Children with Asthma have Fixed Airway Obstruction through Childhood Unaffected by Exacerbations

Henrik W Hallas, Bo L K Chawes, Lambang Arianto, Morten A Rasmussen, Asja Kunøe, Jakob Stokholm, Klaus Bønnelykke, Hans Bisgaard

9 Citationer (Scopus)


Background: Children with asthma may have a disease course with or without exacerbations, but the relationship between exacerbations and lung function development is poorly understood. Objective: To compare lung function trajectories from birth till adolescence in asthmatic children with and without exacerbations. Methods: Children with asthma from the Copenhagen Prospective Studies on Asthma in Childhood 2000 (COPSAC 2000) birth cohort had lung function and bronchial reactivity assessed repeatedly from 1 month to 13 years. Exacerbations were diagnosed at the COPSAC clinic defined as symptoms requiring hospitalization, oral or high-dose inhaled corticosteroid treatment. Mixed models were applied to analyze lung function trajectories. Results: Children with asthma with exacerbations (N = 50) had a trajectory of increased, fixed airway obstruction compared with children without exacerbations (N = 47): z-score difference in airway resistance (sRaw z) (95% confidence interval [CI]): +0.34 (+0.03; +0.66), P = .03, and maximal mid-expiratory flow (MMEF z): −0.41 (−0.69; −0.13), P = .004, but no differences in forced expiratory volume (FEV z): −0.14 (−0.41; +0.13), P = .29, or bronchial reactivity to methacholine (PD z): +0.08 (−0.26; +0.42), P = .65. This did not change comparing lung function trajectories before and after exacerbations: z-score difference (95% CI) sRaw z: −0.04 (−0.35; 0.27), P = .80; MMEF z: 0.01 (−0.02; 0.04), P = .55; FEV z: 0.02 (−0.02; 0.05), P = .42; and PD z: −0.01 (−0.06; 0.05), P = .88. Conclusion: Children with asthma with exacerbations compared with children with asthma without exacerbations are characterized by increased airway obstruction since infancy through childhood. The airway obstruction is a fixed trajectory without progression due to exacerbations, suggesting that exacerbations are a consequence rather than a cause of diminished airway caliber in childhood.

TidsskriftThe journal of allergy and clinical immunology. In practice
Udgave nummer4
Sider (fra-til)1263-1271.e3
Antal sider9
StatusUdgivet - apr. 2020


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