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Original Research: Asthma |

Abnormal Small Airways Function in Children With Mild AsthmaSmall Airways Function in Pediatric Mild Asthma

Florian Singer, MD, PhD; Chiara Abbas, MD; Sophie Yammine, MD; Carmen Casaulta, MD; Urs Frey, MD, PhD; Philipp Latzin, MD, PhD
Author and Funding Information

From the University Children’s Hospital Zurich (Dr Singer), Zurich; University Children’s Hospital Bern (Drs Singer, Abbas, Yammine, Casaulta, and Latzin), Bern; and University Children’s Hospital Basel (Drs Yammine, Frey, and Latzin), Basel, Switzerland.

Correspondence to: Philipp Latzin, MD, PhD, Division of Respiratory Medicine, University Children’s Hospital Basel, Spitalstrasse 33, 4005 Basel, Switzerland; e-mail: philipp.latzin@ukbb.ch


Drs Singer and Abbas contributed equally to this work.

Funding/Support: This work was funded by the Federal Department of Economic Affairs Switzerland, Commission for Technology and Innovation, Innovation Promotion Agency [unrestricted educational grant 14435.1 PFLS-LS] and the Julia Bangerter-Rhyner Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):492-499. doi:10.1378/chest.13-0784
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Background:  Small airways disease is a hallmark in adults with persistent asthma, but little is known about small airways function in children with mild asthma and normal spirometry. We assessed ventilation heterogeneity, a marker of small airways function, with an easy tidal breath single-breath washout (SBW) technique in school-aged children with mild asthma and normal FEV1 and healthy age-matched control subjects.

Methods:  The primary outcome was the double-tracer gas phase III slope (SDTG), an index of ventilation heterogeneity in acinar airways derived from the tidal double-tracer gas SBW test. The second outcome was the nitrogen phase III slope (SN2), an index of global ventilation heterogeneity derived from the tidal nitrogen SBW test using pure oxygen. Triplicate SBW and spirometry tests were performed in healthy children (n = 35) and children with asthma (n = 31) at baseline and in children with asthma after bronchodilation.

Results:  Acinar (SDTG) but not global (SN2) ventilation heterogeneity was significantly increased in asthma despite normal FEV1. Of the 31 children with asthma, abnormal results were found for SDTG (≤ −2 z scores) in 11; forced expiratory flow, midexpiratory phase (FEF25%-75%) in three; and FEV1 in zero. After bronchodilation, SDTG, SN2, FEF25%-75%, and FEV1 significantly changed (mean [95% CI] change from baseline, 36% [15%-56%], 38% [18%-58%], 17% [9-25%], and 6% [3%-9%], respectively).

Conclusions:  Abnormal acinar ventilation heterogeneity in one-third of the children suggests that small airways disease may be present despite rare and mild asthma symptoms and normal spirometry. The easy tidal SBW technique has considerable potential as a clinical and research outcome in children with asthma.

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