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. 2006 Dec;118(6):1218-25.
doi: 10.1016/j.jaci.2006.08.019. Epub 2006 Oct 10.

Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

Anne M Fitzpatrick  1 , Benjamin M Gaston, Serpil C Erzurum, W Gerald Teague; National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program
Affiliations

Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

Anne M Fitzpatrick et al. J Allergy Clin Immunol. 2006 Dec.

Abstract

Background: Children with severe asthma have persistent symptoms despite treatment with inhaled corticosteroids (ICSs). The differentiating features of severe asthma in children are poorly defined.

Objective: To identify features of severe versus mild-to-moderate asthma in school-age children using noninvasive assessments of lung function, atopy, and airway inflammation.

Methods: A total of 75 children (median age, 10 years) with asthma underwent baseline characterization including spirometry and lung volume testing, methacholine bronchoprovocation, allergy evaluation, and offline measurement of exhaled nitric oxide (F(ENO)). Twenty-eight were followed longitudinally over 6 months. Participants were assigned to the severe asthma subgroup if they required high-dose ICS plus 2 or more minor criteria.

Results: Children with severe versus mild-to-moderate asthma had more symptoms, greater airway obstruction, more gas trapping, and increased bronchial responsiveness to methacholine. Subjects with severe asthma also had higher concentrations of F(ENO) and significantly greater sensitization to aeroallergens. With long-term study, both the reduction in FEV(1) and increase in F(ENO) persisted in the severe versus mild-to-moderate group. Furthermore, despite adjustments in ICS doses, the frequency of exacerbations was significantly higher in subjects with severe (83%) versus mild-to-moderate asthma (43%).

Conclusion: Severe asthma in childhood is characterized by poor symptom control despite high-dose ICS treatment and can be differentiated from mild-to-moderate asthma by measurement of lung function and F(ENO).

Clinical implications: Clinicians should suspect severe asthma in children with poor response to ICS, airway obstruction, and high F(ENO).

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Conflict of interest statement

Disclosure of potential conflict of interest: W. G. Teague is on the speakers’ bureau for Merck. The rest of the authors have declared that they have no conflict of interest.

Figures

FIG 1
FIG 1
Recruitment schematic.
FIG 2
FIG 2
Longitudinal FENO and FEV1 data at baseline and over a period of 6 months. Data represent group means (severe asthma is shown in black circles). Group differences are depicted with asterisks (P < .05). Mean differences between groups remain significant over time after controlling for seasonality and serum IgE (repeated-measures ANOVA, P = .005).
FIG 3
FIG 3
Actuarial plot showing the probability of remaining exacerbation-free over the 6-month period study interval for subjects grouped according to high (≥0.80) and low (<0.80) baseline FEV1:FVC. P values were calculated using Cox regression. +, One or more subjects within the group remained exacerbation-free over the duration of the study.
See this image and copyright information in PMC

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