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Predictive value of lung function trend and FeNO for difficult asthma in children
1Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University, Brasov, Romania. ibrumaru@unitbv.ro
Insights
Persistently high fraction of exhaled nitric oxide (FeNO) levels predict difficult asthma in children. Lung function trends were not found to be predictive of difficult asthma in this pediatric cohort.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Biomarker Discovery
Background:
- Difficult asthma in children poses a significant clinical challenge.
- Identifying predictive biomarkers is crucial for early intervention and management.
- Current predictors often lack specificity, necessitating further research.
Purpose of the Study:
- To assess the predictive value of lung function and FeNO for identifying difficult asthma in children.
- To determine if specific pathophysiological features can forecast the development of difficult asthma.
- To enhance diagnostic accuracy for challenging pediatric asthma cases.
Main Methods:
- Prospective 1-year study of children with uncontrolled persistent asthma on inhaled corticosteroids.
- Difficult asthma defined by persistent symptoms/exacerbations despite optimized treatment.
- Analysis included lung function, FeNO levels, and various clinical risk factors via logistic regression.
Main Results:
- Fifty-two percent of enrolled children developed difficult asthma after 1 year.
- Persistently high FeNO levels (> 45 ppb) were a significant predictor (P = .04).
- Obesity (P = .04) and severe rhinitis (P = .03) also independently predicted difficult asthma.
Conclusions:
- Persistently elevated FeNO is a valuable predictor of difficult asthma in pediatric patients.
- Lung function trends did not demonstrate predictive value for difficult asthma.
- FeNO measurement offers a potential tool for risk stratification in childhood asthma.
Objective:
The aim of this study was to evaluate the predictive value of lung function and fraction of exhaled nitric oxide (FeNO) for difficult asthma in children.
Patients And Methods:
Children with asthma referred to an asthma clinic for uncontrolled persistent asthma on inhaled corticosteroids (ICSs) alone or in combination with a long-acting beta2-agonist and/or a leukotriene receptor antagonist were followed in a prospective 1-year study to identify difficult asthma. At the end of the study period, difficult asthma was considered for children with persistent asthma symptoms and/or frequent moderate/severe asthma exacerbations despite regular intake of ICSs (beclomethasone or equivalent) > 800 microg/d for at least 3 months, after correcting for adherence to treatment, inhalation technique, and comorbidities and after implementing an individualized treatment plan. The difficult asthma phenotype was characterized using a multidimensional approach combining clinical features and pathophysiologic features (lung function and inflammation). Unfavorable lung function trend (persistent airway obstruction and fluctuations in forced expiratory volume in the first second of alpha > 0.5) and persistently high FeNO levels (> 45 ppb despite increasing ICS doses) were analyzed as risk factors for difficult asthma in the logistic regression analysis together with male sex, atopy, concurrent severe rhinitis, obesity, psychopathology, exposure to tobacco smoke, low socioeconomic status, lack of adherence to treatment, and persistent bronchodilator response.
Results:
Forty-six asthmatic children (34 males, 74%) with a mean (SEM) age of 7.55 (3.04) years were enrolled. After 1 year, 24 children (52%) were labeled as having difficult asthma. Independent risk factors for difficult asthma were persistently high FeNO (P = .04), obesity (P = .04), and severe rhinitis (P = .03).
Conclusions:
Persistently high FeNO predicts difficult asthma in children, while unfavorable lung function trend does not.
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