Pulmonary function characteristics in children with suspected asthma:
implications for asthma diagnosis
Abstract
Background: In children suspected of asthma, diagnosis is
confirmed via variable expiratory airflow limitation. This study aimed
to evaluate the pulmonary function characteristics in children suspected
of asthma without bronchodilator response (BDR) and bronchial
hyperresponsiveness (BHR). Methods: We utilised two separate
real-world retrospective observational cohorts of children who underwent
both spirometry and bronchial provocation testing for asthma. Spirometry
parameters were collected and compared between definite asthma, probable
asthma, and non-asthma groups. The original cohort comprised 1199
children who visited the Severance Hospital (Seoul, Korea) between
January 2017 and December 2019. The external cohort included 105
children who visited the Gangnam Severance Hospital between January 2000
and December 2017. Results: Probable asthma accounted for
16.8% and 32.4% of the original and external cohorts, respectively.
Baseline forced expiratory volume in 1 second (FEV 1),
FEV 1/forced vital capacity (FVC), forced expiratory
flow at 25-75% of FVC (FEF 25-75), and FEF
75 showed stepwise decrements from non-asthma, probable
asthma, to definite asthma patients ( P < 0.001). The
probable asthma group showed significantly higher odds of abnormal FEV
1/FVC (OR, 2.24 [95%CI, 1.43-3.52]) and FEF
25-75 (OR, 2.05 [95%CI, 1.13-3.73]) than the
non-asthma group and lower odds of abnormal FEV 1 (OR,
0.05 [95%CI, 0.01-0.19]), FEV 1/FVC (OR, 0.27
[95% CI, 0.18-0.41]), FEF 25-75 (OR, 0.17
[95%CI, 0.11-0.28]), and FEF 75 (OR, 0.14
[95%CI, 0.08-0.24]) compared to the definite asthma group. The
external cohort was consistent with the original cohort.
Conclusions: We show evidence of airway dysfunction in children
for whom a high clinical suspicion of asthma exists without evidence of
BDR and BHR.