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Vol. 55. Issue 4.
Pages 181-228 (April 2019)
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Vol. 55. Issue 4.
Pages 181-228 (April 2019)
Original Article
DOI: 10.1016/j.arbr.2018.08.007
Small Airway Dysfunction in Children With Controlled Asthma
Disfunción de la pequeña vía aérea en niños con asma controlada
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Garazi Azaldegia, Javier Kortaa,b, Olaia Sardóna,b, Paula Corcueraa, Eduardo G. Pérez-Yarzaa,b,c,
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gonpeya@icloud.com

Corresponding author.
a Sección de Neumología Infantil, Hospital Universitario Donostia, San Sebastián, Spain
b Departamento de Pediatría, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
c Centro de Investigación Biomédica en Red, Enfermedades Respiratorias (CIBERES), San Sebastián, Spain
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Tables (5)
Table 1. Mean Values of the Various Parameters Indicative of Airway Involvement in the Overall Group of Asthmatic Children and in Subgroups of Moderate Asthma and Severe Asthma.
Table 2. Mean Values of the Various Parameters Indicating Small Airway Involvement in the Overall Group of Asthmatic Children and in Subgroups of Moderate Asthma and Severe Asthma.
Table 3. Number of Parameters Indicating Abnormal Airway Involvement in the Overall Group of Asthmatic Children and in Subgroups of Moderate Asthma and Severe Asthma.
Table 4. Comparisons of the Various Parameters Indicating Small Airway Involvement in the Group of Asthmatic Children With Positive and Negative Bronchodilation Test.
Table 5. Mean Values of the Various Parameters Indicating Small Airway Involvement in the Overall Group of Children With Good and Poor Asthma Control.
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Abstract
Introduction

Asthma is characterized by chronic inflammation of the central and distal airways. The aim of this study was to assess the small airway (SA) of children with moderate-severe asthma with normal FEV1.

Methods

This was an open-label, prospective, observational, cross-sectional study with consecutive inclusion of patients with moderate-severe asthma, receiving standard clinical treatment, with normal baseline FEV1. We determined multiflow FEno (CAno), oscillatory resistance and reactance (R5–R20, X5), forced spirometry (FEV1, FEF25–75), total body plethysmography (RV/TLC) and bronchodilation test. SA involvement was defined as: CAno >4.5ppb, R5–R20 >0.147kPa/L/s, X5 <−0.18kPa/L, FEF25–75 <−1.65 z-score, RV/TLC >33%. Poor asthma control was defined as ≤19 points on the ACT questionnaire or ≤20 on the c-ACT.

Results

In a cohort of 100 cases, 76 had moderate asthma and 24 had severe asthma; 71 children were classified as poorly controlled and 29 were well-controlled. In total, 77.78% of the group with all the correct determinations (n=72) showed ≥ 1 altered SA parameter and 48.61% ≥ 2 parameters. There were no differences between well-controlled or poorly controlled cases.

Conclusions

Children with moderate-severe asthma, with normal FEV1, show a phenotype of dysfunctional SA. In our series, the evaluation of SA using the techniques described above did not provide information on disease control.

Keywords:
Small airway
Asthma
Children
Resumen
Introducción

El asma se caracteriza por una inflamación crónica de las vías respiratorias centrales y distales. El objetivo de este estudio ha sido evaluar la vía aérea pequeña (VAP) en niños con asma moderada y/o grave con FEV1 normal.

Métodos

Estudio abierto, prospectivo, observacional y transversal con inclusión consecutiva de casos con asma moderada o grave, bajo tratamiento clínico habitual con FEV1 basal normal. Se ha determinado la FEno a flujos múltiples (CAno), resistencias y reactancia oscilatorias (R5-R20, X5), espirometría forzada (FEV1, FEF25–75), pletismografía corporal total (RV/TLC) y prueba de broncodilatación. La afectación de la VAP se definió por: CAno>4,5ppb, R5-R20>0,147kPa/L/s, X5<−0,18kPa/L, FEF25–75<−1,65 z-score, RV/TLC>33%. El mal control de asma se definió por19 puntos en el cuestionario ACT o20 en c-ACT.

Resultados

Cohorte de 100 casos, 76 con asma moderada y 24 con asma grave, 71 niños clasificados como mal controlados y 29 bien controlados. El 77,78% del grupo con todas las determinaciones correctas (n=72) mostró1 parámetro alterado de VAP y el 48,61%2 parámetros. No hubo diferencias entre los casos bien y mal controlados.

Conclusiones

Los niños con asma moderada y grave, con el FEV1 preservado, muestran un fenotipo de VAP disfuncionante. En nuestra muestra, la evaluación de la VAP mediante las técnicas descritas, no aporta información sobre el control habitual de la enfermedad.

Palabras clave:
Pequeña vía aérea
Asma
Niños

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