06/25/2026
Riley Children’s Health pulmonologists Rob Tepper, MD, PhD; Erick Forno, MD, MPH; and Ben Gaston, MD joined internationally recognized pediatric respiratory leader Andrew Bush, MD, for a transatlantic roundtable examining evolving lung function standards, dysanapsis in children, and the future of pediatric airway disease interpretation. The conversation fostered collaboration and meaningful dialogue, advancing how pediatric pulmonologists interpret spirometry, airflow limitation and developmental lung physiology.
Here are a few highlights:
- Dysanapsis reframes “obstruction” as developmental, not purely pathologic. Dysanapsis reflects asymmetric growth between airway caliber and lung volume during childhood development, rather than simply obstructive pathology. Experts noted this distinction is critical when interpreting spirometry in pediatric patients.
- Low FEV1/FVC should not trigger automatic steroid escalation. Some children with preserved FEV1 but reduced FEV1/FVC ratios may have developmental dysanapsis rather than steroid-responsive airway inflammation. This has important implications for avoiding overtreatment with inhaled or systemic corticosteroids.
- Experts called for a “measurement culture” over symptom-driven treatment. The session reinforced the importance of structure-function physiology, careful spirometry interpretation and mechanistic thinking in an era increasingly dominated by simplified algorithms and molecular diagnostics.
- Asthma is a syndrome, not a singular disease. Asthma often represents a clinical syndrome rather than a singular disease entity, reinforcing the need to identify underlying mechanisms driving airway obstruction, wheeze or reversibility.
- Early-life factors shape lifelong lung trajectories. There is growing evidence that birth weight, accelerated childhood weight gain, environmental exposures and prematurity may influence lung growth patterns and future respiratory outcomes.
- Race-agnostic spirometry standards introduce both opportunity and risk. Evolving global lung function standards may better identify previously normalized deficits while also raising caution about overtesting or overinterpreting mildly abnormal values.
“Our goal with this discussion was to translate emerging science into practical insights for pediatric pulmonologists, so these concepts can directly inform how we care for patients,” said Dr. Gaston, who was the roundtable moderator. “This kind of dialogue brings together diverse expertise to challenge assumptions and move the field toward more precise, patient-centered care.”
Riley Children’s pulmonology division is contributing to research and advancing conversation around precision interpretation of pediatric pulmonary disease and developmental lung health. Learn more about Riley Children’s Health pulmonology program, research, and clinical breakthroughs in the annual report.
