Age, obesity and uncontrolled asthma closely associated with peripheral airway impairment

A recent study published in the Annals of Allergy, Asthma & Immunology found that clinical features like age, obesity and uncontrolled asthma are closely associated with peripheral airway impairment (PAI) in young children.

In spite of the fact that the peripheral airway impairment (PAI) phenotype determined by impulse oscillometry (IOS) is a major risk factor for uncontrolled asthma, IOS in clinical use is not so common. To identify clinical features that best identify the phenotype the team led by Stanly Galant analyzed 227 asthmatic patients with the PAI phenotype determined by resistance and reactance values, ​​exceeding IOS-predictive normal values ​​using Gochicoa-Rangel equations. Logistic regression analyzes determined factors associated with the PAI phenotype with a risk classification based on the predicted probability from the final fitted model.

The key highlights of the study were:

Analysis to identify PAI was present in 37% of the study population, and it showed a statistically significant OR for age (4 to 7 years) of 3.75 (1.47, 9.55), p=0.006, obesity OR of 2.59 (1.36, 4.96), p=0.004, uncontrolled asthma OR of 2.77 (1.34, 5.74), p=0.006, and abnormal FEF25 75% (<65%) OR of 4.22 (1.59, 11.20), p=0.004.

To identify the well-controlled PAI in patients, the key characteristics were age (4 to 7 years), OR of 2.81 (1.10, 7.18), p=0.031, and obesity OR of 2.18 (1.09, 4.39), p=0.028.

In the 4- to 7-year-olds who were obese and uncontrolled, the PAI probability was more than 80%, regardless of FEF25-75%.

Probabilities from logistic regression analyzes to identify PAI were associated with an AUC of 0.750

By applying the standard threshold of almost 0.50, the accurate probability of identification yielded sensitivity was 49.4%, specificity was 85.3%, PVP was 66 .1%, NPV was 74.4%. 

Source:

Galant, S. P., & Morphew, T. (2023). IN YOUNG ASTHMATIC CHILDREN, OBESITY AND UNCONTROLLED DISEASE ARE HIGHLY ASSOCIATED WITH PERIPHERAL AIRWAY IMPAIRMENT. In Annals of Allergy, Asthma & Immunology. Elsevier BV. https://doi.org/10.1016/j.anai.2022.12.034