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Uncontrolled asthma from childhood to young adulthood associates with airflow obstruction

Ida Mogensen, Jenny Hallberg, Sandra Ekström, Anna Bergström, Erik Melén, Inger Kull
ERJ Open Research 2021 7: 00179-2021; DOI: 10.1183/23120541.00179-2021
Ida Mogensen
1Dept of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
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  • For correspondence: ida.mogensen@ki.se
Jenny Hallberg
1Dept of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
2Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Sandra Ekström
3Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
4Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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Anna Bergström
3Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Erik Melén
1Dept of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
2Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Inger Kull
1Dept of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
2Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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  • FIGURE 1
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    FIGURE 1

    Flow chart of included individuals.

  • FIGURE 2
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    FIGURE 2

    Overall estimates (regression coefficient and 95% CI): differences in lung function z-score for uncontrolled asthma in comparison to controlled asthma from 8 to 24 years of age. #: adjusted for sex, BMI group, allergic sensitisation, ICS use, current asthma, participant's own smoking and environmental smoke exposure. BMI: body mass index; ICS: inhaled corticosteroid.

  • FIGURE 3
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    FIGURE 3

    Estimates (regression coefficient and 95% CI): for the association between uncontrolled asthma and lung function z-score compared to controlled asthma at 8, 16 and 24 years of age. a) FEV1; b) FVC; c) FEV1/FVC. #: adjusted for sex, BMI group, allergic sensitisation, ICS use, current asthma, participant's own smoking and environmental smoke exposure. BMI: body mass index; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; ICS: inhaled corticosteroid.

  • FIGURE 4
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    FIGURE 4

    a) Association between uncontrolled asthma and lung function measured as z-score (regression coefficient and 95% CI), compared to controlled asthma, stratified for elevated blood eosinophils (B-Eos) ≥0.3×109 cells·L−1. b) Association between uncontrolled asthma and lung function measured as z-score (regression coefficient and 95% CI), compared to controlled asthma, stratified for elevated fraction of exhaled nitric oxide (FENO) ≥25 ppb. c) Association between uncontrolled asthma and lung function measured as z-score (regression coefficient and 95% CI), compared to controlled asthma, stratified for allergic sensitisation (positive Phadiatop) at any examination. d) Association between uncontrolled asthma and lung function measured as z-score (regression coefficient and 95% CI), compared to controlled asthma, stratified for never or ever smoking.

Tables

  • Figures
  • Supplementary Materials
  • TABLE 1

    Population characteristics at the three examinations

    Age at examination
    8 years16 years24 years
    Number of participants at
     Questionnaire628616596
     Physical examination549551496
     Spirometry425471431
     Females, n (%)326 (52)329 (53)327 (55)
     Fulfilling criteria for asthma, n (%)290 (46)399 (66)382 (64)
     Fulfilling criteria for asthma males, n (%)172 (57)180 (64)153 (57)
     Fulfilling criteria for asthma females, n (%)118 (36)219 (67)229 (70)
     Environmental tobacco smoke exposure, n (%)104 (16)81 (14)73 (14)
     Own smoking, n (%)–71 (12)131 (22)
    Self-reported ICS use year before examination
     No, n (%)420 (67)397 (65)425 (72)
     When needed, n (%)129 (21)127 (21)105 (18)
     Continuously, n (%)78 (12)91 (15)64 (11)
     Elevated blood eosinophils ≥0.3×109 cells·L−1, n (%)–144 (28)94 (20)
     Elevated blood eosinophils 16 and/or 24 years, n (%)–195 (32)
     Elevated FENO, ≥25 ppb, n (%)–162 (30)111 (26)
     Elevated FENO at 16 and/or 24 years, n (%)–219 (35)
     Allergic sensitisation#, n (%)266 (50)349 (65)316 (64)
     Height, cm, mean (sd)132 (6.2)Male: 179 (7.4)
    Female: 167 (6.6)
    Male: 182 (8.3)
    Female: 168 (6.5)
     Weight, kg, mean (sd)30.5 (5.5)Male: 70.4 (11.4)
    Female: 62.9 (11.2)
    Male: 79.4 (14.5)
    Female: 67.0 (13.2)
    BMI categories (IOTF at 8 and 16)
     Under/normal weight, n (%)413 (75)427 (78)359 (72)
     Overweight, n (%)108 (20)102 (19)96 (19)
     Obese, n (%)27 (5)20 (4)41 (8)
     Mean age in years (sd)8.45 (0.48)16.70 (0.39)22.61 (0.54)

    BMI: body mass index; FENO: fraction of exhaled NO; IgE: immunoglobulin E; IOTF: International Obesity Task Force. #: allergic sensitisation defined as IgE ≥0.35 kU·L−1 against mould, birch, cat, dog, horse, timothy, mugwort and/or house dust mite.

    • TABLE 2

      Asthma control and lung function at the three examinations

      Examination
      8 years n=61816 years n=59024 years n=596
      Uncontrolled asthma (all), n (%)195 (32)188 (32)227 (38)
      Uncontrolled asthma (participants with current asthma), n (%)174 (61)176 (46)217 (57)
      Nightly symptoms (all), n (%)71 (11)60 (10)38 (6)
      Daytime symptoms (all), n (%)26 (4)48 (8)83 (14)
      Breathing difficulties affecting daily activities (all), n (%)129 (21)82 (14)145 (24)
      Asthma exacerbation (all), n (%)84 (13)67 (11)64 (11)
      Need for rescue treatment with SABA ≥2/week (all), n (%)35 (6)68 (11)60 (10)
      Spirometryn=425n=471n=431
       z-score FEV1 mean (sd)0.32 (0.90)−0.26 (0.96)−0.38 (0.89)
       z-score FVC mean (sd)0.64 (0.90)0.12 (0.95)−0.018 (0.88)
       z-score FEV1/FVC mean (sd)−0.53 (0.96)−0.60 (1.02)−0.57 (0.96)
       FEV1 <80% predicted, n (%)6 (1)30 (6)33 (7)

      FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; SABA: short-acting bronchodilator.

      Supplementary Materials

      • Figures
      • Tables
      • Supplementary Material

        Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

        Figure S1 00179-2021.figureS1

        Table S1 00179-2021.tableS1

        Table S2 00179-2021.tableS2

        Table S3 00179-2021.tableS3

        Table S4 00179-2021.tableS4

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      Uncontrolled asthma from childhood to young adulthood associates with airflow obstruction
      Ida Mogensen, Jenny Hallberg, Sandra Ekström, Anna Bergström, Erik Melén, Inger Kull
      ERJ Open Research Oct 2021, 7 (4) 00179-2021; DOI: 10.1183/23120541.00179-2021

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      Uncontrolled asthma from childhood to young adulthood associates with airflow obstruction
      Ida Mogensen, Jenny Hallberg, Sandra Ekström, Anna Bergström, Erik Melén, Inger Kull
      ERJ Open Research Oct 2021, 7 (4) 00179-2021; DOI: 10.1183/23120541.00179-2021
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