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Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation
Alexander Moeller1, Kai-Hakon Carlsen2, Peter D Sly3
1Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland Alexander.Moeller@kispi.uzh.ch.
Insights
Monitoring asthma in children involves measuring airway obstruction and inflammation. Annual spirometry is useful, while other tests like bronchial hyperresponsiveness (BHR) are for specific cases. Evidence for routine use of many methods is limited.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Management
Background:
- Persistent bronchial obstruction in children, even if asymptomatic, is a risk factor for severe asthma exacerbations and poor outcomes.
- Understanding and monitoring key asthma indicators like reversible airway obstruction, bronchial hyperresponsiveness (BHR), and inflammation is crucial for effective management.
Purpose of the Study:
- To review available methods for measuring reversible airways obstruction, BHR, and inflammation in children with asthma.
- To evaluate the role of these measurements in monitoring pediatric asthma and guiding treatment decisions.
Main Methods:
- Review of current literature on pulmonary function tests (spirometry, BHR assessment) and noninvasive inflammatory biomarkers (exhaled nitric oxide, induced sputum, exhaled breath condensate).
- Focus on the utility and evidence base for these methods in routine clinical practice for children with asthma.
Main Results:
- Annual spirometry for forced expiratory volume in 1 second (FEV1) is considered useful for monitoring children with asthma.
- Assessment of BHR and other lung function tests may be reserved for children with specific symptoms or treatment challenges, often requiring specialist evaluation.
- Noninvasive inflammatory biomarkers show potential but lack robust evidence for routine use in guiding therapy in pediatric asthma.
Conclusions:
- While annual spirometry is valuable, the role of advanced lung function tests and noninvasive biomarkers in routine pediatric asthma monitoring and management requires further investigation.
- Current evidence does not fully support the widespread use of most lung function measurements and inflammatory biomarkers for routine asthma care in children.
- The use of specialized tests should be reserved for selected pediatric cases with unclear diagnosis, poor treatment response, or specific clinical indications.
Abstract:
This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children. Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases.
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