Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

Children with severe asthma have persistent symptoms despite treatment with inhaled corticosteroids (ICSs). The differentiating features of severe asthma in children are poorly defined. To identify features of severe versus mild-to-moderate asthma in school-age children using noninvasive assessments...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 2006-12, Vol.118 (6), p.1218-1225
Main Authors: Fitzpatrick, Anne M., Gaston, Benjamin M., Erzurum, Serpil C., Teague, W. Gerald
Format: Article
Language:English
Subjects:
Adolescent
Allergens - immunology
Asthma
Asthma - diagnosis
Asthma - physiopathology
atopy
Biological and medical sciences
Biomarkers - analysis
Bronchial Provocation Tests
Child
Children
Cohort Studies
Diagnosis, Differential
Exhalation
Family medical history
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Hypersensitivity, Immediate - diagnosis
Hypersensitivity, Immediate - physiopathology
Immunization
Immunopathology
Male
Medical sciences
Methacholine Chloride
nitric oxide
Nitric Oxide - analysis
Nitric Oxide - metabolism
pulmonary function testing
Sleep apnea
Spirometry
Studies
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Summary:Children with severe asthma have persistent symptoms despite treatment with inhaled corticosteroids (ICSs). The differentiating features of severe asthma in children are poorly defined. To identify features of severe versus mild-to-moderate asthma in school-age children using noninvasive assessments of lung function, atopy, and airway inflammation. A total of 75 children (median age, 10 years) with asthma underwent baseline characterization including spirometry and lung volume testing, methacholine bronchoprovocation, allergy evaluation, and offline measurement of exhaled nitric oxide (F ENO). Twenty-eight were followed longitudinally over 6 months. Participants were assigned to the severe asthma subgroup if they required high-dose ICS plus 2 or more minor criteria. Children with severe versus mild-to-moderate asthma had more symptoms, greater airway obstruction, more gas trapping, and increased bronchial responsiveness to methacholine. Subjects with severe asthma also had higher concentrations of F ENO and significantly greater sensitization to aeroallergens. With long-term study, both the reduction in FEV 1 and increase in F ENO persisted in the severe versus mild-to-moderate group. Furthermore, despite adjustments in ICS doses, the frequency of exacerbations was significantly higher in subjects with severe (83%) versus mild-to-moderate asthma (43%). Severe asthma in childhood is characterized by poor symptom control despite high-dose ICS treatment and can be differentiated from mild-to-moderate asthma by measurement of lung function and F ENO. Clinicians should suspect severe asthma in children with poor response to ICS, airway obstruction, and high F ENO.
ISSN:0091-6749
1097-6825
DOI:10.1016/j.jaci.2006.08.019