Airway eosinophils in older teenagers with outgrown preschool wheeze: a pilot study

Abstract

Preschool wheezing affects one-third of all children growing up in the UK [1]. It varies in clinical presentation and severity, and there is evidence to suggest the co-existence of different wheeze phenotypes [2], some of which have been associated with adult asthma and chronic obstructive pulmonary disease [3]. Using data from the Leicester Respiratory Cohort studies [4], we have previously applied objective data-driven methods to distinguish three distinct preschool wheeze phenotypes: "atopic" and "non-atopic" persistent wheeze (PW) and transient viral wheeze (TVW) [5]. In children with PW, attacks of wheeze with and without colds were observed both at preschool age (0-5 years) and when followed-up at early school-age (4-8 years). Children with TVW, triggered predominantly by colds, had symptoms at age 0-5 years but not at age 4-8 years. Prognosis 5 years later (aged 8-13 years) was markedly better in children with TVW compared to the two PW phenotypes [6].

Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction

“…5 However, these children still show lung function deficits as young adults and low level eosinophilic airway inflammation. 12 Preschool disease markers predicting the development of severe asthma in older children are lacking; however, a recent study suggests that early sensitisation to thermotolerant fungi is associated with worse lung function in children with asthma. 13 Asthma severity is a spectrum but most children with asthma are controlled with regular use of low-to-medium doses of inhaled corticosteroids (ICS) with or without additional controller drugs.…”

“… 5 However, these children still show lung function deficits as young adults and low level eosinophilic airway inflammation. 12 Preschool disease markers predicting the development of severe asthma in older children are lacking; however, a recent study suggests that early sensitisation to thermotolerant fungi is associated with worse lung function in children with asthma. 13…”

Early Airway Pathological Changes in Children: New Insights into the Natural History of Wheezing

“…While the persistence of wheezing from early life to school age is associated with abnormal histological traits, it is also important to know what happens to these traits with the remission of symptoms. Marshall and co-workers compared the lung function and sputum cellularity of children with persistent or transient wheezing after following them through adolescence [71]. They found that airway eosinophilic inflammation and lung function impairment were seen not only in persistent wheezers, but also in children with a transient wheezing phenotype.…”