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Identification and treatment of persistent small airway dysfunction in paediatric patients with asthma: a
Lulu Zhang1, Zhou Fu1, Hua Deng2
1Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, NO.136, Zhongshan Second Road, 400014, Chongqing, China.
Insights
Persistent small airway dysfunction in children with asthma is linked to specific risk factors and higher FeNO levels. Combination therapies like ICS/LABA show better improvement than ICS alone.
Area of Science:
- Pediatric Respiratory Medicine
- Allergy and Immunology
- Pulmonology
Background:
- Asthma involves significant inflammation and airway remodeling in small airways.
- Persistent small airway dysfunction (p-SAD) is a key concern in pediatric asthma.
- Understanding p-SAD predictors and treatment efficacy is crucial for clinical management.
Purpose of the Study:
- To investigate risk factors and fractional concentration of exhaled nitric oxide (FeNO) for predicting p-SAD in children with asthma.
- To compare the effectiveness of different asthma treatment modalities on p-SAD.
- To identify key indicators for distinguishing p-SAD in pediatric asthma patients.
Main Methods:
- Retrospective cohort study of 248 children (aged 4-11 years) with asthma.
- Binary logistic regression and Spearman's rank correlation were used to analyze risk factors and correlations.
- Receiver operating characteristic (ROC) curves analyzed FeNO's predictive value for p-SAD.
Main Results:
- Older age at regular treatment, younger age at symptom onset, longer ICS/ICS/LABA use, and worse asthma control increased p-SAD risk.
- Small airway function parameters negatively correlated with FeNO (FeNO200) and alveolar/acinar nitric oxide (CaNO).
- FeNO200 and CaNO demonstrated predictive value for p-SAD, with combined analysis showing high accuracy.
Conclusions:
- Pediatric asthma with p-SAD is associated with specific clinical factors and elevated FeNO levels.
- FeNO200 and CaNO, combined with small airway function indicators, can help distinguish p-SAD.
- Inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) combination therapy improves small airway dysfunction more effectively than ICS alone.
Background:
Asthma is a common respiratory disease. In asthma, the small airways have more intensive inflammation and prominent airway remodelling, compared to the central airways. We aimed to investigate the predictive value of risk factors and the fractional concentration of exhaled nitric oxide (FeNO) for persistent small airway dysfunction (p-SAD), and compare the effects of different treatment modalities.
Methods:
This retrospective cohort study included 248 children with asthma (aged 4-11 years). Binary logistic regression was used to analyse the risk factors for p-SAD. Correlations among FEV1/FVC, small airway function parameters, and FeNO levels in patients with asthma were analysed using Spearman's rank correlation. The receiver operating characteristic curve and the Delong test were used to analyse the predictive value of FeNO for p-SAD. Differences in the treatment effects of inhaled corticosteroids (ICS) and ICS with a long-acting beta-agonist (ICS/LABA) on p-SAD were analysed using Fisher's exact test.
Results:
Asthmatic children with older age of receiving the regular treatment (OR 1.782, 95% CI 1.082-2.935), with younger age at the time of onset of suspected asthma symptoms (OR 0.602, 95% CI 0.365-0.993), with longer duration of using ICS or ICS/LABA (OR 1.642, 95% CI 1.170-2.305) and with worse asthma control (OR 3.893, 95% CI 1.699-8.922) had increased risk for p-SAD. Significant negative correlations of small airway function parameters with FeNO at a 200 mL/s flow rate (FeNO200), and the concentration of nitric oxide in the alveolar or acinar region (CaNO) were observed. The areas under the curve of FeNO200 (cut-off:10.5ppb), CaNO (cut-off:5.1ppb), and FeNO200 combined with CaNO were 0.743, 0.697, and 0.750, respectively, for asthma with p-SAD. After using ICS or ICS/LABA, switching to ICS/LABA was easier than continuing with ICS to improve small airway dysfunction (SAD) in the 8th month.
Conclusions:
Paediatric asthma with p-SAD is associated with older age at receiving regular treatment, younger age at the time of onset of suspected asthma symptoms, longer duration of using ICS or ICS/LABA, worse asthma control, and higher FeNO200 and CaNO levels, all of which can be combined with small airway function indicators to distinguish p-SAD from asthma. ICS/LABA improves SAD better than ICS alone.
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