Asthma, rhinitis, other respiratory diseasesFEV1 is associated with risk of asthma attacks in a pediatric population
Abstract
Background: FEV1 is endorsed by the National Asthma Education and Prevention Program as a means for grading asthma severity. However, few data exist on the relationship between FEV1 and asthma outcomes during long-term follow-up. Objective: We explored the relationship between the percent predicted FEV1 (FEV1%) and subsequent asthma attacks in a longitudinal study of pediatric lung health. Methods: A retrospective cohort of 13,842 children (100,292 observations) seen annually over a 15-year interval was analyzed for measurement of pulmonary function, and a respiratory questionnaire was completed. Up to grade 9, a standard questionnaire was completed by a parent or guardian; thereafter it was completed by the patient. For each observation, the report of an attack during the past year was paired with FEV1 recorded at the field survey 1 year earlier. Results: A progressive decrease in the proportion of individuals reporting an attack was associated with increasing decile of FEV1%. Two categorization schemes for FEV1% were examined: a scheme based on the National Asthma Education and Prevention Program recommendations (<60%, 60%-80%, and >80%), and an alternative scheme (<80%, 80%-100%, and >100%). In multivariate models, FEV1% was an independent predictor of attacks: among the parental report group, the odds ratios were 2.1 (95% CI, 1.3-3.4) and 1.4 (95% CI, 1.2-1.6) for FEV1% < 60% and FEV1% of 60% to 80% compared with FEV1% > 80%, respectively; and among the self-report group, odds ratios were 5.3 (95% CI, 2.2-12.9) and 1.4 (95% CI, 1.2-1.7) for FEV1% < 60% and FEV1% of 60% to 80% compared with FEV1% > 80%, respectively. With the alternative classification scheme, the relationship was similar, but the difference in risk between categories of FEV1% decreased. Conclusion: The strong association between FEV1% and risk of asthma attack over the subsequent year supports an emphasis on objective measures of lung function in assessment of risk for adverse asthma outcomes. (J Allergy Clin Immunol 2001;107:61-7.)
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Dupilumab Improves Lung Function Parameters in Pediatric Type 2 Asthma: VOYAGE Study
2024, Journal of Allergy and Clinical Immunology: In PracticeUncontrolled asthma in growing children can impair lung growth that may lead to adverse complications in later life. Dupilumab, a human monoclonal antibody, blocks the shared receptor for IL-4 and IL-13, key drivers of type 2 inflammation.
To extensively evaluate the effect of dupilumab on lung function in children (6-11 years) with moderate-to-severe asthma enrolled in phase 3 LIBERTY ASTHMA VOYAGE (NCT02948959).
Children with asthma were randomized 2:1 to add-on dupilumab 100/200 mg by bodyweight or placebo every 2 weeks, for 52 weeks. We analyzed spirometry parameters in children with type 2 asthma (blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide [FeNO] ≥20 parts per billion [ppb] at baseline) and within subgroups defined by baseline blood eosinophils or FeNO values.
A total of 116 (49%) dupilumab-treated children and 59 (52%) on placebo had impaired lung function (prebronchodilator percent-predicted forced expiratory volume in 1 second [ppFEV1] <80%) at baseline. Dupilumab improved pre- and postbronchodilator ppFEV1 as early as week 2, sustained for up to 52 weeks (least-squares mean difference vs placebo at week 52: 7.79 percentage points; 95% confidence interval [CI]: 4.36-11.22; P < .001 and 4.37 points; 95% CI: 0.95-7.78; P = .01, respectively). Sustained improvements were also observed in other lung function parameters, including pre- and postbronchodilator forced vital capacity (FVC), prebronchodilator forced expiratory flow, and FEV1/FVC ratio across all populations.
Dupilumab led to significant, sustained lung function improvements across a range of lung function measures in children (6-11 years) with uncontrolled, moderate-to-severe type 2 asthma.
Treatment Decisions in Children With Asthma in a Real-Life Clinical Setting: The Swiss Paediatric Airway Cohort
2022, Journal of Allergy and Clinical Immunology: In PracticeAsthma treatment should be modified according to symptom control and future risk, but there are scarce data on what drives treatment adjustments in routine tertiary care.
We studied factors that drive asthma treatment adjustment in pediatric outpatient clinics.
We performed a cross-sectional analysis of the Swiss Paediatric Airway Cohort, a clinical cohort of 0- to 16-year-old children seen by pediatric pulmonologists. We collected information on diagnosis, treatment, lung function, and FeNO from hospital records; and on symptoms, sociodemographic, and environmental factors from a parental questionnaire. We used reported symptoms to classify asthma control and categorized treatment according to the 2020 Global Initiative for Asthma guidelines. We used multivariable logistic regression to study factors associated with treatment adjustment (step-up or down vs no change).
We included 551 children diagnosed with asthma (mean age, 10 years; 37% female). At the clinical visit, most children were prescribed Global Initiative for Asthma step 3 (35%). Compared with previsit treatment, 252 children remained on the same step (47%), 227 were stepped up (42%), and 58 were stepped down (11%). Female sex (adjusted odds ratio [aOR] = 1.61; 95% confidence interval [CI], 1.05-2.47), poor asthma control (aOR = 3.08; 95% CI, 1.72-5.54), and lower FEV1 Z-score (aOR = 0.70; 95% CI, 0.56-0.86 per one Z-score increase) were independently associated with treatment step-up, and low FeNO (aOR = 2.34; 95% CI, 1.23-4.45) was associated with treatment step-down, with marked heterogeneity between clinics.
In this tertiary care real-life study, we identified main drivers for asthma treatment adjustment. These findings may help improve both asthma management guidelines and clinical practice.
Update of the 2021 Recommendations for the management of and follow-up of adolescent asthmatic patients (over 12 years) under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version
2022, Revue des Maladies RespiratoiresAsthma and Allergy
2022, Clinical ImmunologyAllergic diseases are characterized by unfavorable immune responses against allergens that lead to the development of clinical signs and symptoms of allergy. Allergic conditions are one of the most prevalent diseases among people worldwide, and it is still increasing in both developed and developing countries, which could affect the quality of life and result in an economic burden. This chapter focuses on allergic diseases. It starts by mentioning the history and epidemiology of allergy. It then explains the definition, epidemiology, pathogenesis, clinical features, diagnosis, and treatment of allergic diseases, including asthma, allergic rhinitis, allergic conjunctivitis, urticaria and angioedema, atopic dermatitis and allergic contact dermatitis, food allergy and gastrointestinal syndromes, drug allergy, and anaphylaxis.
Exacerbation-Prone Asthma: A Biological Phenotype or a Social Construct
2021, Journal of Allergy and Clinical Immunology: In PracticeAsthma is a complex syndrome with multiple phenotypes and endotypes. Asthma exacerbations are not only the clearest indictor of the morbidity of asthma and of the risk for mortality due to asthma, but also comprise a significant amount of the cost to care for poorly controlled asthma. There continues to be significant disparity in the prevalence, mortality, and morbidity due to asthma. Patients with asthma who suffer recurrent exacerbations are considered to have exacerbation-prone asthma (EPA). Efforts to characterize patients with frequent exacerbations show that the etiology is likely multifactorial. Research to determine the intrinsic risk factors for EPA include studies of both genetic and inflammatory biomarkers. External factors contributing to exacerbations have been extensively reviewed and include viral infection, environmental exposures, air pollution, and psychosocial and economic barriers to optimizing health. It is likely that EPA occurs when patients who have an increased underlying intrinsic/biological risk are placed in a given exposome (environments with a variety of exposures and triggers including allergens, pollution, stress, barriers, and occupational exposures). It is the social construct combined with underlying biology that frequently drives an EPA phenotype.
Diagnostic performance of the physical activity related question of the GINA questionnaire to detect exercise-induced bronchoconstriction in asthma
2021, Anales de PediatriaEl objetivo del estudio fue evaluar el rendimiento diagnóstico de la pregunta relacionada con la actividad física del cuestionario de control del asma de la Global Initiative for Asthma (GINA) para la detección de la broncoconstricción inducida por el ejercicio (BIE) en niños y adolescentes.
Se dividió a pacientes (de seis a 18 años de edad) con diagnóstico de asma en dos grupos de acuerdo con la clasificación de gravedad según el cuestionario GINA: asma leve/moderada (ALM) y asma grave refractaria (AGR). Se recogieron datos antropométricos, clínicos y funcionales (espirometría) y se realizó prueba de broncoprovocación con esfuerzo. Se utilizó la cuarta pregunta del cuestionario GINA, concerniente a los síntomas asociados con el esfuerzo físico, para evaluar el rendimiento diagnóstico de este instrumento.
Se incluyeron a 40 pacientes (17 con ALM y 23 con AGR) con una edad media de 11,3 años y un z-score medio de FEV1 de -0,33, de los que 13 (32,5%) se clasificaron como casos de asma no controlada. De los pacientes con enfermedad no controlada, siete (53,8%) mostraron caídas en el FEV1 tras la prueba de esfuerzo. Se observó una mayor frecuencia de BIE en sujetos con z-score de FEV1 < -1,0 en comparación con aquellos con un z-score ≥ -1,0 (p = 0,05). No hubo diferencias significativas en la frecuencia de BIE con base en la gravedad o el control de la enfermedad. Tampoco se observó asociación entre la pregunta cuatro (GINA) y la BIE. El área bajo la curva de características operativas del receptor (receiver operating characteristic, ROC) evidenció que el poder discriminatorio del cuestionario GINA resulta insuficiente para detectar la BIE (p = 0,41), con una sensibilidad del 42,1% y una especificidad del 57,1%.
La pregunta concerniente al ejercicio físico en el cuestionario GINA carece del poder diagnóstico necesario para detectar la BIE en niños y adolescentes asmáticos.
The aim of the study was to evaluate the diagnostic performance of the item concerning physical activity of the Global Initiative for Asthma (GINA) asthma control questionnaire for detection of exercise-induced bronchoconstriction (EIB) in children and adolescents.
We divided participants (aged 6 to 18 years) with a diagnosis of asthma into two groups according to the GINA severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). We collected anthropometric, clinical and functional data (spirometry) and performed an EIB test. We used item 4 of the GINA questionnaire regarding exercise-induced symptoms to assess the diagnostic power of this instrument.
We included 40 patients (17 with MMA and 23 with STRA) with a mean age of 11.3 years and a mean FEV1 z-score of -0.33, of who 13 (32.5%) were classified as having uncontrolled asthma. Of the patients with uncontrolled asthma, 7 (53.8%) exhibited a decrease in the FEV1 after the EIB test. We found a higher frequency of EIB in participants with FEV1 z-score values of less than -1.0 compared to those with a z-score of -1.0 or greater (p = 0.05). There were no significant differences in the frequency of EIB based on disease severity and control. We also found no association of item 4 (GINA) with EIB. The area under the ROC curve demonstrated that the discriminative power of the GINA questionnaire for the detection of EIB is inadequate (p = 0.41), with sensitivity of 42.1% and specificity of 57.1%.
The physical activity related question of GINA has insufficient diagnostic power to detect EIB in children and adolescents with asthma.