Children with Asthma Have Fixed Airway Obstruction through Childhood Unaffected by Exacerbations

Henrik W Hallas; Bo L Chawes; Lambang Arianto; Morten A Rasmussen; Asja Kunøe; Jakob Stokholm; Klaus Bønnelykke; Hans Bisgaard

doi:10.1016/j.jaip.2019.10.031

Children with Asthma Have Fixed Airway Obstruction through Childhood Unaffected by Exacerbations

J Allergy Clin Immunol Pract. 2020 Apr;8(4):1263-1271.e3. doi: 10.1016/j.jaip.2019.10.031. Epub 2019 Nov 9.

Authors

Henrik W Hallas¹, Bo L Chawes¹, Lambang Arianto¹, Morten A Rasmussen¹, Asja Kunøe¹, Jakob Stokholm¹, Klaus Bønnelykke¹, Hans Bisgaard²

Affiliations

¹ COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
² COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: bisgaard@copsac.com.

PMID: 31707066
DOI: 10.1016/j.jaip.2019.10.031

Abstract

Background: Children with asthma may have a disease course with or without exacerbations, but the relationship between exacerbations and lung function development is poorly understood.

Objective: To compare lung function trajectories from birth till adolescence in asthmatic children with and without exacerbations.

Methods: Children with asthma from the Copenhagen Prospective Studies on Asthma in Childhood₂₀₀₀ (COPSAC₂₀₀₀) birth cohort had lung function and bronchial reactivity assessed repeatedly from 1 month to 13 years. Exacerbations were diagnosed at the COPSAC clinic defined as symptoms requiring hospitalization, oral or high-dose inhaled corticosteroid treatment. Mixed models were applied to analyze lung function trajectories.

Results: Children with asthma with exacerbations (N = 50) had a trajectory of increased, fixed airway obstruction compared with children without exacerbations (N = 47): z-score difference in airway resistance (sRaw_z) (95% confidence interval [CI]): +0.34 (+0.03; +0.66), P = .03, and maximal mid-expiratory flow (MMEF_z): -0.41 (-0.69; -0.13), P = .004, but no differences in forced expiratory volume (FEV_z): -0.14 (-0.41; +0.13), P = .29, or bronchial reactivity to methacholine (PD_z): +0.08 (-0.26; +0.42), P = .65. This did not change comparing lung function trajectories before and after exacerbations: z-score difference (95% CI) sRaw_z: -0.04 (-0.35; 0.27), P = .80; MMEF_z: 0.01 (-0.02; 0.04), P = .55; FEV_z: 0.02 (-0.02; 0.05), P = .42; and PD_z: -0.01 (-0.06; 0.05), P = .88.

Conclusion: Children with asthma with exacerbations compared with children with asthma without exacerbations are characterized by increased airway obstruction since infancy through childhood. The airway obstruction is a fixed trajectory without progression due to exacerbations, suggesting that exacerbations are a consequence rather than a cause of diminished airway caliber in childhood.

Keywords: Asthma; Birth cohort; Bronchial reactivity; Exacerbation; Lung function.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adrenal Cortex Hormones / therapeutic use
Airway Obstruction* / diagnosis
Asthma* / drug therapy
Asthma* / epidemiology
Child
Forced Expiratory Volume
Humans
Prospective Studies

Substances

Adrenal Cortex Hormones