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Published on: May 15, 2013
Small airway dysfunction and prior exacerbations are common in primarily well-controlled pediatric asthma
Preethi Balagani1, Yela Jung2, Sarah S Field3
1Department of Allergy and Immunology, University of California Irvine, Orange, California.
Insights
Many children with mild asthma have small airway dysfunction (SAD) or a history of exacerbations, yet often receive inadequate treatment. Identifying these risk factors is crucial for better asthma management in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Respiratory Medicine
Background:
- Current asthma guidelines are effective, but many children still experience poor asthma control.
- Failure to identify small airway dysfunction (SAD) may contribute to poor control, as SAD is a known exacerbation risk factor.
Purpose of the Study:
- To assess the prevalence of SAD using oscillometry in children with asthma.
- To determine the association between SAD, prior exacerbations, and current therapy patterns.
- To evaluate if SAD and/or prior exacerbations align with current asthma treatment guidelines.
Main Methods:
- A retrospective, cross-sectional analysis of 53 children (ages 2-7) with mild, well-controlled asthma.
- Small airway dysfunction (SAD) was identified using the C100 Airwave Oscillometer.
- High-risk status was defined by SAD and/or more than one exacerbation in the prior 12 months.
Main Results:
- Nearly half (49.1%) of the children had SAD, and 43.3% had prior exacerbations.
- A significant majority (74.0%) met the criteria for high-risk status.
- Only 41% of high-risk children were receiving appropriate therapy (step 2 or higher).
Conclusions:
- Small airway dysfunction and prior exacerbations are common in young children with mild asthma.
- These biomarkers identify a phenotype at risk for future exacerbations that is often unrecognized.
- Current therapy patterns do not adequately address the identified risks in this pediatric asthma population.
Background:
Although current asthma guidelines are effective, many children experience poor asthma control. A possible explanation is the failure to identify small airway dysfunction (SAD), a known risk factor for exacerbation.
Objective:
To assess SAD prevalence by means of oscillometry, its association with previous exacerbations, and whether consideration of SAD and/or previous exacerbations as risk factors aligns with current therapy patterns.
Methods:
This is a post hoc, retrospective, cross-sectional analysis of 53 primarily mild, well-controlled children with asthma (ages 2-7 years) using the C100 Airwave Oscillometer. SAD was defined for R7-R19, AX, and X7 as a Z score greater than 1.645. High-risk status was defined by SAD and/or more than 1 exacerbation in the previous 12 months. Therapy patterns were compared with risk status.
Results:
SAD is seen in 49.1% of the cohort, and 43.3% had previous exacerbations, whereas 74.0% met the criteria for high-risk status. There were no significant differences in demographics, previous-year exacerbations, or treatment patterns among any of these at-risk categories. Only 41% of the children classified as high risk were receiving step 2 or higher therapy.
Conclusion:
Our data suggest that SAD and/or previous exacerbation biomarkers are common in primarily symptom-based mild, well-controlled young children with asthma, identifying a phenotype that is potentially at risk for future exacerbations and is frequently unrecognized, as reflected by current therapy patterns.
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