Daily Respiratory Research Analysis

IMPORTANCE: Use of the race-neutral Global Lung Initiative (GLI) equation has been shown to generate decreased lung function measures in Black children and adults. The effect on asthma detection and diagnosis in children is unknown. OBJECTIVE: To compare the use of race-specific vs race-neutral equations on subsequent asthma diagnosis in children. DESIGN, SETTING, AND PARTICIPANTS: The Childhood Asthma Management Program (CAMP, 1991-2012), the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS, 2001-2010), and the Mechanisms of Progression from Atopic Dermatitis to Asthma (MPAACH, 2016-2024) cohorts were included in this cohort study. Children in the CAMP cohort were aged 5 to 12 years with mild to moderate asthma. The CCAAPS and MPAACH cohorts included infants from atopic parents and children aged 0 to 2 years with atopic dermatitis, respectively. Data were analyzed from November 2023 to May 2024. EXPOSURES: Race-specific vs race-neutral GLI equations to define lung function. MAIN OUTCOMES AND MEASURES: Percent predicted values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), asthma or asthma symptoms, and eligibility for reversibility testing were determined. RESULTS: Among 1533 children, there were 849 CAMP (median [IQR] age, 8.7 [7.1-10.6] years; 138 [16%] Black, 711 [84%] White, and 498 [59%] male participants), 578 CCAAPS (median [IQR] age, 6.9 [6.7-7.0]; 115 [20%] Black, 463 [80%] White, and 315 [55%] male participants) and 106 MPAACH (median [IQR] age, 7.4 [7.1-7.8] years; 62 [58%] Black, 44 [42%] White, and 62 [58%] male participants). The median (IQR) percent predicted FEV1 in Black children decreased by 11.9 percentage points (pp) (10.4-13.1 pp) in CAMP, 13.5% pp (11.8-14.6 pp) in CCAAPS, and 13.2 pp (11.6-14.6 pp) in MPAACH compared with the race-specific equation. The race-specific equation failed to detect reduced percent predicted FEV1 in 12 of 22 Black children in CCAAPS with asthma symptoms (55%) and 5 of 15 Black children in MPAACH with asthma (41%). In CCAAPS, children with less than 90% predicted FEV1 based on race-specific equations were eligible for postreversibility testing to objectively diagnose asthma. When this asthma diagnostic algorithm was applied, 16 of 36 Black children in CCAAPS (44%) and 6 of 16 Black children in MPAACH (38%) who were not eligible for reversibility testing based on the race-specific equation became eligible with a less than 90% predicted FEV1 based on the race-neutral equation. CONCLUSIONS AND RELEVANCE: In this cohort study of 1533 children, the use of the race-neutral equation improved the detection of asthma in children. These results support the universal use of the race-neutral equation to improve asthma detection in children and help guide medical practice toward alleviating asthma-related health disparities.

BACKGROUND: The effects of continuous positive airway pressure (CPAP) on blood pressure (BP) in normotensive subjects, particularly among those with a dipping BP pattern, remain uncertain, raising questions about its indication for this group of patients. We assessed the impact of CPAP on BP in normotensive subjects with a dipping BP pattern and severe obstructive sleep apnoea (OSA). METHODS: This was a randomised, parallel, prospective, controlled trial. Inclusion criteria were: age ≥18 years, apnoea-hypopnoea index ≥30 events·h RESULTS: The 60 patients who completed the follow-up had a mean±sd age of 52.2±10.8 years and 40 (66.7%) were male. The intention-to-treat analysis showed no significant changes with CPAP, whereas the usual care group experienced increases in ABPM parameters. This resulted in a mean difference of -3.4 mmHg (95% CI -6.124- -0.676; p=0.015) in night-time diastolic BP between the groups. The per-protocol analysis indicated significant differences between the CPAP and usual care groups for all primary end-points, except for daytime systolic BP. For night-time systolic BP, the mean difference was -6.052 mmHg (95% CI -10.895- -1.208; p=0.016). CONCLUSION: These findings suggest a protective effect of CPAP, highlighting the importance of CPAP prescription for this population to control potential increases in BP and possibly prevent the onset of hypertension.

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccination may offer benefits for patients with chronic obstructive pulmonary disease (COPD). However, the evidence on whether the vaccination decreases the frequency of acute exacerbation of COPD (AECOPD) is limited. METHODS: This study enrolled 41,606 individuals diagnosed with COPD using the Korean National Health Insurance System-severe acute respiratory syndrome coronavirus 2 (NHIS SARS-CoV-2) database between 2020 and 2021. A cohort of 3,602 individuals was analyzed through 1:1 propensity score matching of vaccinated and unvaccinated groups. The risk of AECOPD was evaluated using a Cox proportional hazards regression analysis. A post hoc analysis examined the impact of COVID-19 on AECOPD in vaccinated and unvaccinated groups among infected and uninfected subgroups. RESULTS: Throughout the study, the exacerbation rate was lower in the vaccinated group (1,683/10,000 person-years) compared to the unvaccinated group (3,410/10,000 personyears). The Cox proportional hazards model showed a significantly decreased risk of AECOPD in vaccinated individuals relative to unvaccinated individuals (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.41 to 0.72). post hoc analysis revealed that COVID-19 was associated with a higher risk of AECOPD in unvaccinated individuals (adjusted HR, 2.06; 95% CI, 1.28 to 3.33), while in vaccinated individuals, the risk did not significantly differ between those infected and not infected with COVID-19 (adjusted HR, 1.35; 95% CI, 0.42 to 4.36). CONCLUSION: COVID-19 vaccination appears to decrease the risk of AECOPD among individuals with COPD.