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. 2023 Jan 9:10:1043047.
doi: 10.3389/fped.2022.1043047. eCollection 2022.

Prognosis of bronchial asthma in children with different pulmonary function phenotypes: A real-world retrospective observational study

Affiliations

Prognosis of bronchial asthma in children with different pulmonary function phenotypes: A real-world retrospective observational study

Lu Liu et al. Front Pediatr. .

Abstract

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.

Keywords: asthma; children; prognosis; pulmonary function phenotypes; small airway dysfunction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for the study design. NPF, normal pulmonary function phenotype; VD, ventilation dysfunction phenotype; SAD, small airway dysfunction phenotype.
Figure 2
Figure 2
Group comparison of age of diagnosis (A) and course of disease (C) among the three phenotypes in baseline. Linear correlation analysis between FEV1/FVC and age of diagnosis (B) and course of disease (D). NPF, normal pulmonary function phenotype; VD, ventilation dysfunction phenotype; SAD, small airway dysfunction phenotype; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 s. Bars indicate the median ± IQR. Group comparison among the three phenotypes: ***P < 0.001; **P < 0.01; *P < 0.05.
Figure 3
Figure 3
Large (A: FVC%, FEV1, FEV1/FVC) and small (B: FEF75%, FEF50%, FEF25–75%) airway function parameters over time. FVC, forced vital capacity; FEV1, forced expiratory volume in 1 s, FEF75%, forced expiratory flow at 75% of forced vital capacity; FEF50%, forced expiratory flow at 50% of forced vital capacity; FEF25–75%, forced expiratory flow between 25% and 75% of vital capacity. Bars indicate the mean ± 95% CI. The dashed line represents the normal values (A: 80%, B: 65%).
Figure 4
Figure 4
Comparison of large (A: FVC%, B: FEV1, C: FEV1/FVC) and small (D: FEF75%, E: FEF50%, F: FEF25–75%) airway function parameters, FeNO (A) and the number of children with different phenotypes (B) before and after treatment. FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second, FEF75%, forced expiratory flow at 75% of forced vital capacity; FEF50%, forced expiratory flow at 50% of forced vital capacity; FEF25–75%, forced expiratory flow between 25% and 75% of vital capacity; FeNO, fractional exhaled nitric oxide. Bars indicate the mean ± 95% CI.
Figure 5
Figure 5
Odds ratios for risk factors for poor asthma control after 1 year of anti-asthmatic treatment. BMI, body mass index; SAD, small airway dysfunction phenotype.

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References

    1. National Cooperative Group on Childhood Asthma, Institute of Environmental Health and Related Product Safety CC for DC and P, Chinese Center for Disease Control and Prevention. Third nationwide survey of childhood asthma in urban areas of China. Zhonghua Er Ke Za Zhi. (2013) 51:729–35. 10.3760/cma.j.issn.0578-1310.2013.10.003 - DOI - PubMed
    1. Hu Y-B, Chen Y-T, Liu S-J, Jiang F, Wu M-Q, Yan C-H, et al. Increasing prevalence and influencing factors of childhood asthma: a cross-sectional study in Shanghai, China. World J Pediatr. (2021) 17:419–28. 10.1007/s12519-021-00436-x - DOI - PubMed
    1. Xiang L, Zhao J, Zheng Y, Liu H, Hong J, Bao Y, et al. Uncontrolled asthma and its risk factors in Chinese children: a cross-sectional observational study. J Asthma. (2016) 53:699–706. 10.3109/02770903.2016.1144199 - DOI - PubMed
    1. Comberiati P, Spahn JD, Paull K, Faino A, Cherniack R, Covar RA. Lung mechanical properties distinguish children with asthma with normal and diminished lung function. Clin Exp Allergy. (2020) 50:453–62. 10.1111/cea.13573 - DOI - PubMed
    1. Burgel P-R. The role of small airways in obstructive airway diseases. Eur Respir Rev. (2011) 20:23–33. 10.1183/09059180.00010410 - DOI - PMC - PubMed

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