC curves with the corresponding areas under the curve (AUCs) and a multivariate analysis adjusted for potential confounders. RESULTS During the follow-up, 7.4% of patients had SAEs, and there were differences between phenotypes (normal, 2.4%; AFL, 17.9%; AT, 22.2%, P = .005). The best AUC corresponded to the forced expiratory flow between 25% and 75% of vital capacity (FEF25-75): 0.787; 95% confidence interval, 0.600-0.973. Other significant AUCs were those for the reactance area (AX), forced expiratory volume in the first second (FEV1), the post-BD change in forced vital capacity (FVC), and the FEV1/FVC ratio. All of the variables had a low sensitivity for prediction of SAEs. The AT phenotype had the best specificity (93.8%; 95% CI, 87.9-97.0), but the positive and negative likelihood ratios were both significant only for the FEF25-75. In the multivariate analysis, only some spirometry parameters were significative for prediction of SAEs (AT phenotype, FEF25-75 and FEV1/FVC). CONCLUSIONS Spirometry performed better than RO for prediction of SAEs in the medium term in schoolchildren with asthma.
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Affiliation(s)
- Clara Domínguez-Martín
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alfredo Cano
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
| | - Nuria Díez-Monge
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
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Grant T, Lilley T, McCormack MC, Rathouz PJ, Peng R, Keet CA, Rule A, Davis M, Balcer-Whaley S, Newman M, Matsui EC. Indoor environmental exposures and obstructive lung disease phenotypes among children with asthma living in poor urban neighborhoods. J Allergy Clin Immunol 2023; 151:716-722.e8. [PMID: 36395986 PMCID: PMC9992008 DOI: 10.1016/j.jaci.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Air trapping is an obstructive phenotype that has been associated with more severe and unstable asthma in children. Air trapping has been defined using pre- and postbronchodilator spirometry. The causes of air trapping are not completely understood. It is possible that environmental exposures could be implicated in air trapping in children with asthma. OBJECTIVE We investigated the association between indoor exposures and air trapping in urban children with asthma. METHODS Children with asthma aged 5 to 17 years living in Baltimore and enrolled onto the Environmental Control as Add-on Therapy for Childhood Asthma study were evaluated for air trapping using spirometry. Aeroallergen sensitization was assessed at baseline, and spirometry was performed at 0, 3, and 6 months. Air trapping was defined as an FVC z score of less than -1.64 or a change in FVC with bronchodilation of ≥10% predicted. Logistic normal random effects models were used to evaluate associations of air trapping and indoor exposures. RESULTS Airborne and bedroom floor mouse allergen concentrations were associated with air trapping but not airflow limitation (odds ratio 1.19, 95% confidence interval 1.02-1.37, P = .02 per 2-fold increase in airborne mouse allergen; odds ratio 1.23, 95% confidence interval 1.07-1.41, P = .003 per 2-fold increase in bedroom floor mouse allergen). Other indoor exposures (cockroach, cat, dog, dust mite, particulate matter, and nicotine) were not associated with air trapping or airflow limitation. CONCLUSION Mouse allergen exposure, but not other indoor exposure, was associated with air trapping in urban children with asthma.
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Affiliation(s)
- Torie Grant
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Travis Lilley
- Department of Population Health, Dell Medical School at UT Austin, Austin, Tex
| | - Meredith C McCormack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School at UT Austin, Austin, Tex
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Corinne A Keet
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Pubilc Health, Baltimore, Md
| | - Meghan Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Pubilc Health, Baltimore, Md
| | - Susan Balcer-Whaley
- Department of Population Health, Dell Medical School at UT Austin, Austin, Tex
| | - Michelle Newman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School at UT Austin, Austin, Tex; Department of Pediatrics, Dell Medical School at UT Austin, Austin, Tex.
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Feng Y, Yu H, Liu X, Chen N, Shang Y, Zhang H. Asthma with recurrent middle lobe syndrome in children: Clinical features and lung function patterns. Front Pediatr 2023; 11:1113652. [PMID: 36814593 PMCID: PMC9939435 DOI: 10.3389/fped.2023.1113652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Middle lobe syndrome (MLS) is a complication of childhood asthma. This study aimed to compare the clinical features and lung function between asthmatic children with recurrent MLS and transient right middle lobe (RML) and/or lingula atelectasis. METHODS This study retrospectively analyzed asthmatic children with RML and/or lingula atelectasis between 2010 and 2020 using data from the pediatric pulmonary department. According to the episodes of atelectasis, children were divided into recurrent (≥2 episodes) and non-recurrent (only 1 episode) MLS groups, to compare clinical features and lung function. Spirometry during acute asthma exacerbation and stable stages were recorded, and variations were calculated. RESULTS A total of 35 children with asthma and RML and/or lingula atelectasis were included, 15 of whom had recurrent MLS. The recurrent MLS group had a higher proportion of girls, infections, family allergy history, severe asthma, severe exacerbation, and higher levels of total IgE than the non-recurrent MLS group (P < 0.05). The recurrent MLS group had a significantly higher % predicted and z-scores for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), a greater proportion of high FEV1 and higher variations in FEV1 and FVC than that in the non-recurrent group (P < 0.05). After excluding children with mild to moderate asthma in the recurrent MLS group, the differences in clinical features disappeared, but the results regarding lung function remained similar, when compared to severe asthma patients without RML and/or lingula atelectasis. CONCLUSIONS Childhood asthma with recurrent MLS has more frequent severe asthma and exacerbation but high lung function and variations.
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Affiliation(s)
- Yong Feng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haoting Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ning Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunxiao Shang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Han Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Hopp R, Lee J, Bohan H. An a Priori Approach to Small Airway Dysfunction in Pediatric Asthmatics. Children 2022; 9:children9101454. [PMID: 36291390 PMCID: PMC9600101 DOI: 10.3390/children9101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
Abstract
Small airway dysfunction remains a stepchild in the pediatric asthma care pathway. In brief, elements of the pulmonary function test (PFT) concerning smaller airway data remain less utilized. To further the value of the standard PFT we underwent a prospective Proof of Concept (POC) project, utilizing the outpatient performance of PFT tests in children 6–18 years during a 15-month period. The goal of the study was to determine if a priori the PFT represented a small airway disease pattern or not. Only the pulmonary function was used to make that distinction. Children 6–18 years with asthma who completed a PFT had their PFT as being characterized with or without a small airway dysfunction (SAD) designation, coded in the electronic medical record as an a priori decision using the code J98.4 (other disorders of lung) as a marker for electronic medical records retrieval. Subsequently, the results were analyzed between a group of 136 children designated (a priori) as having no small airway dysfunction in comparison to 91 children a priori designated as having small airway dysfunction. The a priori designation groups were post hoc compared for large and smaller airway function differences. Both large and smaller airway dysfunction were highly significantly different between the 2 groups, based solely on the initial division of the total group based on the decision the PFT represented a small airway pattern. We concluded the baseline pulmonary function test used in the evaluation of pediatric asthma has readily identifiable information regarding the presence of small airway dysfunction, and we characterized what was unique on the PFT based on that SAD classification
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Affiliation(s)
- Russell Hopp
- Department of Pediatrics, University of Nebraska Medical Center, 42nd and Emile St., Omaha, NE 68198, USA
- Children’s Hospital and Medical Center, 8200 Dodge St., Omaha, NE 68114, USA
- Correspondence:
| | - Junghyae Lee
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Heather Bohan
- Children’s Hospital and Medical Center, 8200 Dodge St., Omaha, NE 68114, USA
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10
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McIntosh MJ, Kooner HK, Eddy RL, Jeimy S, Licskai C, Mackenzie CA, Svenningsen S, Nair P, Yamashita C, Parraga G. Asthma Control, Airway Mucus, and 129Xe MRI Ventilation After a Single Benralizumab Dose. Chest 2022; 162:520-533. [DOI: 10.1016/j.chest.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022] Open
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11
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Nucera E, Rizzi A, Agrosì C, Lohmeyer FM, Inchingolo R. Lung Function Tests, Quality of Life and Telemedicine: Three Windows on the Multifaceted World of Asthma in Adolescents. Children 2022; 9:476. [PMID: 35455520 PMCID: PMC9026868 DOI: 10.3390/children9040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
Asthma is a heterogeneous disease usually characterized by chronic airway inflammation and recognized as the most prevalent chronic illness among children. Despite this, the knowledge as to how asthma affects adolescents is still scarce. One of the main management problems of asthmatic adolescents is the poor adherence to pharmacological and non-pharmacological treatments. The assessment of respiratory function and the impact on quality of life are still two crucial challenges in the management of asthmatic adolescents. Additionally, the COVID-19 pandemic has prompted physicians to explore complementary management strategies including telemedicine technologies. This review aims to provide an update on the contribution of respiratory functional tests, how asthma affects quality of life of adolescents and, finally, how telemedicine contributes to the management of adolescent asthmatics during the COVID-19 pandemic.
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12
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Wawszczak M, Kulus M, Peradzyńska J. Peripheral airways involvement in children with asthma exacerbation. Clin Respir J 2021; 16:97-104. [PMID: 34676678 PMCID: PMC9060097 DOI: 10.1111/crj.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Objective The literature provides some evidence of peripheral airways key role in the pathogenesis of asthma. However, the extent to which lung periphery including acinar zone contribute to asthma activity and control in pediatric population is unclear. Therefore, the aim of the study was to estimate peripheral airways involvement in children with asthma exacerbation and stable asthma simultaneously via different pulmonary function tests. Methods Children with asthma exacerbation (n = 20) and stable asthma (n = 22) performed spirometry, body plethysmography, exhaled nitric oxide, impulse oscillometry (IOS), and multiple‐breath washout (MBW). Results Peripheral airway's function indexes were increased in children with asthma, particularly in group with asthma exacerbation when compared with stable asthma group. The prevalence of abnormal results was significantly higher in asthma exacerbation. All children with asthma exacerbation had conductive ventilation inhomogeneity; 76% had acinar ventilation inhomogeneity. According to IOS measurements, resistance and reactance were within normal range, but other IOS parameters were significantly higher in children with asthma exacerbation compared with stable asthma group. The 36% of children with acute asthma had air trapping. Conclusion Significant involvement of peripheral airways was observed in children with asthma, particularly in asthma exacerbation, which determine lung periphery as important additional target for therapy and provide new insights into pathophysiological process of pediatric asthma.
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Affiliation(s)
- Maria Wawszczak
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzyńska
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
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13
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Abstract
OBJECTIVE Standard spirograms are widely used in the respiratory disease management community to help diagnosis asthma and provide longitudinal information. Surprisingly, basic information obtained on the spirogram, beyond the FEV1 and change in FEV1 after bronchodilator is underutilized. We reviewed information on pulmonary function and bronchodilator response in children since 2016. We present here a discussion of other element of the standard spirogram that can be used for pediatric asthma management.Methods: Medline search of pulmonary function, children, adolescents, bronchodilator reversibility, small airway disease, small airway function, asthma, airflow limitation, bronchodilator response. Studies since 2016 that provide information on normal or asthmatic children bronchodilator response, and/or small airway or pulmonary function values after albuterol. RESULTS Limited data has been published on FEV1 bronchodilator response in children since 2016. Other parameters of the pulmonary function test in children have had recent documentation. CONCLUSIONS New data on FEV1 bronchodilator response in normal children is limited since 2016. However, other details of pulmonary function interpretation in asthmatic children has had considerable attention, and are reviewed here.
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Affiliation(s)
- Russell J Hopp
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
| | - Mark Wilson
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
| | - M Asghar Pasha
- Division of Allergy and Immunology, Albany Medical Center, Albany, NY, USA
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14
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Dufetelle E, Mulier G, Taytard J, Boizeau P, Le Roux E, Beydon N. Peripheral obstruction without airflow limitation is rare and not specific to asthma in children. Pediatr Pulmonol 2021; 56:858-865. [PMID: 33369239 DOI: 10.1002/ppul.25222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 11/10/2022]
Abstract
Peripheral (or small) airway obstruction (PAO) is considered a marker of childhood asthma but the techniques able to directly measure it are rarely used in routine. Usual spirometry and plethysmography can detect a certain degree of PAO when reduced forced vital capacity (FVC) is associated to normal forced expiratory volume in 1 s (FEV1 ) to FVC ratio, and normal total lung capacity (TLC). The frequency of this functional pattern has never been studied in different pediatric respiratory conditions. To assess the prevalence and outcome of PAO in children with different diseases or symptoms, we retrospectively extracted from our database all files of Caucasian subjects encompassing spirometry and plethysmography measurements. Spirometry patterns (normal, airflow limitation [AFL; low FEV1 /FVC], low FVC [with normal FEV1 /FVC]) and final functional patterns (normal, AFL, PAO, restrictive [low TLC], or mixed) were described. We included 4394 files recorded in 1794 children (median [IQR] age: 10.7 [9.2-12.9] years). At inclusion, 125 (7%) children had low FVC of which 56 (44.8%, and 3.1% [95% CI 2.3-3.9] of the whole population) had PAO. PAO prevalence increased with age (OR (95% CI) per 2-year-increase: 2.26 (1.59-3.23); p < .001), and was more frequent in chronic bronchial diseases other than asthma (1.6% vs. 8.0%). On repeated tests, PAO frequently normalized (26.1%) or persisted (43.5%), but it less often progressed into AFL (13%) or restrictive (13%) patterns. PAO is an infrequent nonspecific and persistent functional pattern. Its prevalence increases with age and in diagnosis of chronic respiratory diseases other than asthma.
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Affiliation(s)
- Edouard Dufetelle
- Unité d'Exploration Fonctionnelle Respiratoire, Service de Physiologie, APHP, Hôpital Armand-Trousseau, Paris, France
| | - Guillaume Mulier
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Jessica Taytard
- Service de Pneumologie pédiatrique, Centre National de Référence des Maladies Respiratoires Rares, AP-HP, Hôpital Trousseau, Paris, France.,INSERM, UMR-S 1158, Sorbonne Université, Paris, France
| | - Priscilla Boizeau
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Enora Le Roux
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Nicole Beydon
- Unité d'Exploration Fonctionnelle Respiratoire, Service de Physiologie, APHP, Hôpital Armand-Trousseau, Paris, France.,INSERM U 938, Centre de Recherche Saint Antoine, Sorbonne Université, Paris, France
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15
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Denlinger LC, Phillips BR, Sorkness RL, Bleecker ER, Castro M, DeBoer MD, Fitzpatrick AM, Hastie AT, Gaffin JM, Moore WC, Peters MC, Peters SP, Phipatanakul W, Cardet JC, Erzurum SC, Fahy JV, Fajt ML, Gaston B, Levy BD, Meyers DA, Ross K, Teague WG, Wenzel SE, Woodruff PG, Zein J, Jarjour NN, Mauger DT, Israel E. Responsiveness to Parenteral Corticosteroids and Lung Function Trajectory in Adults with Moderate-to-Severe Asthma. Am J Respir Crit Care Med 2021; 203:841-852. [PMID: 33290668 DOI: 10.1164/rccm.202002-0454oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rationale: It is unclear why select patients with moderate-to-severe asthma continue to lose lung function despite therapy. We hypothesized that participants with the smallest responses to parenteral corticosteroids have the greatest risk of undergoing a severe decline in lung function.Objectives: To evaluate corticosteroid-response phenotypes as longitudinal predictors of lung decline.Methods: Adults within the NHLBI SARP III (Severe Asthma Research Program III) who had undergone a course of intramuscular triamcinolone at baseline and at ≥2 annual follow-up visits were evaluated. Longitudinal slopes were calculated for each participant's post-bronchodilator FEV1% predicted. Categories of participant FEV1 slope were defined: severe decline, >2% loss/yr; mild decline, >0.5-2.0% loss/yr; no change, 0.5% loss/yr to <1% gain/yr; and improvement, ≥1% gain/yr. Regression models were used to develop predictors of severe decline.Measurements and Main Results: Of 396 participants, 78 had severe decline, 91 had mild decline, 114 had no change, and 113 showed improvement. The triamcinolone-induced difference in the post-bronchodilator FEV1% predicted (derived by baseline subtraction) was related to the 4-year change in lung function or slope category in univariable models (P < 0.001). For each 5% decrement in the triamcinolone-induced difference the FEV1% predicted, there was a 50% increase in the odds of being in the severe decline group (odds ratio, 1.5; 95% confidence interval, 1.3-1.8), when adjusted for baseline FEV1, exacerbation history, blood eosinophils and body mass index.Conclusions: Failure to improve the post-bronchodilator FEV1 after a challenge with parenteral corticosteroids is an evoked biomarker for patients at risk for a severe decline in lung function.
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Affiliation(s)
- Loren C Denlinger
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Brenda R Phillips
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Ronald L Sorkness
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, College of Medicine, The University of Arizona, Tucson, Arizona
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, KU School of Medicine, The University of Kansas, Kansas City, Kansas
| | - Mark D DeBoer
- Divisions of Pediatric Diabetes and Endocrinology and Pediatric Respiratory Medicine, Allergy, Immunology and Sleep, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Anne M Fitzpatrick
- Division of Pulmonary, Allergy and Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Annette T Hastie
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jonathan M Gaffin
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Wendy C Moore
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Michael C Peters
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Stephen P Peters
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Wanda Phipatanakul
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Juan Carlos Cardet
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Serpil C Erzurum
- Lerner Research Institute and the Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
| | - John V Fahy
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Merritt L Fajt
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin Gaston
- Division of Pediatric Pulmonary, Allergy and Sleep Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; and
| | - Bruce D Levy
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Deborah A Meyers
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kristie Ross
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - W Gerald Teague
- Divisions of Pediatric Diabetes and Endocrinology and Pediatric Respiratory Medicine, Allergy, Immunology and Sleep, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Joe Zein
- Lerner Research Institute and the Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Elliot Israel
- Divisions of Pulmonary and Critical Care and of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
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16
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Abstract
PURPOSE OF REVIEW Asthma is a chronic inflammatory airway disorder that can involve the entire bronchial tree. Increasing evidence shows that ventilation heterogeneity and small airway dysfunction are relevant factors in the pathogenesis of asthma and represent a hallmark in adults with persistent asthma. Little is known about the contribution of peripheral airway impairment in paediatric asthma, mainly due to the inaccessibility to evaluation by noninvasive techniques, which have only been widely available in recent years. RECENT FINDINGS Emerging evidence suggests that small airways are affected from the early stages of the disease in childhood-onset asthma. Conventional lung function measurement, using spirometry, is unable to sensitively evaluate small airway function and may become abnormal only once there is a significant burden of disease. Recent studies suggest that chronic inflammation and dysfunction in the small airways, as detected with new advanced techniques, are risk factors for asthma persistence, asthma severity, worse asthma control and loss of pulmonary function with age, both in adults and children. Knowing the extent of central and peripheral airway involvement is clinically relevant to achieve asthma control, reduce bronchial hyper-responsiveness and monitor response to asthma treatment. SUMMARY This review outlines the recent evidence on the role of small airway dysfunction in paediatric asthma development and control, and addresses how the use of new diagnostic techniques available in outpatient clinical settings, namely impulse oscillometry and multiple breath washout, could help in the early detection of small airway impairment in children with preschool wheezing and school-age asthma and potentially guide asthma treatment.
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17
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Yoon J, Eom EJ, Kim JT, Lim DH, Kim WK, Song DJ, Yoo Y, Suh DI, Baek HS, Shin M, Kwon JW, Jang GC, Yang HJ, Lee E, Kim HS, Seo JH, Woo SI, Kim HY, Shin YH, Lee JS, Jung S, Han M, Yu J. Heterogeneity of Childhood Asthma in Korea: Cluster Analysis of the Korean Childhood Asthma Study Cohort. Allergy Asthma Immunol Res 2021; 13:42-55. [PMID: 33191676 PMCID: PMC7680825 DOI: 10.4168/aair.2021.13.1.42] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Asthma is a heterogeneous airway disease occurring in children, and it has various clinical phenotypes. A clear differentiation of the clinical phenotypes can provide better asthma management and prediction of asthma prognosis. Little is currently known about asthma phenotypes in Korean children. This study was designed to identify asthma phenotypes in school-aged Korean children. METHODS This study enrolled 674 children with physician-diagnosed asthma from the Korean childhood Asthma Study (KAS) cohort. The physicians verified the relevant histories of asthma and comorbid diseases, as well as airway lability and hyper-responsiveness from the results of pulmonary function tests and bronchial provocation tests. Questionnaires regarding the participants' baseline characteristics, their environment and self-rating of asthma control were collected at the time of enrollment. Laboratory tests were performed to assess allergy and airway inflammation. Children with asthma were classified by hierarchical cluster analysis. RESULTS Of the 674 patients enrolled from the KAS cohort, 447 were included in the cluster analysis. Cluster analysis of these 447 children revealed 4 asthma phenotypes: cluster 1 (n = 216, 48.3%) which was characterized by male-dominant atopic asthma; cluster 2 (n = 79, 17.7%) which was characterized by early-onset atopic asthma with atopic dermatitis; cluster 3 (n = 47, 10.5%) which was characterized by puberty-onset, female-dominant atopic asthma with the low lung function; and cluster 4 (n = 105, 23.5%) which was characterized by early-onset, non-atopic dominant asthma. CONCLUSIONS The asthma phenotypes among Korean children can be classified into 4 distinct clusters. Long-term follow-up with these phenotypes will be needed to define their prognosis and response to treatment.
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Affiliation(s)
- Jisun Yoon
- Department of Pediatrics, Mediplex Sejong Hospital, Incheon, Korea
| | - Eun Jin Eom
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Tack Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's hospital, Uijeongbu, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hey Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Ji Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
| | - Hyeon Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwan Soo Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Ju Hee Seo
- Department of Pediatrics, Dankook University Hospital, Cheonan, Korea
| | - Sung Il Woo
- Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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18
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Feng Y, Yang Q, Shang Y. "Poor Effort" Does Not Account for Reduced Forced Vital Capacity in Asthmatic Children. Front Pediatr 2021; 9:596384. [PMID: 34113583 PMCID: PMC8185061 DOI: 10.3389/fped.2021.596384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/22/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose: Poor forced vital capacity (FVC) effort has been considered to be the main reason for FVC reduction by the ATS/ERS guideline; however, this has rarely been mentioned in previous studies. The present study aims to determine whether reduced FVC in asthmatic children is correlated to poor FVC effort. Methods: A total of 209 asthmatic children within 5-13 years old were included and divided into reduced FVC ("restricted," n = 66) and typical obstruction group ("obstructed," n = 143). Forced expiratory flows before and after bronchodilation were recorded in asthmatic children. The differences in clinical characteristics, spirometric results, FVC effort, and bronchodilator response were compared between two groups. Exhalation time (ET) was divided into effective ET (ETe) and plateau ET (ETp) by the start point of exhalation plateau on the time-volume curve. FVC effort was assessed by ET, ETp, and back extrapolated volume (EV)/FVC (%). Results: Asthmatic children in the restricted group had significantly higher slow vital capacity (SVC)/FVC (%), higher EV/FVC (%), shorter ET, shorter ETe, and longer ETp, when compared with those with obstructed. In the obstructed group, ET (r = 0.201, P = 0.016) and ETe (r = 0.496, P < 0.001) positively correlated with FVC, and ETp (r = -0.224, P = 0.007) negatively correlated with FVC. In the restricted group, FVC positively correlated with ETe (r = 0.350, P = 0.004) but not ET and ETp. FVC z-score significantly correlated with total IgE (n = 51, r = -0.349, P = 0.012) and with FEF25-75% z-score (n = 66, r = 0.531, P < 0.001) in the restricted group. The further logistic regression revealed that the risk of restricted increased by 1.12 (95% CI, 1.04-1.22, P = 0.005) with every 1% increase in %ΔFVC. In subjects with restricted and bronchodilation tests, %ΔFVC was significantly associated with FeNO (n = 29, r = 0.386, P = 0.039), FEF25-75% z-score (n = 29, r = -0.472, P = 0.010), and SVC/FVC (%) (n = 19, r = 0.477, P = 0.039) but not with EV/FVC (%), ET, ETe, or ETp (P > 0.05). Conclusion: These findings suggested that "poor FVC effort" does not account for the FVC reduction in asthmatic children. Short ET and high SVC/FVC (%) are characteristics of reduced FVC.
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Affiliation(s)
- Yong Feng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Que Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunxiao Shang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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19
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Hopp RJ, Wilson MC, Pasha MA. Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary. Clin Rev Allergy Immunol 2020; 62:145-159. [PMID: 33241492 DOI: 10.1007/s12016-020-08818-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.
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Affiliation(s)
- Russell J Hopp
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA.
| | - Mark C Wilson
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA
| | - M Asghar Pasha
- Division of Allergy and Immunology, Albany Medical College, 176 Washington Avenue Extension, Suite 102, Albany, NY, 12203, USA
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20
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Abstract
This article will discuss in detail the pathophysiology of asthma from the point of view of lung mechanics. In particular, we will explain how asthma is more than just airflow limitation resulting from airway narrowing but in fact involves multiple consequences of airway narrowing, including ventilation heterogeneity, airway closure, and airway hyperresponsiveness. In addition, the relationship between the airway and surrounding lung parenchyma is thought to be critically important in asthma, especially as related to the response to deep inspiration. Furthermore, dynamic changes in lung mechanics over time may yield important information about asthma stability, as well as potentially provide a window into future disease control. All of these features of mechanical properties of the lung in asthma will be explained by providing evidence from multiple investigative methods, including not only traditional pulmonary function testing but also more sophisticated techniques such as forced oscillation, multiple breath nitrogen washout, and different imaging modalities. Throughout the article, we will link the lung mechanical features of asthma to clinical manifestations of asthma symptoms, severity, and control. © 2020 American Physiological Society. Compr Physiol 10:975-1007, 2020.
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Affiliation(s)
- David A Kaminsky
- University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - David G Chapman
- University of Technology Sydney, Sydney, New South Wales, Australia
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21
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Affiliation(s)
- Sean B Fain
- From the Departments of Medical Physics and Radiology, School of Medicine and Public Health, and Department of Biomedical Engineering, School of Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Rm 2488, Madison, WI 53705 (S.B.F); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); and Department of Radiology, University of Michigan, Ann Arbor, Michigan, and Imbio, Minneapolis, Minn (C.H.)
| | - David A Lynch
- From the Departments of Medical Physics and Radiology, School of Medicine and Public Health, and Department of Biomedical Engineering, School of Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Rm 2488, Madison, WI 53705 (S.B.F); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); and Department of Radiology, University of Michigan, Ann Arbor, Michigan, and Imbio, Minneapolis, Minn (C.H.)
| | - Charles Hatt
- From the Departments of Medical Physics and Radiology, School of Medicine and Public Health, and Department of Biomedical Engineering, School of Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Rm 2488, Madison, WI 53705 (S.B.F); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); and Department of Radiology, University of Michigan, Ann Arbor, Michigan, and Imbio, Minneapolis, Minn (C.H.)
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22
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Grunwell JR, Nguyen KM, Bruce AC, Fitzpatrick AM. Bronchodilator Dose Responsiveness in Children and Adolescents: Clinical Features and Association with Future Asthma Exacerbations. J Allergy Clin Immunol Pract 2019; 8:953-964. [PMID: 31614217 DOI: 10.1016/j.jaip.2019.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/20/2019] [Accepted: 09/23/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Bronchodilator reversibility measures are often associated with poor asthma outcomes in children. Whether bronchodilator dose responsiveness is similarly useful in children is unclear. OBJECTIVE We hypothesized that children and adolescents requiring higher doses of bronchodilator to achieve maximal bronchodilation would have unique risk factors and increased risk of future exacerbation. METHODS Children (6-11 years, N = 299) and adolescents (12-21 years, N = 331) with confirmed asthma underwent clinical phenotyping procedures and a test of maximal bronchodilation with escalating doses of albuterol sulfate up to 720 mcg. Outcome measures were assessed at 12 months and included exacerbations treated with systemic corticosteroids, emergency department (ED) visits, and hospitalizations for asthma. RESULTS A total of 6.7% of children and 9.3% of adolescents had poor bronchodilator dose responsiveness, defined as attainment of maximal forced expiratory volume in 1 second with 720 mcg albuterol. Risk factors included type 2 inflammation, prior exacerbations, and greater asthma severity; historical pneumonia and tobacco exposure were also risk factors in children. Children and adolescents with poor bronchodilator dose responsiveness did not have increased current symptoms or impaired quality of life, but had approximately 2-fold increased odds of exacerbation or ED visit and approximately 3-fold increased odds of hospitalization by 12 months, independent of airflow obstruction. CONCLUSIONS Bronchodilator dose responsiveness may be useful for phenotyping and may be of utility in practice and future studies focused on asthma outcomes or quantification of treatment responses. In children and adolescents, this phenotype of poor bronchodilator responsiveness may be associated with periods of relatively stable disease yet marked airway constriction in response to triggers, including tobacco smoke, respiratory infections/pneumonia, and aeroallergens.
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Affiliation(s)
- Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | | | - Alice C Bruce
- Department of Pediatrics, Emory University, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
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23
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Bacharier LB, Mori A, Kita H. Advances in asthma, asthma-COPD overlap, and related biologics in 2018. J Allergy Clin Immunol 2019; 144:906-919. [PMID: 31476323 DOI: 10.1016/j.jaci.2019.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 01/14/2023]
Abstract
Over the past year, numerous important advances in our understanding of multiple aspects of asthma, ranging from disease pathogenesis to epidemiology to therapeutics, have been reported. This review is a compilation of highlights from articles published largely in the Journal of Allergy and Clinical Immunology and supplemented by articles published elsewhere that have substantially advanced the fields of asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap and biologic therapies for these disorders. The intention of this article is not to provide a comprehensive review but rather to focus on several areas that have developed quickly and/or received extensive attention from our readers.
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Affiliation(s)
- Leonard B Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.
| | - Akio Mori
- Department of Advanced Medicine, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Hirohito Kita
- Division of Allergic Diseases, Department of Medicine and Department of Immunology, Mayo Clinic, Rochester, Minn; Division of Allergic Diseases, Department of Medicine and Department of Immunology, Mayo Clinic, Scottsdale
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24
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Khan DA, Oppenheimer JJ, Lee GB, Fineman SM. Asthma. Ann Allergy Asthma Immunol 2019; 123:416-7. [PMID: 31351982 DOI: 10.1016/j.anai.2019.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
Abstract
"From the Pages of AllergyWatch" is devoted to publishing synopses of Allergy and Asthma literature relevant to a topic of emphasis. These unbiased synopses and comments by our Editors have been previously printed in the AllergyWatch bimonthly newsletter, and it is our hope that presenting carefully selected article summaries and comments in the Annals will serve as a valuable educational resource for practicing allergists.
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Custovic A, Henderson J, Simpson A. Does understanding endotypes translate to better asthma management options for all? J Allergy Clin Immunol 2019; 144:25-33. [PMID: 31145940 DOI: 10.1016/j.jaci.2019.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/20/2022]
Abstract
Despite the development of novel treatments, improvement in the design of delivery devices, and new technologies for monitoring and improving adherence, the burden of asthma is not decreasing. Predicting an individual patient's response to asthma drugs remains challenging, and the provision of personalized treatment remains elusive. Although biomarkers, such as allergic sensitization and blood eosinophilia, might be important predictors of response to inhaled corticosteroids in preschool children, these relatively cheap and available investigations are seldom used in clinical practice to select patients for corticosteroid prescription. However, for the majority of patients, response to different treatments cannot be accurately predicted. One of the key factors preventing further advances is the reductionist view of asthma as a single disease, which is forcing patients with different asthma subtypes into a single group for empiric treatment. This inevitably results in treatment failures and, for some, an unacceptable risk/benefit ratio. The approach to asthma today is an example of the traditional symptom (diagnosis)-based, one-size-fits-all approach rather than a stratified approach, and our guidelines-driven management based on a unitary diagnosis might not be the optimal way to deliver care. The only way to deliver stratified medicine and find a cure is through the understanding of asthma endotypes. We propose that the way to discover endotypes, biomarkers, and personalized treatments is through the iterative process based on interpretation of big data analytics from birth and patient cohorts, responses to treatments in randomized controlled trials, and in vitro mechanistic studies using human samples and experimental animal models, with technological and methodological advances at its core.
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26
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Sorkness RL, Kienert C, O'Brien MJ, Fain SB, Jarjour NN. Compressive air trapping in asthma: effects of age, sex, and severity. J Appl Physiol (1985) 2019; 126:1265-1271. [PMID: 30844338 DOI: 10.1152/japplphysiol.00924.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Air trapping due to airway closure has been associated with unstable asthma. In addition to airway closure that occurs at lower lung volumes during slow expiration, there may be further closure during a forced expiration because of airway compression. The purpose of this study was to define a reference range from a nonasthmatic population and investigate the characteristics of compressive air trapping in asthma. Spirometry and plethysmography were performed in 117 nonasthmatic subjects (ages 18-87 yr) and 153 asthma subjects (ages 12-72 yr). Air trapping was assessed as residual lung volume and the ratio of forced expiratory vital capacity (FVC) to slow inspiratory vital capacity (iVC) (FVC/iVC). There were no significant age or sex effects on the FVC/iVC ratio in the nonasthmatic subjects, and a fifth percentile lower limit of normal (LLN) of 0.93 was computed. An FVC/iVC ratio less than LLN defined compressive air trapping. Asthma subjects exhibited an age-related decline in the FVC/iVC ratio of 0.0027 per year (P < 0.0001) in a mixed effects model, with additional decreases associated with severe asthma and male sex. FVC/iVC ratios< LLN were infrequent in subjects <30 yr but evident in most asthma subjects >50 yr. Lung residual volumes followed similar patterns of greater elevations in subjects with severe asthma, older age, and male sex. Compressive air trapping occurs frequently in older asthmatics, appearing to be a feature of the natural history of asthma that is greater in severe asthma and men. This component of premature airway closure affects spirometric assessment of airway function and may contribute to asthma symptoms during physical exertion. NEW & NOTEWORTHY Premature airway closure during exhalation is a component of airway obstruction that is associated with asthma severity and instability. Compressive air trapping is airway closure that is more extensive during a forced exhalation than with a slow, passive exhalation. We report that compressive air trapping occurs in most people > 50 yr with asthma, affects men more than women, and persists after bronchodilator treatment. This component of obstruction appears to be part of the natural history of asthma.
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Affiliation(s)
- Ronald L Sorkness
- School of Pharmacy; School of Medicine and Public Health, University of Wisconsin , Madison, Wisconsin.,Department of Medicine, University of Wisconsin , Madison, Wisconsin
| | - Casey Kienert
- School of Pharmacy; School of Medicine and Public Health, University of Wisconsin , Madison, Wisconsin
| | - Matthew J O'Brien
- Pulmonary Function Lab, University Hospitals and Clinics, University of Wisconsin , Madison, Wisconsin
| | - Sean B Fain
- Department of Medical Physics, University of Wisconsin , Madison, Wisconsin
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin , Madison, Wisconsin
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Smith CJ, Spaeder MC, Sorkness RL, Teague WG. Disparate diagnostic accuracy of lung function tests as predictors of poor asthma control in children. J Asthma 2019; 57:327-334. [PMID: 30663912 DOI: 10.1080/02770903.2019.1566471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Rationale: In practice, asthma control is assessed according to symptom burden and office spirometry. However, spirometry poorly tests peripheral lung function, which may be abnormal in asthma. Impluse oscillometry (IOS) and multiple-breath washout (MBW) are novel methods which measure reactance (X5) and ventilation heterogeneity (VH) in the peripheral lung, but how well these tests reflect asthma control is poorly understood. Objective: To compare the diagnostic accuracy of tests of large airways caliber (FEV1, FEV1/FVC, R20), peripheral zone properties (X5, VH), and airways inflammation (FeNO) as predictors of poor control in asthmatic children (44 poorly controlled/10 controlled). Methods: 54 children enriched in severe asthma completed a symptom-based control scale (ACT/cACT) and lung function tests after overnight bronchodilator withhold. The accuracy of each variable to predict poor control was ranked by area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. Results: Among measures of large airways caliber, the FEV1% had the highest ROC curve area, with low sensitivity but perfect specificity. Among measures of peripheral lung function, X5 and VH in the conducting zone had fair curve areas with higher sensitivity but lower specificity compared to the FEV1%. VH in the acinar zone and FeNO both had poor accuracy. Conclusion: Tests of large airway and peripheral zone lung function performed disparately as predictors of poor control in a sample of children enriched in severe asthma. Further studies in a larger sample with more diverse phenotypic features are necessary to validate this preliminary conclusion.
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Affiliation(s)
- Clyde J Smith
- Division of Critical Care Medicine, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Michael C Spaeder
- Division of Critical Care Medicine, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ronald L Sorkness
- School of Pharmacy and Departments of Medicine and Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - W Gerald Teague
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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Menezes AMB, de Oliveira PD, Blumenberg C, Sanchez-Angarita E, Niño-Cruz GI, Zabert I, Costa JC, Ricardo LIC, Martins RC, Wehrmeister FC. Longitudinal association of adiposity with wheezing and atopy at 22 years: the 1993 Birth Cohort, Pelotas, Brazil. J Asthma Allergy 2018; 11:283-291. [PMID: 30555245 PMCID: PMC6280885 DOI: 10.2147/jaa.s183699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Asthma is a highly prevalent noncommunicable lung disease. The aim of this study was to evaluate the longitudinal association of obesity/adiposity with wheezing and atopy. Methods The population of the study was composed of participants from the 1993 Pelotas (Brazil) Birth Cohort. The following outcome variables were measured at 22 years: wheezing in the last 12 months, wheezing with atopy, wheezing without atopy, only atopy, and persistent wheezing at 18 and 22 years. Exposure variables were obesity body mass index, percent fat mass (FM), and fat mass index, which were obtained by precise methods (BOD POD and dual-energy X-ray absorptiometry [DXA]). Crude and adjusted logistic and multinomial logistic regressions were used in the analyses. Results The prevalence of wheezing (with and without atopy), wheezing without atopy, only atopy, and persistent wheezing were 10.6%, 3.9%, 30.9%, and 4.0%, respectively. To be obese or to belong to the highest tertile of obesity/adiposity at two follow-ups showed a cumulative and positive association with wheezing in the adjusted analysis; for atopy there was no significant association. The odds ratio (OR) for wheezing according to the percentage of total FM measured by DXA in the highest tertile at both follow-ups was 1.58 (95% CI: 1.14–2.20) against an OR of 1.16 (95% CI: 0.92–1.47) for atopy. Persistent wheezing was also associated with adiposity, but without statistical significance. Conclusions We found a positive longitudinal association between several measures of adiposity and wheezing at 22 years old. The effect was higher for cumulative adiposity; the results for atopy were not consistent.
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Affiliation(s)
| | | | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil,
| | - Efrain Sanchez-Angarita
- Pulmonary Department, Hospital Universitario de Caracas, Universidad Central de Venezuela, Capital District, Venezuela
| | | | - Ignacio Zabert
- Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina
| | - Janaina Calu Costa
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil,
| | | | - Rafaela Costa Martins
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil,
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Dufetelle E, Bokov P, Delclaux C, Beydon N. Should reversibility be assessed in all asthmatic children with normal spirometry? Eur Respir J 2018; 52:13993003.00373-2018. [PMID: 29853493 DOI: 10.1183/13993003.00373-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/20/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Edouard Dufetelle
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires Pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - Plamen Bokov
- AP-HP, Hôpital Universitaire Robert Debré, Service de Physiologie Pédiatrique, Paris, France.,INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Christophe Delclaux
- AP-HP, Hôpital Universitaire Robert Debré, Service de Physiologie Pédiatrique, Paris, France.,INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Nicole Beydon
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires Pédiatrique, Hôpital Armand Trousseau, Paris, France.,INSERM U938, Centre de Recherche Saint Antoine, Paris, France
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Licari A, Castagnoli R, Brambilla I, Marseglia A, Tosca MA, Marseglia GL, Ciprandi G. Asthma Endotyping and Biomarkers in Childhood Asthma. Pediatr Allergy Immunol Pulmonol 2018; 31:44-55. [PMID: 30069422 PMCID: PMC6069590 DOI: 10.1089/ped.2018.0886] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/23/2018] [Indexed: 12/17/2022]
Abstract
Childhood asthma represents a heterogeneous challenging disease, in particular in its severe forms. The identification of different asthma phenotypes has stimulated research in underlying molecular mechanisms, such as the endotypes, and paved the way to the search for related specific biomarkers, which may guide diagnosis, management, and predict response to treatment. A limited number of biomarkers are currently available in clinical practice in the pediatric population, mostly reflecting type 2-high airway inflammation. The identification of biomarkers of childhood asthma is an active area of research that holds a potential great clinical utility and may represent a step forward toward tailored management and therapy: the so-called Precision Medicine. The aim of the present review is to provide an updated overview of asthma endotyping, mostly focusing on novel noninvasive biomarkers in childhood asthma.
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Affiliation(s)
- Amelia Licari
- Pediatric Clinic, Fondazione IRCCS San Matteo, Pavia, Italy
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