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Persistent airflow obstruction in inner-city children with asthma
Kenny Y Kwong1, Yang Z Lu2, Emilio Jauregui1
1From the Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County/University of Southern California Medical Center, Los Angeles, California; and.
Insights
Early airflow obstruction in children with asthma often leads to persistent poor lung function, even with guideline-based care. This suggests current asthma therapies may not fully address airway remodeling in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Airway Remodeling
Background:
- Asthma is characterized by persistent airway remodeling, impacting lung function despite controller medications.
- Early airflow obstruction in asthmatic children can lead to long-term poor lung function outcomes.
Purpose of the Study:
- To investigate if early airflow obstruction in inner-city children with asthma persists despite guideline-based asthma care.
- To determine the long-term lung function trajectory in children with asthma stratified by initial lung function.
- To identify factors associated with persistent poor lung function in pediatric asthma.
Main Methods:
- Retrospective cohort study of inner-city children with asthma.
- Stratification into "low" or "high" lung function groups based on initial spirometry (FEV1% predicted and FEV1/FVC).
- Follow-up of lung function (FEV1% predicted and FEV1/FVC) for up to 10 years with guideline-based asthma treatment.
Main Results:
- Children with initially "high" lung function maintained normal levels (FEV1% predicted 94-96%, FEV1/FVC 87-89%) over 10 years.
- Children with initially "low" lung function showed only slight improvements (FEV1% predicted 77-82%, FEV1/FVC 78-82%) over 10 years.
- Low initial lung function, African American ethnicity, and male gender were associated with increased risk of persistent poor lung function.
Conclusions:
- Early airflow obstruction in inner-city children with asthma is linked to poor lung function later in life, irrespective of guideline-based care.
- Current asthma therapies may not effectively target the underlying pathways driving airway remodeling in pediatric asthma.
- Further research is needed to develop treatments that can reverse or prevent persistent airflow obstruction and airway remodeling in children with asthma.
Abstract:
Background: Airway remodeling has been shown to be persistent in patients with asthma despite treatment with controller medications. Patients with early airflow obstruction may continue to experience poor lung function despite treatment. Objectives: To determine whether early airflow obstruction in inner-city children with asthma persists despite guideline-based asthma care. Methods: In a retrospective study that used a cohort of inner-city children with asthma treated by using an asthma-specific disease management system, the patients were stratified into "low" or "high" lung function groups at the time of the initial visit (high, forced expiratory volume in the first second of expiration [FEV1] % predicted and FEV1/forced vital capacity [FVC] ≥ 80%; and low, FEV1% predicted and FEV1/FVC < 80%). These patients then received National Heart, Lung, and Blood Institute guideline-based asthma treatment at regular follow-up intervals with spirometry performed at these visits as part of regular care. FEV1% predicted and FEV1/FVC were followed up for up to 10 years for both the high and low cohorts. Results: Over 10 years, the patients initially in the "high" group maintained FEV1% predicted and FEV1/FVC at values similar to the initial visit (94 to 96% and 87 to 89%, respectively), whereas those in the low group had only slight increases of FEV1% predicted and FEV1/FVC over the same time (77 to 82% and 78 to 82%, respectively). Low FEV1% predicted and FEV1/FVC at the time of the first visit was significantly associated with an increased risk of low values of these lung functions over the next 3-5 years despite treatment. African American ethnicity and male gender were also associated with lower lung function over time. Conclusion: Early airflow obstruction in inner city children asthma is associated with poor lung function in later life despite guideline-based asthma care. Current asthma therapy may not affect pathways and leads to airway remodeling in children with asthma.
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