title: Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation.
abstract: This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children. Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases.
authors.affiliation: Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland Alexander.Moeller@kispi.uzh.ch.
authors.forename: Alexander
authors.initials: A
authors.lastname: Moeller
authors.affiliation: Dept of Paediatrics, Women and Children's Division, University of Oslo and Oslo University Hospital, Oslo, Norway.
authors.forename: Kai-Hakon
authors.initials: KH
authors.lastname: Carlsen
authors.affiliation: Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Sly
authors.affiliation: Women's and Children's Health Department, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
authors.affiliation: Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Piacentini
authors.affiliation: Dept of Respiratory Medicine, University of Oxford, NDM Research Building, Oxford, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Pavord
authors.affiliation: Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Paediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Lex
authors.affiliation: Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Sejal
authors.initials: S
authors.lastname: Saglani
mesh_terms: D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D016084:Bronchoconstriction / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D006801:Humans; D007223:Infant; D018836:Inflammation Mediators / Q000276:immunology; D008168:Lung / Q000187:drug effects / Q000276:immunology* / Q000503:physiopathology*; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012129:Respiratory Function Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D018836:Inflammation Mediators