Peripheral airways involvement in children with asthma exacerbation

Objective

The literature provides some evidence of peripheral airways key role in the pathogenesis of asthma. However, the extent to which lung periphery including acinar zone contribute to asthma activity and control in pediatric population is unclear. Therefore, the aim of the study was to estimate peripheral airways involvement in children with asthma exacerbation and stable asthma simultaneously via different pulmonary function tests.

Methods

Children with asthma exacerbation (n=20) and stable asthma (n=22) performed spirometry, bodyplethysmography, exhaled nitric oxide, IOS and MBW.

Results

Peripheral airway’s function indexes were increased in children with asthma, particularly in group with asthma exacerbation when compared to stable asthma group. The prevalence of abnormal results was significantly higher in asthma exacerbation. All children with asthma exacerbation had conductive ventilation inhomogeneity, 76% had acinar ventilation inhomogeneity. According to IOS measurements, resistance and reactance were within normal range, but other IOS parameters were significantly higher in children with asthma exacerbation compared to stable asthma group. The 36% of children with acute asthma had air trapping.

Conclusion

Significant involvement of peripheral airways was observed in children with asthma, particularly in asthma exacerbation, which determine lung periphery as important additional target for therapy and provide new insights into pathophysiological process of pediatric asthma.

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