Children With Persistent Asthma At Risk For Future Lung Disease Interview with:

Michael McGeachie, PhD Instructor in Medicine Harvard Medical School Channing Division of Network Medicine Brigham and Women's Hospital

Dr. Michael McGeachie

Michael McGeachie, PhD
Instructor in Medicine
Harvard Medical School
Channing Division of Network Medicine
Brigham and Women’s Hospital What is the background for this study?

Dr. McGeachie: In asthma, and in general but particularly in asthma, a person’s level of lung function has a big impact on his or her quality of life, level of respiratory symptoms and complications, and general morbidity. In asthma, low lung function leads to greater severity and frequency of asthma symptoms. Asthma is a common childhood illness, affecting 9-10% of children. Many children grow out of asthma as they become adults, but other asthmatics remain effected through adulthood, which can lead to a lifetime of respiratory symptoms and chronic airway obstruction, including chronic obstructive pulmonary disease (COPD).

If you consider lung function longitudinally, throughout development, plateau, and decline, different people and different asthmatics tend to exhibit different patterns of lung function. Healthy, non-asthmatic people tend to have a period of rapid lung function increase in adolescence, a plateau of lung function level in their late teens and early 20s, and starting around 25 or so a slow, gradual decline of lung function that continues throughout old age. We call this Normal Growth of lung function. However, some people exhibit Reduced Growth, where they don’t reach their expected maximum lung function for a person of the same age, sex, height, and race. Others can show Early Decline, who might reach a normal maximum but then begin to decline immediately without a plateau or with a truncated plateau. We hypothesized that these patterns, Reduced Growth and Early Decline, might have different baseline indicators, precursors, outcomes, and risk of developing COPD. What are the main findings?

Dr. McGeachie: Of 1041 children, studied from ages 5-12yrs to 23-30yrs, with persistent, mild-to-moderate asthma, 75% have an abnormal longitudinal lung function pattern, which means they experience abnormally decreased lung function by the study end. 11% fulfill spirometric criteria for COPD by their late 20s, indicating an unusually early occurrence of chronic airway obstruction. There were strong baseline indicators of longitudinal Reduced Growth lung function, including lung function tests before adolescence; but not for Early Decline. What should readers take away from your report?

Dr. McGeachie: Children with persistent asthma are at risk for future lung disease, chronic obstruction, and increased morbidity. There may be interventions that can help mitigate these risks, although we do not specifically identify any. What recommendations do you have for future research as a result of this study?

Dr. McGeachie: There are many avenues of additional work that can be pursued. Longer and closer follow up on asthmatics would enable more accurate classification of the Early Decline lung function group, in particular. This could lead to a better understanding of the severity of that condition, the risk factors for it, and how it may be remedied. Trials of new drugs for that mitigate the loss of lung function over time that show promise could be considered for much younger asthmatics at particular risk for chronic airway obstruction. Is there anything else you would like to add?

Dr. McGeachie: Thank you for your contribution to the community.


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

Michael J. McGeachie, Ph.D., Katherine P. Yates, Sc.M., Xiaobo Zhou, Ph.D., Feng Guo, Ph.D., Alice L. Sternberg, Sc.M., Mark L. Van Natta, M.H.S., Robert A. Wise, M.D., Stanley J. Szefler, M.D., Sunita Sharma, M.D., Alvin T. Kho, Ph.D., Michael H. Cho, M.D., Damien C. Croteau-Chonka, Ph.D., Peter J. Castaldi, M.D., Gaurav Jain, M.S., Amartya Sanyal, Ph.D., Ye Zhan, Bryan R. Lajoie, Ph.D., Job Dekker, Ph.D., John Stamatoyannopoulos, M.D., Ronina A. Covar, M.D., Robert S. Zeiger, M.D., Ph.D., N. Franklin Adkinson, M.D., Paul V. Williams, M.D., H. William Kelly, Pharm.D., Hartmut Grasemann, M.D., Judith M. Vonk, Ph.D., Gerard H. Koppelman, M.D., Dirkje S. Postma, M.D., Benjamin A. Raby, M.D., Isaac Houston, Ph.D., Quan Lu, Ph.D., Anne L. Fuhlbrigge, M.D., Kelan G. Tantisira, M.D., Edwin K. Silverman, M.D., Ph.D., James Tonascia, Ph.D., Scott T. Weiss, M.D., and Robert C. Strunk, M.D., for the CAMP Research Group*

N Engl J Med 2016; 374:1842-1852
May 12, 2016DOI: 10.1056/NEJMoa1513737

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

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

[wysija_form id=”5″]



Last Updated on May 15, 2016 by Marie Benz MD FAAD