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N Engl J Med. 2016 May 12;374(19):1842-1852. doi: 10.1056/NEJMoa1513737.

Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma.

Collaborators (307)

Williams P, Lasley MV, Chinn T, Hinatsu M, Furukawa CT, Altman LC, Virant FS, Kennedy MS, Tilles S, Becker JW, Bierman C, Crawford D, DuHamel T, Eliassen H, Hammond B, MacLaren M, Minotti DA, Reagan C, Shapiro G, Sharpe M, Tatum A, White G, Wighton TG, Fuhlbrigge A, Plunkett A, Madden N, Anderson S, Boehnert M, Feins A, Gentile A, Kandror N, MacAulay K, Sampong E, Weiss S, Torda W, Tata M, Babigian S, Barrant P, Benson L, Caicedo J, Calder T, Darcy C, DeFilippo A, Dorsainvil C, Erickson J, Fulton P, Grace M, Gilbert J, Greineder D, Haynes S, Higham M, Jakubowski D, Kelleher S, Koslof J, Mandel D, Martin P, Martinez A, McAuliffe J, Nakamoto E, Pacella P, Parks P, Sagarin J, Seligsohn K, Swords S, Syring M, Traylor J, Van Horn M, Wells C, Whitman A, Grasemann H, Miki M, Solomon M, Subbarao P, MacLusky I, Reisman J, Levison H, Hall A, Benedet Y, Carpenter S, Chay J, Collinson M, Finlayson-Kulchin J, Gore K, Hipolito N, Holmes N, Hoorntje E, Klassen S, Quenneville J, Sananes R, Wasson C, Wilson M, Adkinson N Jr, Bull D, Philips S, Eggleston P, Huss K, Plotnick L, Pulsifer M, Rand C, Aylward E, Bollers N, Pessaro K, Wheeler B, Szefler S, Covar R, Nelson HS, Bender B, Liu A, Sundström D, Phillips M, White MP, Gleason M, Brelsford K, Bridges J, Ciacco J, Eltz M, Feeley J, Flynn M, Junk-Blanchard T, Hassell J, Hefner M, Hendrickson C, Hettleman D, Irvin CG, Kamada A, Krawiec M, Larsen G, Nimmagadda S, Sandoval K, Sheridan J, Spahn J, Spears G, Washington T, Willcutt E, Cardona I, Carel K, Doshi J, Hendershot R, Jacobs J, Jain N, Kang JK, Kruzick T, Leo H, Macomber B, Malka J, Mjaanes C, Prpich J, Stewart L, Song B, Tamesis G, Zeiger RS, Friedman N, Mellon MH, Schatz M, Long T, Macaraeg T, Christensen S, Easton JG, Feinberg M, Galbreath LL, Gulczynski J, Harden K, Hansen E, Jalowayski A, Jenson E, Lincoln A, Kaufman J, King S, Lopez B, Magiari-Ene M, Mostafa K, Moscona A, Nelle CA, Powers J, Rodriguez E, Rodriguez E, Sandoval K, Wilson NW, Raissy HH, Jacobs A, Kelly HW, Spicher M, Batson C, Harkings M, McCallum K, Annett R, Archibeque T, Bashir N, Bereket H, Braun M, Bush C, Bush SC, Clayton M, Colon-Semidey A, Devault S, Esparham A, Grad R, Hunt D, Larsson J, McClelland S, McWilliams B, Montoya E, Moreshead M, Murphy S, Ortega B, Weers D, Zayas J, Strunk RC, Bacharier L, Rodgers D, Albers E, Belle G, Bloomberg GR, Buchanan WP, Caesar M, Corry JM, DeMuth K, Dolinsky M, Fisher EB, Gaioni SJ, Glynn E, Heckman BD, Kemp D, Kertz L, Lawhon C, Morgan V, Moseid C, Oliver-Welker T, Richardson D, Ryan E, Sagal S, Smith TF, Sylvia S, Turner C, White DK, Tonascia J, Belt P, Collins K, Collison B, Dodge J, Donithan M, Ewing C, Jackson R, May P, Meinert J, Reyes G, Smith M, Sternberg AL, Van Natta ML, Wagoner A, Wilson L, Wise R, Yates K, Taggart V, Eggers L, Kiley J, Moore H, Zheng G, Albert P, Hurd S, Parker S, Randall P, Wu M, Cloutier M, Connett J, Cuttler L, Gilliland F, Davis CE, Eigen H, Evans D, Kattan M, Menendez R, Simons F, Leikin S, Strunk R, Adkinson N, Annett R, Bender B, Caesar M, Cherniack R, Covar R, DuHamel TR, Fuhlbrigge A, Grasemann H, Kelly H, Levison H, Lincoln A, MacLusky I, McWilliams B, Meinert CL, Parker S, Raissy HH, Reisman J, Rodgers D, Seligsohn K, Shapiro GG, Sharpe M, Sundström D, Szefler S, Taggart V, Tata M, Tonascia J, Weiss S, Wheeler B, Williams P, Wise R, Zeiger R.

Author information

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Contributed equally

Abstract

BACKGROUND:

Tracking longitudinal measurements of growth and decline in lung function in patients with persistent childhood asthma may reveal links between asthma and subsequent chronic airflow obstruction.

METHODS:

We classified children with asthma according to four characteristic patterns of lung-function growth and decline on the basis of graphs showing forced expiratory volume in 1 second (FEV1), representing spirometric measurements performed from childhood into adulthood. Risk factors associated with abnormal patterns were also examined. To define normal values, we used FEV1 values from participants in the National Health and Nutrition Examination Survey who did not have asthma.

RESULTS:

Of the 684 study participants, 170 (25%) had a normal pattern of lung-function growth without early decline, and 514 (75%) had abnormal patterns: 176 (26%) had reduced growth and an early decline, 160 (23%) had reduced growth only, and 178 (26%) had normal growth and an early decline. Lower baseline values for FEV1, smaller bronchodilator response, airway hyperresponsiveness at baseline, and male sex were associated with reduced growth (P<0.001 for all comparisons). At the last spirometric measurement (mean [±SD] age, 26.0±1.8 years), 73 participants (11%) met Global Initiative for Chronic Obstructive Lung Disease spirometric criteria for lung-function impairment that was consistent with chronic obstructive pulmonary disease (COPD); these participants were more likely to have a reduced pattern of growth than a normal pattern (18% vs. 3%, P<0.001).

CONCLUSIONS:

Childhood impairment of lung function and male sex were the most significant predictors of abnormal longitudinal patterns of lung-function growth and decline. Children with persistent asthma and reduced growth of lung function are at increased risk for fixed airflow obstruction and possibly COPD in early adulthood. (Funded by the Parker B. Francis Foundation and others; ClinicalTrials.gov number, NCT00000575.).

PMID:
27168434
PMCID:
PMC5032024
DOI:
10.1056/NEJMoa1513737
[Indexed for MEDLINE]
Free PMC Article

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