Clinical characterization of children with resistant airflow obstruction, a multicenter study

ABSTRACT

Objective: To characterize a cohort of children with airflow limitation resistant to bronchodilator (BD) therapy. Methods: Pulmonary function tests performed in children 6–17 years of age at 15 centers in a clinical research consortium were screened for resistant airflow limitation, defined as a post-BD FEV₁ and/or an FEV₁/FVC less than the lower limits of normal. Demographic and clinical data were analyzed for associations with pulmonary function. Results: 582 children were identified. Median age was 13 years (IQR: 11, 16), 60% were males; 62% were Caucasian, 28% were African-American; 19% were obese; 32% were born prematurely and 21% exposed to second hand smoke. Pulmonary diagnoses included asthma (93%), prior significant pneumonia (28%), and bronchiectasis (5%). 65% reported allergic rhinitis, and 11% chronic sinusitis. Subjects without a history of asthma had significantly lower post-BD FEV₁% predicted (p = 0.008). Subjects without allergic rhinitis had lower post-BD FEV₁% predicted (p = 0.003). Children with allergic rhinitis, male sex, obesity and Black race had better pulmonary function post-BD. There was lower pulmonary function in children after age 11 years without a history of allergic rhinitis, as compared to those with a history of allergic rhinitis. Conclusions: The most prevalent diagnosis in children with BD-resistant airflow limitation is asthma. Allergic rhinitis and premature birth are common co-morbidities. Children without a history of asthma, as well as those with asthma but no allergic rhinitis, had lower pulmonary function. Children with BD-resistant airflow limitation may represent a sub-group of children with persistent obstruction and high risk for life-long airway disease.

KEYWORDS:

• Allergic rhinitis
• bronchodilator
• pulmonary function tests

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

American Lung Association - Airways Clinical Research Centers network (ALA-ACRC).