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Variability in forced expiratory volume in 1 s in children with symptomatically well-controlled asthma
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  • Published on: 26 November 2024
    Getting on the front foot in airways disease: time to target disease activity
    • Andrew Bush, Paediatric Chest Physician Imperial College and Royal Brompton Hospital, London, UK
    • Other Contributors:
      • Ian D Pavord, Respiratory Physician

    We read with interest very large dataset of Filipow et al1, the conclusions of which were that paediatric asthma should be managed by symptoms not spirometry. The authors interpret the variability in first second forced expired volume (FEV1) between occasions when asthma is well controlled as evidence that a change in spirometry is not useful in the clinical management of asthma. Their data could also be used to show that symptoms are not accurately reported in the clinic (which is well known), and therefore spirometry should be the gold standard! However, in the 21st century, when we treat asthma with anti-inflammatory therapy, should we not be measuring what we are trying to treat, namely inflammation2? Both in adults3 and children4,5, elevated peripheral blood eosinophil count (BEC) and exhaled nitric oxide (FeNO) are established markers of active, high-risk disease, and we need to be exploring strategies to use them effectively in treatment, so that those with active inflammation (raised BEC and FeNO) get more anti-inflammatory therapy to try to prevent attacks, and those with inactive disease (low biomarkers) can wean anti-inflammatory treatment.

    References
    1. Filipow N, Turner S, Petsky HL, et al. Variability in forced expiratory volume in 1 s in children with symptomatically well-controlled asthma. Thorax 2024; 79(12): 1145-50.

    2. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. Lancet (London, England) 2018; 391...

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    Conflict of Interest:
    None declared.