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Prognosis of bronchial asthma in children with different pulmonary function phenotypes: A real-world retrospective
Lu Liu1, Hui Ma1, Shuhua Yuan1
1Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
Persistent small airway dysfunction is linked to poor asthma control in children, even with good treatment adherence. Approximately 15% of children experienced incomplete asthma control after one year.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Clinical Phenotyping
Background:
- Asthma management in children requires understanding pulmonary function changes.
- Identifying risk factors for poor control is crucial for effective treatment.
Purpose of the Study:
- To track pulmonary function phenotypes in children with asthma during the first year post-diagnosis.
- To identify risk factors associated with poor asthma control in compliant pediatric patients.
Main Methods:
- 142 children diagnosed with asthma were monitored for one year.
- Pulmonary function, spirometry, and fractional exhaled nitric oxide (FeNO) were assessed.
- Clinical data and asthma attack frequency were analyzed to identify risk factors.
Main Results:
- Pulmonary function improved, with increased normal function phenotypes and decreased ventilation dysfunction.
- Persistent small airway dysfunction (SAD) was observed in 14.8% of children after one year.
- Increased asthma attacks and persistent SAD were significant predictors of incomplete asthma control.
Conclusions:
- Around 15% of children with good treatment compliance had uncontrolled asthma after one year.
- Persistent small airway dysfunction is a key risk factor for poor asthma control in pediatric patients.
Objective:
To follow up on the changes in pulmonary function phenotypes in children with asthma in the first year after diagnosis, and explore the risk factors of poor control in children with good treatment compliance.
Methods:
Children who were diagnosed with asthma in the Respiratory Department of Shanghai Children's Medical Center from January 1, 2019 to December 31, 2020 and were re-examined every 3 months after diagnosis for 1 year were continuously included, regardless of gender. We collected the clinical data, analyzed clinical characteristics of the different pulmonary function phenotypes at baseline and explored risk factors of poor asthma control after 1 year of standardized treatment.
Results:
A total of 142 children with asthma were included in this study, including 54 (38.0%) with normal pulmonary function phenotype (NPF), 75 (52.8%) with ventilation dysfunction phenotype (VD), and 13 (9.2%) with small airway dysfunction phenotype (SAD) in the baseline. Among them, there were statistically significant differences in all spirometry parameters, age, and course of disease before diagnosis (P < 0.05), and a negative correlation between age (r 2 = -0.33, P < 0.001), course of disease before diagnosis (r 2 = -0.23, P = 0.006) and FEV1/FVC. After 1-year follow-up, large airway function parameters and small airway function parameters were increased, fractional exhaled nitric oxide (FeNO) was decreased, the proportion of NPF was increased, the proportion of VD was decreased (P < 0.05), while there was no significant difference in the proportion of SAD. After 1 year of standardized treatment, 21 patients (14.8%) still had partly controlled or uncontrolled asthma. Our results showed that the more asthma attacks occurred within 1 year (OR = 6.249, 95% CI, 1.711-22.818, P = 0.006), the more times SAD presented at baseline and Assessment 1-4 (OR = 3.092, 95% CI, 1.222-7.825, P = 0.017), the higher the possibility of incomplete control of asthma.
Conclusion:
About 15% of the children with good treatment compliance were still not completely controlled after 1 year of treatment, which is closely associated with persistent small airway dysfunction.
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