Development of a tool to detect small airways dysfunction in asthma clinical practice.

Background: Small airways dysfunction (SAD) in asthma is difficult to measure and a gold standard is lacking. The aim of this study was to develop a simple tool including items of the Small Airways Dysfunction Tool (SADT) questionnaire, basic patient characteristics and respiratory tests available depending on the clinical setting to predict SAD in asthma.
Methods: This study was based on the data of the multinational ATLANTIS (Assessment of Small Airways Involvement in Asthma) study including the earlier developed SADT questionnaire. Key SADT items together with clinical information were now used to build logistic regression models to predict SAD group (less likely or more likely to have SAD). Diagnostic ability of the models was expressed as area under the receiver operating characteristic curve (AUC) and positive likelihood ratio (LR+).
Results: SADT item 8, "I sometimes wheeze when I am sitting or lying quietly", and the patient characteristics age, age at asthma diagnosis and body mass index could reasonably well detect SAD (AUC 0.74, LR+ 2.3). The diagnostic ability increased by adding spirometry (percentage predicted forced expiratory volume in 1 s: AUC 0.87, LR+ 5.0) and oscillometry (resistance difference between 5 and 20 Hz and reactance area: AUC 0.96, LR+ 12.8).
Conclusions: If access to respiratory tests is limited ( e.g. primary care in many countries), patients with SAD could reasonably well be identified by asking about wheezing at rest and a few patient characteristics. In (advanced) hospital settings patients with SAD could be identified with considerably higher accuracy using spirometry and oscillometry.
Competing Interests: Conflict of interest: J. Kocks reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKline, grants and personal fees from Chiesi and Teva, nonfinancial support from Mundi Pharma, personal fees from MSD and COVIS Pharma, grants from Valneva, outside the submitted work; holds <5% shares of Lothar Medtec GmbH and 72.5% of shares in the General Practitioners Research Institute. T. van der Molen reports personal fees and nonfinancial support from Chiesi, GlaxoSmithKline and AstraZeneca. J. Voorham reports no conflict of interest. S. Baldi reports no conflict of interest. M. van den Berge reports research grants paid to institution from Chiesi, Novartis, Genentech, Roche, AstraZeneca and GlaxoSmithKline. C. Brightling reports support for the present manuscript from Chiesi and NIHR BRC; grants and consulting fees from AstraZeneca, GlaxoSmithKline, Chiesi, Sanofi, Roche, Genentech, Mologic and 4DPharma, outside the submitted work. L.M. Fabbri reports grants, personal fees, and nonfinancial support from AstraZeneca, Chiesi, GlaxoSmithKline, Alfasigma, Lusofarma and Novartis. M. Kraft reports grants (paid to institution) for research from the National Institutes of Health, American Lung Association and Chiesi (for support of this study), AstraZeneca and Sanofi Regeneron; personal fees for consultancies from Chiesi, Genentech (Roche), GlaxoSmithKline, Sanofi Regeneron and AstraZeneca, speaker fees from Chiesi; personal fees from participation on data safety and monitoring boards from AstraZeneca and ALung; and leadership of the American Thoracic Society. G. Nicolini is an employee of Chiesi, the company who sponsored the ATLANTIS study generating the data analysed in the current manuscript. A. Papi reports grants from Chiesi, AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Teva and Sanofi; consulting fees, honoraria for lectures or advisory boards from Chiesi, AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Novartis, Sanofi, IQVIA, Avillon, Elpen Pharmaceuticals, Menarini, Zambon and Mundipharma. K.F. Rabe reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, Chiesi, DevPro and Sanofi Regeneron. Klaus F. Rabe is co-founder of rnatics and receives federal grants from the BMBF, Germany for the German Center for Lung Research. S. Siddiqui reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Boehringer Ingelheim, Novartis, ERT Medical, Knopp Biosciences and Thorasys Ltd. D. Singh has received personal fees from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, Epiendo, Genentech, GlaxoSmithKline, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Pulmatrix, Sanofi, Synairgen, Teva, Theravance and Verona. J. Vonk reports no conflict of interest. M. Leving and B. Flokstra-de Blok were employed by General Practitioners Research Institute (GPRI) at the time of the study. In the past 3 years (2019–2021), GPRI conducted investigator- and sponsor-initiated research funded by noncommercial organisations, academic institutes, and pharmaceutical companies (including AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Novartis and Teva).
(Copyright ©The authors 2023.)