Jon Roald Konradsen

Aim: Knowledge of spirometric patterns beyond obstruction with low forced expiratory volume in 1 s (FEV ₁ ) remains limited. We assessed the prevalence, characteristics, and transitions of unimpaired spirometry, preserved ratio impaired spirometry (PRISm), dysanapsis and obstruction with low FEV ₁ (Obst‐low‐FEV ₁ ) at 7 and 11 years. Methods: We included former preschool wheezers (cases; n ₇ = 102 and n ₁₁ = 97) and healthy controls (37 at both ages), of whom 87 cases and 20 controls had spirometry at both ages. Assessments comprised questionnaires, clinical examinations, spirometry, bronchodilator responsiveness (BDR), fractional exhaled nitric oxide (FeNO) and blood sampling. Results: PRISm was the most common pathological phenotype in cases (17.6%/14.4%, age 7/11) and controls (13.5% at both ages). Among cases, Obst‐low‐FEV ₁ was more common (8.8%/11.3%, 7/11 years) than dysanapsis (5.9%/8.2% age 7/11). Phenotypes changed in 54% of participants between 7 and 11 years. BDR > 10% occurred across all phenotypes but was significantly associated with dysanapsis (OR _adj = 2.88, CI 1.00–8.27) and Obst‐low‐FEV ₁ (OR _adj = 16.14, CI 4.89–53.30) among cases. Higher FeNO was associated with Obst‐low‐FEV ₁ (OR _adj = 1.03, CI 1.00–1.07), whereas lower FeNO (OR _adj = 0.90, CI 0.82–1.00) and sensitization (OR _adj = 6.22, CI 0.97–39.77) were associated with dysanapsis in cases. Conclusion: PRISm and dysanapsis are common, dynamic phenotypes differing from Obst‐low‐FEV ₁ in their clinical and inflammatory profiles.

Background: Achieving and maintaining pediatric asthma control depends on effective and regular monitoring. While a wide range of monitoring tools are available, how and why clinicians use these in routine practice has not been formally characterized. Here we describe distinct real‐world monitoring patterns among healthcare professionals ( HCPs ) caring for children with asthma in an international convenience survey, examining the geographic, professional, and institutional factors associated with them. Methods: Data from the international cross‐sectional Pediatric Asthma in Real Life ( PeARL ) HCP survey, administered to clinicians with expertise in childhood asthma, were analyzed. Monitoring patterns were derived by Ward agglomerative hierarchical clustering on four standardized domains: clinical evaluation, spirometry, fractional exhaled nitric oxide ( FeNO ), and home‐monitoring. Independent associations between cluster membership and region, specialty, sector, and level of care were estimated by multinomial logistic regression ( MLR ). Results: 951 HCPs from 78 countries were included. Four monitoring patterns emerged: Low‐intensity ( n = 88, 9.3%), lower overall monitoring intensity but moderate clinical assessment; Clinical ( n = 449, 47.2%), predominantly clinical assessment with moderate spirometry but infrequent FeNO and home monitoring; Clinical & Objective ( n = 308, 32.4%) with additional regular spirometry with moderate FeNO use and Comprehensive ( n = 106, 11.1%), also providing home monitoring. In MLR ( n = 933), region and care level were significantly associated with cluster membership ( p < .001), and specialty ( p = .012) and sector ( p = .039) also contributed independently. The most pronounced gradients involved objective in‐clinic testing: specialists were 3.5‐fold (95% CI 1.68–7.37) more likely than generalists, and tertiary‐care HCPs 3.3‐fold (95% CI 1.99–5.58) more likely than primary‐care HCPs, to belong to the Clinical & Objective pattern, with routine use of objective measures concentrated in Western and Northern European practices. Home monitoring showed no consistent gradient across the measured characteristics. Conclusion: Real‐world pediatric asthma monitoring follows recognizable patterns, distinguished by the use of objective in‐clinic testing and between‐visit home‐based practices. Nearly half of HCPs relied predominantly on clinical assessment with limited use of FeNO and home‐based monitoring, and only a minority integrated home‐monitoring tools. Objective in‐clinic testing concentrated in specialist services and Western/Northern European practices, while home‐monitoring adoption showed no consistent gradient. These findings identify factors associated with pediatric asthma monitoring and suggest system‐level factors that warrant direct evaluation in dedicated implementation studies. image

Aim: We estimated the coverage of children recorded in the Swedish National Airway Register (SNAR) and identified predictors of registration among those with asthma and moderate to severe asthma. Methods: This study comprised 85 656 children aged 5–17 years with asthma, born 2000–2019 and living in Stockholm. The children were identified through diagnoses and dispensed medication in national and regional health registers. Registration in the SNAR was assessed. Logistic regression compared characteristics of registered and unregistered children, with associations presented as odds ratios (OR) and 95% confidence intervals (CI). Results: Overall, 33 815 (39.5%) of children with asthma were registered in the SNAR. Registration was more common among children with allergic rhinitis (OR 1.83, 95% CI 1.77–1.88), parental asthma and allergic rhinitis (maternal OR 1.47, 95% CI 1.43–1.51), higher parental income and education (OR 1.09, 95% CI 1.05–1.12), and moderate to severe asthma (OR 1.37, 95% CI 1.32–1.42). Findings were similar in the moderate to severe asthma sub‐cohort. Conclusion: Nearly 40% of children with asthma in Stockholm were registered in the SNAR, and they were more likely to have familial atopy, higher socioeconomic status, and more severe disease. The SNAR is being developed to increase coverage, support standardized registration, and improve care.

Background: Previously identified asthma-susceptibility genes account for a small part of asthma heritability and their role in asthma pathogenesis is unclear. We explored associations between genetic variants in the 17q21 locus, CDHR3 (cadherin-related family member 3), coding a receptor for Rhinovirus-C, preschool wheeze and asthma at 7 years. Methods: Four genetic variants in the 17q21 locus (rs8076131, rs12603332, rs8079416, rs3859192) and rs6967330 in CDHR3 were studied regarding associations with preschool wheeze and asthma at 7 years. We compared 125 cases, enrolled during an acute wheezing episode, with 96 healthy controls at preschool age (6–45 months). A total of 99 of 125 children attended the follow-up at 7 years old. Cases with asthma (N = 68) and without asthma (N = 31) at 7 years old were compared regarding genetic variants and other clinical parameters. Results: Rs8076131 (AA vs. GG) was associated with preschool wheeze (OR 3.50, p = 0.001), and asthma at 7 years (OR 8.55, p = 0.002). Rs12603332 (CC vs. TT) was related to asthma at 7 years irrespective of rhinovirus infection at inclusion or current signs of airborne allergy (aOR 7.17, p = 0.016). The association of rs6967330 with asthma was restricted to children with specific genotypes in the 17q21 locus; rs8076131-AA (p = 0.028), rs8079416-CC (p = 0.006), and rs3859192-TT (p = 0.042). Rhinovirus infection at inclusion was significantly related to asthma exclusively in homozygotes rs8079416-CC (p = 0.032) and rs3859192-TT (p = 0.027). Conclusions: Our results highlight the impact of asthma heritability by reporting strong associations between the 17q21 locus and asthma in a high-risk cohort. The association of rs6967330 in CDHR3 and early-life rhinovirus infection with asthma at school age might be dependent on specific genotypes in the 17q21 locus.

Asthma control is multifaceted, involving symptoms and risk of adverse outcomes. Emerging evidence suggests a bidirectional link between poor asthma control and severe COVID-19, but large studies addressing all components of asthma control in this context are lacking. Our aims were to evaluate if 1) uncontrolled asthma was a risk factor for COVID-19 hospitalization and death, 2) asthma control changed during the pandemic and 3) COVID-19 hospitalization was a risk factor for future uncontrolled asthma. Patients with asthma (n = 125,362) were identified in the Swedish National Airway Register from January 2014 to 2020, whereof n = 2377 were hospitalized and n = 305 died due to COVID-19 during follow-up until December 2022. Asthma control was evaluated by symptoms (Asthma Control Test (ACT) ≥ 20: well controlled, ACT 16–19 not well-controlled and ACT < 16 very poorly controlled asthma), lung function (FEV₁% predicted (pp)) and frequent and/or severe exacerbations (dispensed oral corticosteroids and asthma inpatient care). ACT 16–19 (RR 1.57, 95% CI 1.34–1.84), ACT < 16 (1.72, 1.46–2.02), FEV₁ < 80pp (1.29, 1.13–1.48), frequent (1.99, 1.79–2.21) and severe exacerbations (2.54, 2.09–3.08) were associated with a higher risk for COVID-19 hospitalization. COVID-19 death was associated with ACT < 16, frequent and severe exacerbations. Overall, at follow-up, proportions of ACT < 20 (36.1%) and FEV₁ < 80pp (48.3%) were stable, while exacerbations decreased (frequent; 7.9% to 6.8%, severe; 1.3% to 0.4%). COVID-19 hospitalization was a risk factor for frequent (1.35, 1.22–1.51) and severe (3.42, 1.22–1.51) future asthma exacerbations. All dimensions of poor asthma control were associated with an increased risk of severe COVID-19. In contrast, only exacerbation risk was elevated following COVID-19.

Rationale: Few studies have identified risk sets for perinatal factors and airflow obstruction into middle adulthood. Objectives: To investigate associations between gestational age (GA), GA-adjusted birthweight, and mode of delivery and persistent airflow obstruction among patients 7–49 years old with obstructive lung diseases. Methods: The study population encompassed 44,778 individuals with asthma or chronic obstructive pulmonary disease (COPD) and one or more registration of post-bronchodilator values of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) recorded in the Swedish National Airway Register in 2014–2022 and with both GA and birthweight data in the Medical Birth Register between 1973–2015. Persistent airflow obstruction was defined as a FEV1/FVC z-score below the lower limit of normal. Analyses were done separately for children, young adults, and middle-aged adults. Results: Subjects who were extremely, very, moderate, and late preterm-born all had increased odds ratios (ORs) of persistent airflow obstruction up to age 49 years compared with those term-born. Middle-aged adults born small for GA had increased OR of persistent airflow obstruction compared with those appropriate for GA (OR, 1.49; 95% confidence interval, 1.23–1.81). In the risk sets, GA was the most significant covariate for persistent airflow obstruction. GA-adjusted birthweight was an additional covariate for those born late preterm, term, or postterm. Mode of delivery did not contribute. Conclusions: GA was an independent covariate of persistent airflow obstruction and, in the risk sets, proved to be the most important covariate in patients of all ages with either asthma or COPD. GA-adjusted birthweight further improved the prediction.