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Vol. 46. Issue 4.
Pages 313-321 (July - August 2018)
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Vol. 46. Issue 4.
Pages 313-321 (July - August 2018)
Original Article
DOI: 10.1016/j.aller.2017.09.025
Small-airway dysfunction precedes the development of asthma in children with allergic rhinitis
E. Skylogiannia, M. Trigaa, K. Dourosb, K. Bolisa, K.N. Priftisb, S. Fouzasa,1,
Corresponding author

Corresponding author.
, M.B. Anthracopoulosa,1
a Pediatric Pulmonology and Allergy Unit, Department of Pediatrics, University of Patras Medical School, Patras, Greece
b 3rd Department of Pediatrics, “Attikon” Hospital, University of Athens School of Medicine, Athens, Greece
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Figures (1)
Tables (5)
Table 1. Population characteristics.
Table 2. Baseline lung function.
Table 3. Lung function at AR exacerbation.
Table 4. Predictive ability of lung function parameters for development of asthma.
Table 5. Predictors of asthma development in children with AR.
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Epidemiological evidence suggests the existence of a direct link between allergic rhinitis (AR) and asthma. Several studies also support the presence of small-airway dysfunction (SAD) in non-asthmatic children with AR. However, it remains unknown whether SAD can predict the progression of AR to asthma. Our objective was to explore the existence of SAD in non-asthmatic children with AR and to assessed its ability to predict the development of asthma.


Seventy-three 6-year-old children with intermittent moderate-severe AR but without asthma symptoms/medication within the last two years, underwent spirometry and measurement of respiratory resistance (Rrs) and reactance (Xrs) before and after bronchodilation (BD) (300mcg salbutamol). Lung function measurements were performed in the absence of nasal symptoms and repeated at AR exacerbation. SAD was defined as >30% decrease in Rrs or >50% increase in Xrs at 6 or 8Hz post-BD. Participants were followed for five years.


Twenty-three children (31.5%) developed asthma; this group presented significant post-BD changes in Rrs and Xrs, but only at AR exacerbation. The ability of these changes to predict the development of asthma was exceptional and superior to that of the spirometric parameters. SAD (22 children, 30.1%), emerged as the single most efficient predictor of asthma, independently of other risk factors such as parental asthma, personal history of eczema and type of allergic sensitisation.


SAD precedes the development of asthma in children with AR. Changes in respiratory impedance at AR exacerbation may assist in identifying those at risk to progress to asthma.

Allergic rhinitis
Small-airway dysfunction
Forced oscillations


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