Andrea M Coverstone1, Leonard B Bacharier1, Bradley S Wilson2, Anne M Fitzpatrick3, William Gerald Teague4, Wanda Phipatanakul5, Sally E Wenzel6, Benjamin M Gaston7, Eugene R Bleecker8, Wendy C Moore9, Sima Ramratnam10, Nizar N Jarjour11, Ngoc P Ly12, John V Fahy13, David T Mauger14, Kenneth B Schechtman15, Huiqing Yin-DeClue15, Jonathan S Boomer15, Mario Castro15. 1. Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri. 2. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in Saint Louis, St. Louis, Missouri. 3. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 4. Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia. 5. Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 6. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 7. Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio. 8. Department of Medicine, University of Arizona, Tucson, Arizona. 9. Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. 10. Department of Pediatrics, University of Wisconsin School of Medicine, Madison, Wisconsin. 11. Department of Medicine, University of Wisconsin School of Medicine, Madison, Wisconsin. 12. Department of Pediatrics, University of California, San Francisco, San Francisco, California. 13. Department of Medicine, University of California, San Francisco, San Francisco, California. 14. Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania. 15. Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri.
Abstract
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 FEV1 ). 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) FEV1 % 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 FEV1 % 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 FEV1 % 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.
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 FEV1 ). 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) FEV1 % 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 FEV1 % 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 FEV1 % 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.
Authors: Robyn T Cohen; Benjamin A Raby; Kristel Van Steen; Anne L Fuhlbrigge; Juan C Celedón; Bernard A Rosner; Robert C Strunk; Robert S Zeiger; Scott T Weiss Journal: J Allergy Clin Immunol Date: 2010-07-31 Impact factor: 10.793
Authors: Sze Man Tse; Diane R Gold; Joanne E Sordillo; Elaine B Hoffman; Matthew W Gillman; Sheryl L Rifas-Shiman; Anne L Fuhlbrigge; Kelan G Tantisira; Scott T Weiss; Augusto A Litonjua Journal: J Allergy Clin Immunol Date: 2013-05-14 Impact factor: 10.793
Authors: David B Price; Roland Buhl; Adrian Chan; Daryl Freeman; Elizabeth Gardener; Clifford Godley; Kevin Gruffydd-Jones; Lorcan McGarvey; Ken Ohta; Dermot Ryan; Jörgen Syk; Ngiap Chuan Tan; TzeLee Tan; Mike Thomas; Sen Yang; Priyanka Raju Konduru; Marcus Ngantcha; Martina Stagno d'Alcontres; Therese S Lapperre Journal: Lancet Respir Med Date: 2017-11-03 Impact factor: 30.700
Authors: Kian Fan Chung; Sally E Wenzel; Jan L Brozek; Andrew Bush; Mario Castro; Peter J Sterk; Ian M Adcock; Eric D Bateman; Elisabeth H Bel; Eugene R Bleecker; Louis-Philippe Boulet; Christopher Brightling; Pascal Chanez; Sven-Erik Dahlen; Ratko Djukanovic; Urs Frey; Mina Gaga; Peter Gibson; Qutayba Hamid; Nizar N Jajour; Thais Mauad; Ronald L Sorkness; W Gerald Teague Journal: Eur Respir J Date: 2013-12-12 Impact factor: 16.671
Authors: María G Contreras; Kevin Keys; Joaquin Magaña; Pagé C Goddard; Oona Risse-Adams; Andrew M Zeiger; Angel C Y Mak; Lesly-Anne Samedy-Bates; Andreas M Neophytou; Eunice Lee; Neeta Thakur; Jennifer R Elhawary; Donglei Hu; Scott Huntsman; Celeste Eng; Ting Hu; Esteban G Burchard; Marquitta J White Journal: Ethn Dis Date: 2021-01-21 Impact factor: 1.847
Authors: Andrea M Coverstone; Jonathan S Boomer; Daphne Lew; Leonard B Bacharier; Mario Castro Journal: Ann Allergy Asthma Immunol Date: 2020-12-02 Impact factor: 6.347
Authors: Jaehyun Joo; Angel C Y Mak; Shujie Xiao; Patrick M Sleiman; Donglei Hu; Scott Huntsman; Celeste Eng; Mengyuan Kan; Avantika R Diwakar; Jessica A Lasky-Su; Scott T Weiss; Joanne E Sordillo; Ann C Wu; Michelle Cloutier; Glorisa Canino; Erick Forno; Juan C Celedón; Max A Seibold; Hakon Hakonarson; L Keoki Williams; Esteban G Burchard; Blanca E Himes Journal: Sci Rep Date: 2022-07-22 Impact factor: 4.996