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This impaired ratio may originate from a low FEV<jats:sub>1<\/jats:sub>(classic) or a normal FEV<jats:sub>1<\/jats:sub>in combination with a large FVC (dysanaptic). The clinical implications of dysanaptic obstruction during childhood and adolescence in the general population remain unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate the association between airway obstruction with a low or normal FEV<jats:sub>1<\/jats:sub>in childhood and adolescence, and asthma, wheezing and bronchial hyperresponsiveness (BHR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the BAMSE (Barn\/Child, Allergy, Milieu, Stockholm, Epidemiology; Sweden) and PIAMA (Prevention and Incidence of Asthma and Mite Allergy; the Netherlands) birth cohorts, obstruction (FEV<jats:sub>1<\/jats:sub>:FVC ratio less than the lower limit of normal, LLN) at ages 8, 12 (PIAMA only) or 16 years was classified as classic (FEV<jats:sub>1<\/jats:sub>&lt;LLN) or dysanaptic (FEV<jats:sub>1<\/jats:sub>\u2265LLN) obstruction. Cross-sectional and longitudinal associations between these two types of obstruction and respiratory health outcomes were estimated by cohort-adjusted logistic regression on pooled data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of classic obstruction at ages 8, 12 and 16 in the two cohorts was 1.5%, 1.1% and 1.5%, respectively. Dysanaptic obstruction was slightly more prevalent: 3.9%, 2.5% and 4.6%, respectively. Obstruction, regardless of FEV<jats:sub>1<\/jats:sub>, was consistently associated with higher odds of asthma (dysanaptic obstruction: OR 2.29, 95%\u2009CI 1.40 to 3.74), wheezing, asthma medication use and BHR compared with the normal lung function group. Approximately one-third of the subjects with dysanaptic obstruction in childhood remained dysanaptic during adolescence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical implications<\/jats:title><jats:p>Children and adolescents with airway obstruction had, regardless of their FEV<jats:sub>1<\/jats:sub>level, a higher prevalence of asthma and wheezing. Follow-up and treatment at these ages should be guided by the presence of airway obstruction.<\/jats:p><\/jats:sec>","DOI":"10.1136\/thorax-2023-220952","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T17:20:44Z","timestamp":1711041644000},"page":"573-580","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical implications of airway obstruction with normal or low FEV<sub>1<\/sub>in childhood and adolescence"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8285-0492","authenticated-orcid":false,"given":"Hans Jacob Lohne","family":"Koefoed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3612-5780","authenticated-orcid":false,"given":"Ulrike","family":"Gehring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2060-8190","authenticated-orcid":false,"given":"Sandra","family":"Ekstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6096-3771","authenticated-orcid":false,"given":"Inger","family":"Kull","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roel","family":"Vermeulen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanda M A","family":"Boer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bergstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard H","family":"Koppelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8248-0663","authenticated-orcid":false,"given":"Erik","family":"Mel\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7531-4547","authenticated-orcid":false,"given":"Judith M","family":"Vonk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Hallberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"2024052010001199000_79.6.573.1","doi-asserted-by":"publisher","DOI":"10.1183\/20734735.0021711"},{"key":"2024052010001199000_79.6.573.2","unstructured":"Global Initiative for Asthma . 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