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

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • Krishnan, S; Dozor, AJ; Bacharier, L; Lang, JE; Irvin, CG; Kaminsky, D; Farber, HJ; Gerald, L; Brown, M; Holbrook, JT; Wise, RA; Ryu, J; Bose, S; Yasin, R; Saams, J; Henderson, RJ; Teague, WG; American Lung Association Airway Clinical Research Centers (ALA-ACRC) Network,

Published Date

  • June 2019

Published In

Volume / Issue

  • 56 / 6

Start / End Page

  • 611 - 617

PubMed ID

  • 29771599

Electronic International Standard Serial Number (EISSN)

  • 1532-4303

Digital Object Identifier (DOI)

  • 10.1080/02770903.2018.1477956


  • eng

Conference Location

  • England