Clinical significance of the bronchodilator response in children with severe asthma.

Autor: Coverstone AM; Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri., Bacharier LB; Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri., Wilson BS; Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in Saint Louis, St. Louis, Missouri., Fitzpatrick AM; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia., Teague WG; Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia., Phipatanakul W; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Wenzel SE; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Gaston BM; Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio., Bleecker ER; Department of Medicine, University of Arizona, Tucson, Arizona., Moore WC; Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Ramratnam S; Department of Pediatrics, University of Wisconsin School of Medicine, Madison, Wisconsin., Jarjour NN; Department of Medicine, University of Wisconsin School of Medicine, Madison, Wisconsin., Ly NP; Department of Pediatrics, University of California, San Francisco, San Francisco, California., Fahy JV; Department of Medicine, University of California, San Francisco, San Francisco, California., Mauger DT; Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania., Schechtman KB; Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri., Yin-DeClue H; Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri., Boomer JS; Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri., Castro M; Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri.
Jazyk: angličtina
Zdroj: Pediatric pulmonology [Pediatr Pulmonol] 2019 Nov; Vol. 54 (11), pp. 1694-1703. Date of Electronic Publication: 2019 Aug 19.
DOI: 10.1002/ppul.24473
Abstrakt: Background: Our objective was to determine those characteristics associated with reversibility of airflow obstruction and response to maximal bronchodilation in children with severe asthma through the Severe Asthma Research Program (SARP).
Methods: We performed a cross-sectional analysis evaluating children ages 6 to 17 years with nonsevere asthma (NSA) and severe asthma (SA). Participants underwent spirometry before and after 180 µg of albuterol to determine reversibility (≥12% increase in FEV 1 ). Participants were then given escalating doses up to 720 µg of albuterol to determine their maximum reversibility.
Results: We evaluated 230 children (n = 129 SA, n = 101 NSA) from five centers across the United States in the SARP I and II cohorts. SA (odds ratio [OR], 2.08, 95% confidence interval [CI], 1.05-4.13), second-hand smoke exposure (OR, 2.81, 95%CI, 1.23-6.43), and fractional exhaled nitric oxide (FeNO; OR, 1.97, 95%CI, 1.35-2.87) were associated with increased odds of airway reversibility after maximal bronchodilation, while higher prebronchodilator (BD) FEV 1 % predicted (OR, 0.91, 95%CI, 0.88-0.94) was associated with decreased odds. In an analysis using the SARP III cohort (n = 186), blood neutrophils, immunoglobulin E (IgE), and FEV 1 % predicted were significantly associated with BD reversibility. In addition, children with BD response have greater healthcare utilization. BD reversibility was associated with reduced lung function at enrollment and 1-year follow-up though less decline in lung function over 1 year compared to those without reversibility.
Conclusions: Lung function, that is FEV 1 % predicted, is a predictor of BD response in children with asthma. Additionally, smoke exposure, higher FeNO or IgE level, and low peripheral blood neutrophils are associated with a greater likelihood of BD reversibility. BD response can identify a phenotype of pediatric asthma associated with low lung function and poor asthma control.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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