Small Airway Dysfunction, a Risk for Exacerbations, is Common in Children With Mild, Well-controlled Asthma in Specialty Care
Bibliographic record
Abstract
Abstract Rationale: Although current asthma guidelines have proven effective, many children experience poor asthma control with increased risks of exacerbations and loss of lung function. One possibility could be the failure to recognize the peripheral airways as major sites of airway obstruction. Oscillometry, an in-office procedure, is an effort-independent and effective measurement to identify asthma, uncontrolled asthma, and exacerbation risk in children. It assesses peripheral and central airway function by impedance, including resistance (Rrs) and reactance (Xrs). Although small airway dysfunction (SAD) is most prevalent in children with uncontrolled asthma, studies suggest it is common in well-controlled children with asthma. The purpose of this study was to further establish whether SAD is commonly present in mild, well-controlled children with asthma, and assess characteristics associated with SAD, particularly exacerbations. Methods: This is a post-hoc analysis of a study comparing a new Tremoflo Airwave Oscillometer (AOS) (produced by Thorasys, Montreal, Canada) C2 with the prior FDA-approved device C100. Fifty-three patients from the Allergy-Immunology Department, ages 2 to 7 years, with physician-diagnosed asthma, were evaluated. C100 AOS indices included resistance R7, frequency dependence resistance R7-R19, reactance area (AX), and reactance X7. SAD was identified by a Z score greater than 1.645 RSD, or less than -1.645 for X7. P values indicated the significance of distributional differences between groups based on the Chi-Square Test categorical and independent t-test, and the distributional difference between SAD positive and negative groups. Asthma severity and control were based on National Asthma Education and Prevention Program 2020 guidelines. Results: Nearly half (49.1%) of the children had SAD, despite 84.9% having mild asthma, and 86.8% well-controlled asthma. There was a trend for a higher proportion of SAD-positive children 2-4 years old compared to SAD-negative children (42.3% versus 33.3%), and a greater percentage of males in the SAD-positive group (84.6% versus 63.0%). While 44.2% of the overall population had experienced exacerbations in the previous 12 months, the prevalence was not greater in those SAD-positive. Conclusions: AOS demonstrated that SAD is common in children as young as 2-4 years old with mild, well-controlled asthma. We were unable to demonstrate SAD as a risk factor for previous exacerbations, perhaps due to an inadequate sample size. Prospective studies establishing the value of SAD as an early risk factor for future exacerbations in this susceptible population are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".