Disparate diagnostic accuracy of lung function tests as predictors of poor asthma control in children

Abstract

Rationale: In practice, asthma control is assessed according to symptom burden and office spirometry. However, spirometry poorly tests peripheral lung function, which may be abnormal in asthma. Impluse oscillometry (IOS) and multiple-breath washout (MBW) are novel methods which measure reactance (X5) and ventilation heterogeneity (VH) in the peripheral lung, but how well these tests reflect asthma control is poorly understood. Objective: To compare the diagnostic accuracy of tests of large airways caliber (FEV₁, FEV₁/FVC, R20), peripheral zone properties (X5, VH), and airways inflammation (FeNO) as predictors of poor control in asthmatic children (44 poorly controlled/10 controlled). Methods: 54 children enriched in severe asthma completed a symptom-based control scale (ACT/cACT) and lung function tests after overnight bronchodilator withhold. The accuracy of each variable to predict poor control was ranked by area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. Results: Among measures of large airways caliber, the FEV₁% had the highest ROC curve area, with low sensitivity but perfect specificity. Among measures of peripheral lung function, X5 and VH in the conducting zone had fair curve areas with higher sensitivity but lower specificity compared to the FEV₁%. VH in the acinar zone and FeNO both had poor accuracy. Conclusion: Tests of large airway and peripheral zone lung function performed disparately as predictors of poor control in a sample of children enriched in severe asthma. Further studies in a larger sample with more diverse phenotypic features are necessary to validate this preliminary conclusion.

Keywords:

• Asthma
• lung function
• impulse oscillometry
• asthma control
• ACT
• lung clearance index
• expired nitric oxide

Acknowledgments

The authors acknowledge the invaluable effort and time committed by the two research coordinators who completed this study, Kristin Wavell and Theresa Altherr. We also wish to thanks the parents and children who graciously volunteered to participate.

Declaration of interest

The authors have no conflict of interest to declare.

Funding

Grant in aid University of Virginia Children’s Hospital and National Heart, Lung, and Blood Institute (NIH/NHLBI SARP U10 HL109250).