Identification and treatment of persistent small airway dysfunction in paediatric patients with asthma: a retrospective cohort study

作者全名："Zhang, Lulu; Fu, Zhou; Deng, Hua; Xie, Qin; Wu, Wenjie"

作者地址："[Zhang, Lulu; Fu, Zhou] Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Resp Med, Minist Educ,Childrens Hosp,Key Lab Child Dev & Dis, 136 Zhongshan Second Rd, Chongqing 400014, Peoples R China; [Deng, Hua; Xie, Qin; Wu, Wenjie] Chongqing Youyoubaobei Women & Childrens Hosp, Dept Pediat Internal Med, 999 Jiarong Rd, Chongqing 401122, Peoples R China"

通信作者："Wu, WJ (通讯作者)，Chongqing Youyoubaobei Women & Childrens Hosp, Dept Pediat Internal Med, 999 Jiarong Rd, Chongqing 401122, Peoples R China."

来源：BMC PULMONARY MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001172560200001

JCR分区：Q2

影响因子：2.6

年份：2024

卷号：24

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Paediatric asthma; Persistent small airway dysfunction; Identification; Treatment; Risk factors

摘要："BackgroundAsthma is a common respiratory disease. In asthma, the small airways have more intensive inflammation and prominent airway remodelling, compared to the central airways. We aimed to investigate the predictive value of risk factors and the fractional concentration of exhaled nitric oxide (FeNO) for persistent small airway dysfunction (p-SAD), and compare the effects of different treatment modalities.MethodsThis retrospective cohort study included 248 children with asthma (aged 4-11 years). Binary logistic regression was used to analyse the risk factors for p-SAD. Correlations among FEV1/FVC, small airway function parameters, and FeNO levels in patients with asthma were analysed using Spearman's rank correlation. The receiver operating characteristic curve and the Delong test were used to analyse the predictive value of FeNO for p-SAD. Differences in the treatment effects of inhaled corticosteroids (ICS) and ICS with a long-acting beta-agonist (ICS/LABA) on p-SAD were analysed using Fisher's exact test.ResultsAsthmatic children with older age of receiving the regular treatment (OR 1.782, 95% CI 1.082-2.935), with younger age at the time of onset of suspected asthma symptoms (OR 0.602, 95% CI 0.365-0.993), with longer duration of using ICS or ICS/LABA (OR 1.642, 95% CI 1.170-2.305) and with worse asthma control (OR 3.893, 95% CI 1.699-8.922) had increased risk for p-SAD. Significant negative correlations of small airway function parameters with FeNO at a 200 mL/s flow rate (FeNO200), and the concentration of nitric oxide in the alveolar or acinar region (CaNO) were observed. The areas under the curve of FeNO200 (cut-off:10.5ppb), CaNO (cut-off:5.1ppb), and FeNO200 combined with CaNO were 0.743, 0.697, and 0.750, respectively, for asthma with p-SAD. After using ICS or ICS/LABA, switching to ICS/LABA was easier than continuing with ICS to improve small airway dysfunction (SAD) in the 8th month.ConclusionsPaediatric asthma with p-SAD is associated with older age at receiving regular treatment, younger age at the time of onset of suspected asthma symptoms, longer duration of using ICS or ICS/LABA, worse asthma control, and higher FeNO200 and CaNO levels, all of which can be combined with small airway function indicators to distinguish p-SAD from asthma. ICS/LABA improves SAD better than ICS alone."

基金机构：The Research and Cultivation Fund of Chongqing Youyoubaobei Women and Children's Hospital

基金资助正文：The authors sincerely acknowledge the assistance of the children and their parents who participated in the study and the staff of the Children's Hospital of Chongqing Medical University and Chongqing Youyoubaobei Women and Children's Hospital.