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

Ronald L. Sorkness; Edward M. Zoratti; Meyer Kattan; Peter J. Gergen; Michael D. Evans; Cynthia M. Visness; Michelle Gill; Gurjit K. Khurana Hershey; Carolyn M. Kercsmar; Andrew H. Liu; George T. O'Connor; Jacqueline A. Pongracic; Dinesh Pillai; Christine A. Sorkness; Alkis Togias; Robert A. Wood; William W. Busse

doi:10.1016/j.jaci.2017.09.047

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

Ronald L. Sorkness, Edward M. Zoratti, Meyer Kattan, Peter J. Gergen, Michael D. Evans, Cynthia M. Visness, Michelle Gill, Gurjit K. Khurana Hershey, Carolyn M. Kercsmar, Andrew H. Liu, George T. O'Connor, Jacqueline A. Pongracic, Dinesh Pillai, Christine A. Sorkness, Alkis Togias, Robert A. Wood, William W. Busse

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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.

Original language	English (US)
Pages (from-to)	1090-1099.e4
Journal	Journal of Allergy and Clinical Immunology
Volume	142
Issue number	4
DOIs	https://doi.org/10.1016/j.jaci.2017.09.047
State	Published - Oct 2018
Externally published	Yes

Bibliographical note

Funding Information:
We thank the APIC study participants and their families who gave of themselves to be our investigational partners; our study staff personnel, who are dedicated to our inner-city asthma mission and clinical research excellence; and Patrick Heinritz in the Inner-City Asthma Consortium Administrative Center (Madison, Wis) and Samuel Arbes, Michelle Walter, and Herman Mitchell at Rho for their leadership, commitment to excellence despite all the challenges, and legacies in inner-city asthma research.

Publisher Copyright:
© 2017 American Academy of Allergy, Asthma & Immunology

Keywords

Small-airways dysfunction
airflow limitation
airway closure
asthma exacerbation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Sorkness, R. L., Zoratti, E. M., Kattan, M., Gergen, P. J., Evans, M. D., Visness, C. M., Gill, M., Khurana Hershey, G. K., Kercsmar, C. M., Liu, A. H., O'Connor, G. T., Pongracic, J. A., Pillai, D., Sorkness, C. A., Togias, A., Wood, R. A., & Busse, W. W. (2018). Obstruction phenotype as a predictor of asthma severity and instability in children. Journal of Allergy and Clinical Immunology, 142(4), 1090-1099.e4. https://doi.org/10.1016/j.jaci.2017.09.047

Sorkness, RL, Zoratti, EM, Kattan, M, Gergen, PJ, Evans, MD, Visness, CM, Gill, M, Khurana Hershey, GK, Kercsmar, CM, Liu, AH, O'Connor, GT, Pongracic, JA, Pillai, D, Sorkness, CA, Togias, A, Wood, RA & Busse, WW 2018, 'Obstruction phenotype as a predictor of asthma severity and instability in children', Journal of Allergy and Clinical Immunology, vol. 142, no. 4, pp. 1090-1099.e4. https://doi.org/10.1016/j.jaci.2017.09.047

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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.",

keywords = "Small-airways dysfunction, airflow limitation, airway closure, asthma exacerbation",

author = "Sorkness, {Ronald L.} and Zoratti, {Edward M.} and Meyer Kattan and Gergen, {Peter J.} and Evans, {Michael D.} and Visness, {Cynthia M.} and Michelle Gill and {Khurana Hershey}, {Gurjit K.} and Kercsmar, {Carolyn M.} and Liu, {Andrew H.} and O'Connor, {George T.} and Pongracic, {Jacqueline A.} and Dinesh Pillai and Sorkness, {Christine A.} and Alkis Togias and Wood, {Robert A.} and Busse, {William W.}",

note = "Funding Information: We thank the APIC study participants and their families who gave of themselves to be our investigational partners; our study staff personnel, who are dedicated to our inner-city asthma mission and clinical research excellence; and Patrick Heinritz in the Inner-City Asthma Consortium Administrative Center (Madison, Wis) and Samuel Arbes, Michelle Walter, and Herman Mitchell at Rho for their leadership, commitment to excellence despite all the challenges, and legacies in inner-city asthma research. Publisher Copyright: {\textcopyright} 2017 American Academy of Allergy, Asthma & Immunology",

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T1 - Obstruction phenotype as a predictor of asthma severity and instability in children

AU - Sorkness, Ronald L.

AU - Zoratti, Edward M.

AU - Kattan, Meyer

AU - Gergen, Peter J.

AU - Evans, Michael D.

AU - Visness, Cynthia M.

AU - Gill, Michelle

AU - Khurana Hershey, Gurjit K.

AU - Kercsmar, Carolyn M.

AU - Liu, Andrew H.

AU - O'Connor, George T.

AU - Pongracic, Jacqueline A.

AU - Pillai, Dinesh

AU - Sorkness, Christine A.

AU - Togias, Alkis

AU - Wood, Robert A.

AU - Busse, William W.

N1 - Funding Information: We thank the APIC study participants and their families who gave of themselves to be our investigational partners; our study staff personnel, who are dedicated to our inner-city asthma mission and clinical research excellence; and Patrick Heinritz in the Inner-City Asthma Consortium Administrative Center (Madison, Wis) and Samuel Arbes, Michelle Walter, and Herman Mitchell at Rho for their leadership, commitment to excellence despite all the challenges, and legacies in inner-city asthma research. Publisher Copyright: © 2017 American Academy of Allergy, Asthma & Immunology

PY - 2018/10

Y1 - 2018/10

N2 - 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.

AB - 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.

KW - Small-airways dysfunction

KW - airflow limitation

KW - airway closure

KW - asthma exacerbation

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

Abstract

Bibliographical note

Keywords

UN SDGs

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