Airway resistance was associated with increased exacerbation rates in the placebo group but not the mepolizumab treatment groups.
RT’s Three Key Takeaways:
- Reduced Airway Dysfunction Risk: Research presented at AAAAI 2026 found that children treated with mepolizumab had a lower risk of exacerbations linked to small airway dysfunction compared to placebo-treated peers.
- Protective Effect in Small Airways: In a secondary analysis of a pediatric randomized trial published in an online supplement to The Journal of Allergy and Clinical Immunology, increased baseline airway resistance predicted higher exacerbation rates in the placebo group but not in the mepolizumab group, suggesting a protective anti-IL5 effect.
- Baseline Lung Function Still Matters: Lower baseline FEV1/FVC was associated with greater exacerbation frequency in both treatment and placebo groups, underscoring the importance of early lung function assessment in managing pediatric asthma.
Mepolizumab-treated groups of children experience lower risk of airway dysfunction compared to placebo groups, according to new research being presented at AAAAI 2026.
The researchers suggest that mepolizumab may produce a potential protective effect of anti-IL5 therapy in children with small airway dysfunction, highlighting an important treatment option to optimize patient care.
“In a secondary analysis of a pediatric randomized controlled trial, we assessed the association between baseline lung function impairment (measured by spirometry and impulse oscillometry) and exacerbation risk. Greater baseline obstruction was associated with higher exacerbation frequency in both placebo and mepolizumab treatment groups. Whereas greater baseline airway resistance was associated with higher exacerbation frequency mainly in the placebo group, indicating a potential protective effect of anti-IL5 therapy in children with small airway dysfunction,” said co-author Courtney Gaberino, MD.
Within the study, 271 participants, aged 6-17 years old, with exacerbation-prone asthma and blood eosinophils >=150/microliter, were randomized to receive placebo or mepolizumab injections added to their guideline-based care for 52 weeks. Researchers collected spirometry (GLI race-neutral values) and impulse oscillometry (IOS) data and examined the association between baseline lung function and the number of exacerbations during the trial by using negative binomial regression models.
The researchers found that greater baseline airway resistance at 5Hz (R5), 5Hz-20Hz (R5-20) and the area under the curve of reactance (AX) were all associated with increased exacerbation risks for the children treated with a placebo. However, airway dysfunction as assessed by IOS was not associated with an exacerbation risk in the group of mepolizumab-treated children. In a combined model, researchers found no significant interaction between treatment group and IOS parameters in predicting the exacerbation risk (R5, R5-20, AX). Lower FEV1/FVC at the baseline was significantly associated with greater exacerbation frequency for both the placebo and mepolizumab-treatment groups of children.
