Pulmonary function in various phenotypes of bronchial asthma in children aged under 5 years old

   Objective: to evaluate the features of pulmonary function in children over two years of age with different phenotypes of bronchial asthma.

   Methods. 261 children aged 3 to 5 years with a confirmed diagnosis of bronchial asthma were examined. The reversibility of bronchial obstruction (ΔRINTexp > 0.21 kPa·l^-1·s) was recorded in all groups. Four asthma phenotypes were identified: isolated bronchial asthma (n = 56), bronchial asthma + atopic dermatitis (n = 81), bronchial asthma + allergic rhinitis (n = 54), and bronchial asthma + atopic dermatitis + allergic rhinitis (n = 70). All patients underwent measurement of airway resistance using the interrupter technique (RINT) on a SuperSpiro spirometer, both initially and after a salbutamol test. Statistical processing included univariate analysis of variance (ANOVA), Student's t-test with correction for inequality of variances, and Pearson's χ² test.

   Results. The initial values of RINTexp are minimal in the group of isolated bronchial asthma (0.9046±0.16496 kPa·l^-1·s) and maximal in the group of bronchial asthma + atopic dermatitis + allergic rhinitis. The differences between all phenotypes are statistically significant (ANOVA, p < 0.001; pairwise comparisons, p from 0.022 to < 0.001). The analysis of the distribution along the centile ranges revealed an extremely significant relationship between the phenotype and the RINTexp level (χ² = 69, p < 0.001).

   Conclusion. The pulmonary function in children aged 3 to 5 years with bronchial asthma significantly depends on the disease phenotype. An increase in comorbidity (a combination of asthma with atopic dermatitis and/or allergic rhinitis) is associated with a progressive increase in airway resistance. The most pronounced impairments of pulmonary function are observed in the phenotype of bronchial asthma + atopic dermatitis + allergic rhinitis.

1. Zajceva S.V., Zastrozhina A.K., Zajceva O.V., Snitko S.Ju. Prakticheskaja pul'monologija. Practical Pulmonology. – 2018. – N 3. (In Russ.)

2. Maljuzhinskaja N.V., Garina M.V., Shatalin A.V., Smirnov N.N., Gorbunova V.N., Razvaljaeva A.V. Voprosy sovremennoj pediatrii. Current Pediatrics. – 2010. – V. 9. N 5. – P. 30–34. (In Russ.)

3. Fajzullina R.M., Viktorov V.V., Gafurova R.R. Vestnik Avicenny. Avicenna Bulletin. – 2021. – V. 23. N 3. – P. 418–431. (In Russ.)

4. Furman E.G., Grymova N.N., Sanakoeva L.P., Krylova O.A., Mazunina E.S. Rossijskij vestnik perinatologii i pediatrii. Russian Bulletin of Perinatology and Pediatrics. – 2018. – V. 63. N 1. – P. 34-39. (In Russ.)

5. Abdullaev S.K., Shamsiev F.M., Karimova N.I. Clinical and functional features of the course of bronchial asthma with allergic rhinitis in children // International Journal of Scientific Pediatrics. – 2023. – Issue 04. Article 06. – P. 36–41.

6. Beydon N., Davis S.D., Lombardi E., Allen J.L., Arets H.G., Aurora P., et al. An official American Thoracic Society/European Respiratory Society statement: pulmonary function testing in preschool children // American Journal of Respiratory and Critical Care Medicine. – 2007. – V. 175. N 12. – P. 1304–1345.

7. Beydon N., M'buila C., Bados A., Peiffer C., Bernard A., Zaccaria I., et al. Interrupter resistance short-term repeatability and bronchodilator response in preschool children // Respiratory Medicine. – 2007. – V. 101. N12. – P. 2482–2487.

8. Eichenfield L.F., Tom W.L., Chamlin S.L., Feldman S.R., Hanifin J.M., Simpson E.L., et al. Guidelines of care for the management of atopic dermatitis // Journal of the American Academy of Dermatology. – 2014. – V. 70. N 2. – P. 338–351.

9. Fitzpatrick A.M., Moore W.C. Severe asthma phenotypes – how should they guide evaluation and treatment? // Journal of Allergy and Clinical Immunology: In Practice. – 2017. – V. 5. N 4. – P. 901–908.

10. GINA. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023. https://www.ginasthma.org.

11. Haccuria A., Van Muylem A., Malinovschi A., Van de Maele B., Michils A. Small airways dysfunction: the link between allergic rhinitis and allergic asthma // European Respiratory Journal. – 2018. – V. 5. N 2. – P. 1701749.

12. Henderson A. Childhood asthma phenotypes in the twenty-first century // Breathe. – 2014. – V. 10. N 2. – P. 100–108.

13. Lazic N., Roberts G., Custovic A., Belgrave D., Bishop C.M., Winn J., et al. Multiple atopy phenotypes and their associations with asthma: similar findings from two birth cohorts // Allergy. – 2013. – V. 68. N 6. – P. 764–770.

14. Merkus P.J., Mijnsbergen J.Y., Hop W.C., de Jongste J.C. Interrupter resistance in pre-school children: measurement characteristics and reference values // American Journal of Respiratory and Critical Care Medicine. – 2001. – V. 163. N 6. – P. 1350–1355.

15. Merkus P.J., Stocks J., Beydon N., Lombardi E., Jones M., McKenzie S.A., et al. Reference ranges for interrupter resistance technique: the Asthma UK Initiative // European Respiratory Journal. – 2010. – V. 36. N 1. – P. 157–163.

16. Miller R.L., Schuh H., Chandran A., Aris I.M., Bendixsen C., Blossom J., et al. Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program // Journal of Allergy and Clinical Immunology. – 2023. – V. 152. N 1. – P. 84–93.

17. Spergel J.M. From atopic dermatitis to asthma: the atopic march // Annals of Allergy, Asthma & Immunology. – 2010. – V. 105. N 2. – P. 99–106.

18. Vitaliti G., Leonardi S., La Rosa M. Opening interrupter technique in pre-school children with chronic respiratory diseases: a perspective case-control study in the diagnosis of airway hyperresponsiveness // Journal of Asthma. – 2013. – V. 50. N 10. – P. 1045–1048.

19. Zhou W., Tang J. Prevalence and risk factors for childhood asthma : a systematic review and meta-analysis // BMC Pediatrics. – 2025. – V. 25. N 1. – P. 50.