Airway Dysfunction and Risk of Exacerbations in Children on Biologic Therapy
Recommended Citation
Nguyen D, Altman M, Bacharier L, Becker P, Cohen R, Kattan M, Hershey GK, Kumar R, Liu A, Sheehan W, Zoratti E, Jackson D, Gaberino C. Airway Dysfunction and Risk of Exacerbations in Children on Biologic Therapy. J Allergy Clin Immunol 2026; 157(2):AB184.
Document Type
Conference Proceeding
Publication Date
2-10-2026
Publication Title
J Allergy Clin Immunol
Keywords
mepolizumab, placebo, airway resistance, asthma, biological therapy, child, conference abstract, controlled study, drug therapy, female, human, impulse oscillometry, inhalational drug administration, lung function, major clinical study, male, randomized controlled trial, special situation for pharmacovigilance, spirometry
Abstract
Rationale: Impulse oscillometry (IOS) is a complementary tool to spirometry, particularly given its potential to detect small airway dysfunction and predict future loss of asthma control. Methods: 271 participants (6-17 years) with exacerbation-prone asthma and blood eosinophils ≥150/microliter were randomized (1:1) to receive placebo or mepolizumab injections added to guideline-based care for 52 weeks. Spirometry (GLI race-neutral values) and IOS data were collected at baseline. We assessed the association between baseline lung function and number of exacerbations during the trial using negative binomial regression models. Results: Greater baseline airway resistance at 5Hz (R5), 5Hz-20Hz (R5-20), and area under the curve of reactance (AX) were associated with increased exacerbation risk during the study for placebo-treated children (R5: β=2.00, p=0.016; R5-R20: β=2.31, p=0.068; AX: β=0.26, p=0.096). Airway dysfunction as assessed by IOS was not associated with exacerbation risk in mepolizumab-treated children (R5: β=1.04, p=0.26; R5-20: β=1.40, p=0.25; AX: β=0.12, p=0.43). In a combined model, there was not a significant interaction between treatment group and IOS parameters in predicting exacerbation risk (R5, R5-20, AX: p>0.05). Lower FEV1/FVC at baseline was significantly associated with greater exacerbation frequency for both treatment groups (placebo: β=-3.02, p=0.009; mepolizumab: β=-2.41, p=0.04). The same direction of association existed for baseline FEV1% predicted but was not statistically significant (placebo: β=-0.009, p=0.17; mepolizumab: β=-0.010, p=0.15). Conclusions: Greater baseline airway resistance was associated with increased exacerbation rates in the placebo but not mepolizumab treatment groups, indicating a potential protective effect of anti-IL5 therapy in children with small airway dysfunction.
Volume
157
Issue
2
First Page
AB184
