Dataset Information

Risk Factors for Lung Function Decline in Pediatric Asthma under Treatment: A Retrospective, Multicenter, Observational Study.

ABSTRACT:

Background

Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known.

Objective

To identify clinical factors in children with asthma associated with low or declining lung function during the treatment.

Methods

We enrolled children with asthma who had been treated throughout three age periods, i.e., 6-9, 10-12, and 13-15 years old, at seven specialized hospitals in Japan. Clinical information and lung function measurements were retrieved from the electronic chart systems. To characterize the lung function trajectories during each age period, we evaluated the forced expiratory volume 1 (FEV1) with % predicted values and individual changes by the slope (S) from linear regression. We defined four trajectory patterns: normal (Group N) and low (Group L), showing %FEV1 ≥80% or <80% throughout all three periods; upward (Group U) and downward (Group D), showing S ≥ 0 or S < 0%. Logistic regression analysis was performed to compare factors associated with the unfavorable (D/L) versus favorable (N/U) groups.

Results

Among 273 eligible patients, 197 (72%) were classified into Group N (n = 150)/U (n = 47), while 76 (28%) were in Group D (n = 66)/L (n = 10). A history of poor asthma control, long-acting beta2 agonist use, and a lower height Z-score during 13-15 years were associated with an unfavorable outcome (Group D/L). Conversely, inhaled corticosteroid (ICS) use during 10-12 years and high-dose ICS use during 13-15 years were associated with a favorable outcome (Group N/U).

Conclusion

We identified several factors that are associated with unfavorable lung function changes in pediatric asthma. Attention should be paid to the possible relationship between yearly changes in lung function and poor asthma control, use of ICS (and its dose) and use of LABA.

SUBMITTER: Yamada S

PROVIDER: S-EPMC9600699 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Risk Factors for Lung Function Decline in Pediatric Asthma under Treatment: A Retrospective, Multicenter, Observational Study.

Yamada Shingo S Fujisawa Takao T Nagao Mizuho M Matsuzaki Hiroshi H Motomura Chikako C Odajima Hiroshi H Nakamura Toshinori T Imai Takanori T Nagakura Ken-Ichi KI Yanagida Noriyuki N Mitomori Masatoshi M Ebisawa Motohiro M Kabashima Shigenori S Ohya Yukihiro Y Habukawa Chizu C Tomiita Minako M Hirayama Masahiro M

Children (Basel, Switzerland) 20221004 10

Background: Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known. Objective: To identify clinical factors in children with asthma associated with low or declining lung function during the treatment. Methods: We enrolled children with asthma who had been treated throughout three age periods, i.e., 6−9, 10−12, and 13−15 years old, at seven specialized hospitals in Japan. Clinic ...[more]

PMID: 36291452

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Project description:BackgroundTracking longitudinal measurements of growth and decline in lung function in patients with persistent childhood asthma may reveal links between asthma and subsequent chronic airflow obstruction.MethodsWe classified children with asthma according to four characteristic patterns of lung-function growth and decline on the basis of graphs showing forced expiratory volume in 1 second (FEV1), representing spirometric measurements performed from childhood into adulthood. Risk factors associated with abnormal patterns were also examined. To define normal values, we used FEV1 values from participants in the National Health and Nutrition Examination Survey who did not have asthma.ResultsOf the 684 study participants, 170 (25%) had a normal pattern of lung-function growth without early decline, and 514 (75%) had abnormal patterns: 176 (26%) had reduced growth and an early decline, 160 (23%) had reduced growth only, and 178 (26%) had normal growth and an early decline. Lower baseline values for FEV1, smaller bronchodilator response, airway hyperresponsiveness at baseline, and male sex were associated with reduced growth (P<0.001 for all comparisons). At the last spirometric measurement (mean [±SD] age, 26.0±1.8 years), 73 participants (11%) met Global Initiative for Chronic Obstructive Lung Disease spirometric criteria for lung-function impairment that was consistent with chronic obstructive pulmonary disease (COPD); these participants were more likely to have a reduced pattern of growth than a normal pattern (18% vs. 3%, P<0.001).ConclusionsChildhood impairment of lung function and male sex were the most significant predictors of abnormal longitudinal patterns of lung-function growth and decline. Children with persistent asthma and reduced growth of lung function are at increased risk for fixed airflow obstruction and possibly COPD in early adulthood. (Funded by the Parker B. Francis Foundation and others; ClinicalTrials.gov number, NCT00000575.).

Project description:BackgroundAsthma is a common respiratory disease in children, and air pollution is a risk factor for pediatric asthma. However, how air pollution affects blood cells in pediatric patients with asthma remains unclear.MethodsThis retrospective observational study, performed in 2007-2018 at a medical center, enrolled non-trauma patients aged < 17 years who visited the emergency department and had asthma. Medical records and blood cell counts, including absolute neutrophil count (ANC), eosinophil count, and platelet count were extracted. The concentrations of PM2.5, PM10, sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) were measured from 11 air-monitoring stations in Kaohsiung City.ResultsOne-unit increases in PM2.5 (regression coefficient: 25.618; S.E.: 5.937; p < 0.001), PM10 (19.97; 3.541; p < 0.001), NO2 (70.681; 15.857; p < 0.001), SO2 (81.694; 30.339; p = 0.007), and O3 (23.42; 8.831; p = 0.022) on lag 0-6 (7 d average) correlated positively with ANC. One-unit increases in PM2.5 (0.859; 0.357; p = 0.016), PM10 (0.728; 0.213; p = 0.001), and SO2 (4.086; 1.811; p = 0.024) on lag 0-6 correlated positively with eosinophil count. Additionally, one-unit increases in PM2.5 (0.302; 0.101; p = 0.003) and PM10 (0.229; 0.06; p < 0.001) on lag 0-6 correlated positively with platelet count. In a two-pollutant model, the impacts of PM2.5 and PMC on ANC and platelet count remained statistically significant after adjusting for other air pollutants. Additionally, PMC correlated significantly with eosinophil count after adjusting for PM2.5, NO2, SO2, and O3. Quartile increases in PM2.5 and PMC levels correlated positively with ANC, eosinophil count, and platelet count (all p for trend < 0.05).ConclusionsPM2.5, PMC, and NO2 were independently and positively associated with ANC, PMC was positively associated with eosinophil count, and PM2.5 and PMC were positively associated with platelet count in pediatric patients with asthma. Our results highlight the relationship between air pollution and blood cell counts in pediatric patients with asthma.

Dataset Information

Risk Factors for Lung Function Decline in Pediatric Asthma under Treatment: A Retrospective, Multicenter, Observational Study.

Background

Objective

Methods

Results

Conclusion

Publications

Risk Factors for Lung Function Decline in Pediatric Asthma under Treatment: A Retrospective, Multicenter, Observational Study.

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