Frequency of spirometric changes, air trapping, and lung hyperinflation in children and adolescents with therapy-resistant severe asthma

A pilot study

Keywords: severe asthma resistant to therapy, respiratory function tests, lung volume measurements, pediatrics

Abstract

Aims: to assess the frequency of spirometric and plethysmographic changes in children and adolescents with severe therapy-resistant asthma (SRTA). In addition, possible associations between these outcome were tested.
Methods: this is a retrospective study. Children and adolescents (6-18 years old), diagnosed with SRTA and who were in regular outpatient follow-up were included. Everyone should have anthropometric (weight, height, body mass index), demographic (age, ethnicity and gender), clinical (skin test, asthma control test, family smoking and medications in use) and pulmonary function (spirometry and body plethysmography) recorded in the service's database. Pulmonary function tests followed the recommendations of national and international guidelines. For statistical purposes, descriptive analysis and Pearson's chi-square test were used.
Results: from a total of 15 patients with SRTA, 12 of them were included in the sample. The average age was 12.2 years, with a predominance of females (66.7%). Of these, 50.0% had the disease under control, 83.3% were considered atopic, and 50.0% had a family history of smoking. Regarding the pulmonary function tests (% of predicted), the means of spirometric parameters and body plestismography were within the lower limits of normality. Only 16.7% of the sample had altered spirometry (<5th percentile), 25.0% air trapping (residual volume>130.0%) and 16.7% pulmonary hyperinflation (total lung capacity>120.0%). There was a statistically higher frequency (p=0.045) of air trapping in participants with altered spirometry, compared to normal spirometry. However, there was no difference (p=0.341) in relation to pulmonary hyperinflation.
Conclusions: the findings demonstrated little impairment of spirometry and lung volumes and capacities in children and adolescents with AGRT. In addition, those participants with altered spirometry had a higher frequency of air trapping in the body plethysmography exam.

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Author Biographies

Claudia Adamatti, Centro Universitário Cenecista de Osório (UNICNEC), Osório, RS, Brasil.

Bacharel em Fisioterapia pelo Centro Universitário Cenecista de Osório (UNICNEC), em Osório, RS, Brasil.

João Paulo Heinzmann-Filho, Centro Universitário Cenecista de Osório (UNICNEC), Osório, RS, Brasil.

Doutor em Saúde da Criança pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil; professor do Centro Universitário Cenecista de Osório (UNICNEC), em Osório, RS, Brasil.

Giovana dos Santos, Wixia Trials, Pesquisa Clínica, Porto Alegre, RS, Brasil.

Bacharel em Pedagogia pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil.

Anasthácia Ferreira Wiemann, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Pneumologista Pediátrica pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil.

Gabriel Azeredo de Magalhães, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Acadêmico de Medicina pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil.

Paulo Márcio Pitrez, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.

Doutor em Medicina (Pneumologia) pela Universidade Federal do Rio Grande do Sul (UFRGS), em Porto Alegre, RS, Brasil; Pneumologista Pediátrico do Hospital São Lucas da PUCRS e do Hospital Moinhos de Vento, em Porto Alegre, RS, Brasil.

References

Maslan J, Mims JW. What is asthma? Pathophysiology, demographics, and health care costs. Otolaryngol Clin North Am. 2014;47(1):13-22. https://doi.org/10.1016/j.otc.2013.09.010

Mims JW. Asthma: definitions and pathophysiology. Int Forum Allergy Rhinol. 2015;5(Suppl 1):2-6. https://doi.org/10.1002/alr.21609

Dias C, Salles M, Friche A, Almeida M, Viana T, Mingoti S, et al. Temporal and Spatial Trends in Childhood Asthma-Related Hospitalizations in Belo Horizonte, Minas Gerais, Brazil and Their Association with Social Vulnerability. Res Public Helath. 2016;13(7):704. https://doi.org/10.3390/ijerph13070704

Solé D, Camelo-Nunes IC, Wandalsen GF, Mallozi MC. Asthma in children and adolescents in Brazil: contribution of the International Study of Asthma and Allergies in Childhood (ISAAC). Rev Paul Pediatr. 2014;32(1):114-25. https://doi.org/10.1590/s0103-05822014000100018

Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A; ISAAC Phase Three Study Group. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergol Immunopathol (Madr). 2013;41(2):73-85. https://doi.org/10.1016/j.aller.2012.03.001.

Costa E, Md, Phd, Melo JML, Md, Phd, et al. Guia para o manejo da asma grave. Braz J Allergy Immunol. 2015;3(5):205-25. https://doi.org/10.5935/2318-5015.20150025

Damasceno E, Costa Carvalho B, Solé D, Waldalsen G. Custos diretos e indiretos da asma: revisão de literatura. Rev Bras Alerg Imunopatol [Internet]. 2012 [updated 2012 Dec];35(6):234-40. Available from: http://aaai-asbai.org.br/detalhe_artigo.asp?id=652

Stirbulov R, Bernd LAG, Solé D. IV diretrizes brasileiras para o manejo da asma. J Bras Pneumol [Internet]. 2006;32(Supl7):447-74. Available from: http://www.jornaldepneumologia.com.br/details-supp/39

Pereira CAC, Moreira MAF. Pletismografia–resistência das vias aéreas. J Bras Pneumol [Internet]. 2002 [updated 2002 Oct];28(Suppl3):139-150. Available from: https://www.jornaldepneumologia.com.br/details-supp/45

Pereira CAC, Moreira MAF. Espirometria. J Bras Pneumol [Internet]. 2002 [updated 2002 Oct];28(Suppl3):1-82. Available from: https://www.jornaldepneumologia.com.br/details-supp/45

Rodrigues A, Roncada C, Santos G, Heinzmann-Filho JP, Godinho R, Vargas M, et al. Características clínicas de crianças e adolescentes com asma grave resistente a terapia. J Bras Pneumol. 2015;41(4):343-50. https://doi.org/10.1590/S1806-37132015000004462

Global Iniatiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention [Internet]. 2021 June 01 [updated 2021]. Disponível em: https://ginasthma.org/gina-reports

Bacharier LB, Strunk RC, Mauger D, White D, Lemanske RF Jr, Sorkness CA. Classifying asthma severity in children: mismatch between symptoms, medication use, and lung function. Am J Respir Crit Care Med. 2004;170(4):426-32. https://doi.org/10.1164/rccm.200308-1178OC

Bártholo RM. Diferenças clínicas entre asma e doença pulmonar obstrutiva crônica. Rev HUPE. 2013;12(2):62-70. https://doi.org/10.12957/rhupe.2013.8488

Sorkness RL, Kienert C, O’Brien MJ, Fain SB, Jarjour NN. Compressive air trapping in asthma: effects of age, sex, and severity. J Appl Physiol (1985). 2019;126 (5):1265-71. https://doi.org/10.1152/japplphysiol.00924.2018

Luo J, Liu D, Chen G, Liang B, Liu C. Clinical Roles of Lung Volumes Detected by Body Plethysmography and Helium Dilution in Asthmatic Patients: A Correlation and Diagnosis Analysis. Sci Rep. 2017;7:40870. https://doi.org/10.1038/srep40870

G Labbé , E Merlin, C Kauffman, J-L Fauquert, M-C Héraud, A Labbé. The role of lung volume measurements by plethysmography in the follow-up of asthma in children. Rev Mal Respir. 2010;27 (1): 42-8. https://doi.org/10.1016/j.rmr.2009.11.002

Jenkins HA, Cherniack R, Szefler SJ, Covar R, Gelfand EW, Spahn JD. A comparison of the clinical characteristics of children and adults with severe asthma. Chest. 2003;124(4):1318-24. https://doi.org/10.1378/chest.124.4.1318

Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019;200(8):e70-e88. https://doi.org/10.1164/rccm.201908-1590ST

Stocks J, Godfrey S, Beardsmore C, Bar-Yishay E, Castile R; ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/American Thoracic Society. Plethysmographic measurements of lung volume and airway resistance. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/ American Thoracic Society. Eur Respir J. 2001;17(2):302-12. https://doi.org/10.1183/09031936.01.17203020

de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660-7. https://doi.org/10.2471/blt.07.043497

Roxo JP, Ponte EV, Ramos DC, Pimentel L, D’Oliveira Júnior A, Cruz AA. Validação do Teste de Controle da Asma em português para uso no Brasil: validation for use in Brazil [Portuguese-language version of the Asthma Control Test]. J Bras Pneumol. 2010 Mar-Apr;36(2):159-66. Portuguese. https://doi.org/10.1590/s1806-37132010000200002.

Heinzerling L, Mari A, Bergmann KC, et al. The skin prick test - European standards. Clin Transl Allergy. 2013;3(1):1-10. https://doi.org/10.1186/2045-7022-3-3

Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40(6):1324-43. https://doi.org/10.1183/09031936.00080312

Koopman M, Zanen P, Kruitwagen CL, van der Ent CK, Arets HG. Reference values for paediatric pulmonary function testing: The Utrecht dataset. Respir Med. 2011;105(1):15-23. https://doi.org/10.1016/j.rmed.2010.07.020

Fernandez JJ, Castellano MVCO, Vianna FAF, Nacif SR, Rodrigues JR, Rodrigues SCS. Correlação clínica e funcional da diferença entre capacidade vital lenta e CVF. J Bras Pneumol. 2020;46(1):e20180328. https://doi.org/10.1590/1806-3713/e20180328

Francisco B, Ner Z, Ge B, Hewett J, König P. Sensitivity of different spirometric tests for detecting airway obstruction in childhood asthma. J Asthma. 2015 Jun;52(5):505-11. https://doi.org/10.3109/02770903.2014.984842.

Mattiello R, Mallol J, Fischer GB, Mocelin T, Rueda B, Sarria EE. Pulmonary function in children and adolescents with postinfectious bronchiolitis obliterans. J Bras Pneumol. 2010;36(4):453-9. https://doi.org/10.1590/s1806-37132010000400010

Malucelli M, Rosário N, Riedi C, Kovalhuk L, Barros JA. Acurácia da espirometria na classificação da gravidade da asma em crianças e adolescentes. Rev Bras Alegia Imunopatol [Internet]. 2007 [updated 2007 jan];30(1):27-31. Available from: http://aaai-asbai.org.br/detalhe_artigo.asp?id=267

Sorkness RL, Bleecker ER, Busse WW, Calhoun WJ, Castro M, Chung KF, et al. Lung function in adults with stable but severe asthma: air trapping and incomplete reversal of obstruction with bronchodilation. J Appl Physiol (1985). 2008;104(2):394-403. https://doi.org/10.1152/japplphysiol.00329.2007

Mahut B, Peiffer C, Bokov P, Beydon N, Delclaux C. Gas trapping is associated with severe exacerbation in asthmatic children. Respir Med. 2010;104(8):1230-3. https://doi.org/10.1016/j.rmed.2010.05.005

Rao DR, Gaffin JM, Baxi SN, Sheehan WJ, Hoffman EB, Phipatanakul W. The utility of forced expiratory flow between 25% and 75% of vital capacity in predicting childhood asthma morbidity and severity. J Asthma. 2012;49(6):586-92. https://doi.org/10.3109/02770903.2012.690481

Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26: 948–968. https://doi.org/10.1183/09031936.05.00035205

Pellegrino R, Brusasco V. On the causes of lung hyperinflation during bronchoconstriction. Eur Respir J. 1997;10(2):468-75. https://doi.org/10.1183/09031936.97.10020468.

Santos N, Almeida I, Couto M, Morais-Almeida M, Borrego LM. Feasibility of routine respiratory function testing in preschool children. Rev Port Pneumol. 2013;19(1):38-41. https://doi.org/10.1016/j.rppneu.2012.09.004.

Heinzmann-Filho JP, Donadio MV. Teste de força muscular ventilatória: é viável em crianças jovens? Rev Paul Pediatr. 2015;33(3):274-9. https://doi.org/10.1016/j.rpped.2015.01.008

Veras TN, Pinto LA. Viabilidade da realização de espirometria em pré-escolares. J Bras Pneumol. 2011;37(1):69-74. https://doi.org/10.1590/S1806-37132011000100011

Published
2021-12-15
How to Cite
Adamatti, C., Heinzmann-Filho, J. P., Santos, G. dos, Wiemann, A. F., Magalhães, G. A. de, & Pitrez, P. M. (2021). Frequency of spirometric changes, air trapping, and lung hyperinflation in children and adolescents with therapy-resistant severe asthma: A pilot study. Scientia Medica, 31(1), e41296. https://doi.org/10.15448/1980-6108.2021.1.41296
Section
Original Articles