Dataset Information

Obstruction phenotype as a predictor of asthma severity and instability in children.

ABSTRACT: BACKGROUND:Small-airways instability resulting in premature airway closure has been recognized as a risk for asthma severity and poor control. Although spirometry has limited sensitivity for detecting small-airways dysfunction, a focus on the air-trapping component of obstruction might identify a risk factor for asthma instability. OBJECTIVE:We sought to use spirometric measurements to identify patterns of airway obstruction in children and define obstruction phenotypes that relate to asthma instability. METHODS:Prebronchodilation and postbronchodilation spirometric data were obtained from 560 children in the Asthma Phenotypes in the Inner City study. An air-trapping obstruction phenotype (A Trpg) was defined as a forced vital capacity (FVC) z score of less than -1.64 or an increase in FVC of 10% of predicted value or greater with bronchodilation. The airflow limitation phenotype (A Limit) had an FEV1/FVC z score of less than -1.64 but not A Trpg. The no airflow limitation or air-trapping criteria (None) phenotype had neither A Trpg nor A Limit. The 3 obstruction phenotypes were assessed as predictors of number of exacerbations, asthma severity, and airway lability. RESULTS:Patients with the A Trpg phenotype (14% of the cohort) had more exacerbations during the 12-month study compared with those with the A Limit (P < .03) and None (P < .001) phenotypes. Patients with the A Trpg phenotype also had the highest Composite Asthma Severity Index score, the highest asthma treatment step, the greatest variability in FEV1 over time, and the greatest sensitivity to methacholine challenge. CONCLUSIONS:A Trpg and A Limit patterns of obstruction, as defined by using routine spirometric measurements, can identify obstruction phenotypes that are indicators of risk for asthma severity and instability.

SUBMITTER: Sorkness RL

PROVIDER: S-EPMC5951738 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Obstruction phenotype as a predictor of asthma severity and instability in children.

Sorkness Ronald L RL Zoratti Edward M EM Kattan Meyer M Gergen Peter J PJ Evans Michael D MD Visness Cynthia M CM Gill Michelle M Khurana Hershey Gurjit K GK Kercsmar Carolyn M CM Liu Andrew H AH O'Connor George T GT Pongracic Jacqueline A JA Pillai Dinesh D Sorkness Christine A CA Togias Alkis A Wood Robert A RA Busse William W WW

The Journal of allergy and clinical immunology 20171114 4

<h4>Background</h4>Small-airways instability resulting in premature airway closure has been recognized as a risk for asthma severity and poor control. Although spirometry has limited sensitivity for detecting small-airways dysfunction, a focus on the air-trapping component of obstruction might identify a risk factor for asthma instability.<h4>Objective</h4>We sought to use spirometric measurements to identify patterns of airway obstruction in children and define obstruction phenotypes that relat ...[more]

PMID: 29146272

Similar Datasets

Project description:BackgroundPathway analyses can be used to determine how host and environmental factors contribute to asthma severity.ObjectiveTo investigate pathways explaining asthma severity in inner-city children.MethodsOn the basis of medical evidence in the published literature, we developed a conceptual model to describe how 8 risk-factor domains (allergen sensitization, allergic inflammation, pulmonary physiology, stress, obesity, vitamin D, environmental tobacco smoke [ETS] exposure, and rhinitis severity) are linked to asthma severity. To estimate the relative magnitude and significance of hypothesized relationships among these domains and asthma severity, we applied a causal network analysis to test our model in an Inner-City Asthma Consortium study. Participants comprised 6- to 17-year-old children (n = 561) with asthma and rhinitis from 9 US inner cities who were evaluated every 2 months for 1 year. Asthma severity was measured by a longitudinal composite assessment of day and night symptoms, exacerbations, and controller usage.ResultsOur conceptual model explained 53.4% of the variance in asthma severity. An allergy pathway (linking allergen sensitization, allergic inflammation, pulmonary physiology, and rhinitis severity domains to asthma severity) and the ETS exposure pathway (linking ETS exposure and pulmonary physiology domains to asthma severity) exerted significant effects on asthma severity. Among the domains, pulmonary physiology and rhinitis severity had the largest significant standardized total effects on asthma severity (-0.51 and 0.48, respectively), followed by ETS exposure (0.30) and allergic inflammation (0.22). Although vitamin D had modest but significant indirect effects on asthma severity, its total effect was insignificant (0.01).ConclusionsThe standardized effect sizes generated by a causal network analysis quantify the relative contributions of different domains and can be used to prioritize interventions to address asthma severity.

Dataset Information

Obstruction phenotype as a predictor of asthma severity and instability in children.

Publications

Obstruction phenotype as a predictor of asthma severity and instability in children.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets