Determinants of lung function across childhood in the Severe Asthma Research Program (SARP) 3

National Heart, Lung, and Blood Institute’s Severe Asthma Research Program-3 Investigators

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: Children with asthma are at risk for low lung function extending into adulthood, but understanding of clinical predictors is incomplete. Objective: We sought to determine phenotypic factors associated with FEV1 throughout childhood in the Severe Asthma Research Program 3 pediatric cohort. Methods: Lung function was measured at baseline and annually. Multivariate linear mixed-effects models were constructed to assess the effect of baseline and time-varying predictors of prebronchodilator FEV1 at each assessment for up to 6 years. All models were adjusted for age, predicted FEV1 by Global Lung Function Initiative reference equations, race, sex, and height. Secondary outcomes included postbronchodilator FEV1 and prebronchodilator FEV1/forced vital capacity. Results: A total of 862 spirometry assessments were performed for 188 participants. Factors associated with FEV1 include baseline FENO (B, −49 mL/log2 PPB; 95% CI, −92 to −6), response to a characterizing dose of triamcinolone acetonide (B, −8.4 mL/1% change FEV1 posttriamcinolone; 95% CI, −12.3 to −4.5), and maximal bronchodilator reversibility (B, −27 mL/1% change postbronchodilator FEV1; 95% CI, −37 to −16). Annually assessed time-varying factors of age, obesity, and exacerbation frequency predicted FEV1 over time. Notably, there was a significant age and sex interaction. Among girls, there was no exacerbation effect. For boys, however, moderate (1-2) exacerbation frequency in the previous 12 months was associated with −20 mL (95% CI, −39 to −2) FEV1 at each successive year. High exacerbation frequency (≥3) 12 to 24 months before assessment was associated with −34 mL (95% CI, −61 to −7) FEV1 at each successive year. Conclusions: In children with severe and nonsevere asthma, several clinically relevant factors predict FEV1 over time. Boys with recurrent exacerbations are at high risk of lower FEV1 through childhood.

Original languageEnglish (US)
Pages (from-to)138-146.e9
JournalJournal of Allergy and Clinical Immunology
Volume151
Issue number1
DOIs
StatePublished - Jan 2023

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

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