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Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

Anne M Fitzpatrick1, Benjamin M Gaston, Serpil C Erzurum

  • 1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA. anne.fitzpatrick@emory.edu

The Journal of Allergy and Clinical Immunology
|December 13, 2006
PubMed

Insights

Severe asthma in children presents with persistent symptoms despite inhaled corticosteroid (ICS) treatment. Differentiating severe asthma involves assessing lung function, atopy, and airway inflammation, particularly exhaled nitric oxide (F(ENO)).

Area of Science:

  • Pediatric Pulmonology
  • Allergy and Immunology
  • Respiratory Medicine

Background:

  • Severe asthma in children often persists despite inhaled corticosteroid (ICS) therapy.
  • Distinctive features differentiating severe pediatric asthma remain poorly defined.
  • Understanding these features is crucial for effective management and treatment strategies.

Purpose of the Study:

  • To identify key characteristics distinguishing severe from mild-to-moderate asthma in school-aged children.
  • To utilize noninvasive assessments including lung function, atopy, and airway inflammation markers.
  • To establish objective criteria for diagnosing severe asthma in pediatric populations.

Main Methods:

  • Seventy-five school-aged children with asthma underwent comprehensive assessments.
  • Evaluations included spirometry, lung volume testing, methacholine challenge, allergy testing, and exhaled nitric oxide (F(ENO)) measurement.
  • Participants were classified into severe or mild-to-moderate asthma groups based on ICS dosage and clinical criteria.

Main Results:

  • Children with severe asthma exhibited increased symptoms, greater airway obstruction, and heightened bronchial responsiveness.
  • Higher exhaled nitric oxide (F(ENO)) levels and significant aeroallergen sensitization were observed in the severe asthma group.
  • Despite ICS adjustments, severe asthma was associated with more frequent exacerbations and persistent lung function deficits.

Conclusions:

  • Severe childhood asthma is characterized by poor symptom control and high-dose ICS requirement.
  • Lung function parameters and exhaled nitric oxide (F(ENO)) levels effectively differentiate severe from mild-to-moderate pediatric asthma.
  • Clinicians should consider severe asthma in children with ICS non-response, airway obstruction, and elevated F(ENO).
Abstract

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