Predictors of specific airway resistance during childhood.

摘要: The study by Belgrave and colleagues (pp. 1101–1109) in this issue of the Journal comprehensively explores predictors change specific airway resistance (sRaw) during childhood (1). Using well-characterized Manchester Asthma Allergy Study (MAAS) birth cohort more than 1,000 children (2), authors examined how anthropometric measures, wheezing atopy phenotypes, asthma exacerbation severity, parental history atopy, as well environmental exposures influenced trajectory sRaw from age 3 to 11 years. Initially, each risk factor was separately relation give a fixed-effect estimate across observation period. Interaction with then evaluated determine whether or not given associated progressive worsening over time. Finally, those factors that had significant fixed effects were included best-fit multivariable model tested for interactions (Figure 1). Figure 1. Relation years age. Bold text indicates univariate models. Arrows indicate multivariate model. ... Unlike prior studies (3–5), large single-center showed an increase This finding is compatible reductions rate constant lung forced expiration (6, 7). Furthermore, higher boys increased at steeper compared girls (2.3% per yr 1.3% girls). Importantly, transient early wheezing, late-onset persistent all who did wheeze. However, only wheeze Of atopic phenotypes (8), multiple sensitization Although univariable analysis, demonstrated fared worst. The technical methodology current strong. measured on same plethysmographic equipment technician ages, minimizing operator error used single-step measurement, which independent effort, making it particularly effective measure function (4). unlike expiratory flow, directly evaluates less dependent elastic recoil. It would have been helpful know similar findings present spirometric measures older age-related changes reported seem reflect seen constants estimated flow/volume ratios (FEV1/FVC) Because elastance appears (9), likely observed declines are due sRaw, occurring naturally growth worsened disease. Children highest levels, consistent low flows Tucson Children’s Respiratory (CRS) (10, 11) Copenhagen Studies Childhood (COPSAC) (12) asthma. These between infancy school symptomatic group. By evaluating adds critical data demonstrating wheezers established dysfunction age, possibly because least partly (12, 13). noted authors, known there In addition, after bronchodilator administration reported, unknown tone effect remodeling growth. After integrating physiologic several other cohorts, implications challenging. Low could lead wheeze, suggested both groups 12). absence sensitization, stops nonatopic group (14). contrast, allergic inflammation exacerbated viral infections may remodeling, impairs long-term reduced (15). Follow-up MAAS teenage young adult will offer compelling information progression these groups, their continued trajectories function, worsen ameliorate impact As recent National Institutes Health workshop Birth Cohorts Allergic diseases (16), proteomic, genetic, immunologic, influences evaluation pulmonary physiology provide insights into disease.