Cookie Notice

This site uses cookies. By continuing to browse this site, you are agreeing to our use of cookies. Review our cookies information for more details.

OK
skip to main content

Lung function determinants in childhood asthma

Published: August 27, 2022

Childhood origins of lifelong lung diseases have been widely acknowledged; the most fundamental and consistent finding is that reduced lung function during childhood is predictive of low lung function in adulthood. Childhood asthma is a strong and significant negative influence on forced expiratory volume in one second (FEV1) through adolescence and adulthood. Identifying risk factors for low lung function in childhood is paramount to identifying high risk populations that may require closer clinical follow-up and to test targeted interventions that may delay or prevent the development of lung function impairment across the lifespan.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Gaffin et al. evaluated determinants of lung function across childhood in a longitudinal observational cohort of children with severe and non-severe asthma enrolled in the Severe Asthma Research Program (SARP 3) study. Participants were carefully characterized and lung function, as well as other clinically relevant assessments, were checked annually. The investigators evaluated the relationship of several key predictors of FEV1, specifically evaluating severe versus non-severe asthma determination at each assessment and the change in lung function approximately 2 weeks after a dose of intramuscular (IM) triamcinolone acetonide performed at enrollment.

One hundred and eighty-eight children (mean age at baseline 11.5 ± 2.8 years) provided 862 lung function observations for up to six years of follow-up. Several baseline factors were associated with lower FEV1 including baseline fractional exhaled nitric oxide (FENO), greater response to IM triamcinolone and greater maximal bronchodilator reversibility. One of the most notable findings was the harmful effect of exacerbation frequency present in boys, but not girls. Outside of the exacerbation frequency, asthma severity (severe vs non-severe) was not a significant predictor of lower FEV1. Consistent with prior research in this field, there was no significant relationship of inhaled corticosteroid use with lung function outcomes.

Children with asthma are at risk for poor lung function trajectories into adulthood but predicting who will do so is still not clear. This study identified a novel sex-specific risk of exacerbations on lower lung function in boys through adolescence, but not girls, in a carefully phenotyped population of children with severe and non-severe asthma. Several findings, including greater response to a dose of triamcinolone, maximum bronchodilator reversibility, and higher FeNO pointed to ongoing airways inflammation as a risk factor, as well. In addition, this study reaffirms that inhaled steroid therapy has little effect on FEV1 over time. These findings offer a framework of clinically available measures that can identify children with asthma who are at risk of lung function impairment and a potential for future intervention studies aiming to improve lung function in at-risk children.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Full Article