Airway Hyperresponsiveness to Inhaled Mannitol Identifies a Cluster of Noneosinophilic Asthma Patients with High Symptom Burden

Sverrild, Asger; Andreasen, Anne Helms; Westergaard, Christian Grabow; Bülow, Anna Von; Udesen, Pernille Bækgaard; Thomsen, Simon Francis; Allin, Kristine H.; Backer, Vibeke; Porsbjerg, Celeste

doi:10.1016/j.jaip.2021.07.021

Cited by 4 publications

(1 citation statement)

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“…[1][2][3] Recent work emphasizes the importance of indirect AHR tests in predicting asthma exacerbations regardless of the inflammatory phenotype. 4 Mucosal eosinophilic airway inflammation and mast cell activation are associated with the risk of exacerbation of asthma. 5 Intraepithelial eosinophils and mast cells are related to the presence and severity of indirect AHR.…”

Section: Introductionmentioning

confidence: 99%

Childhood asthma treatment based on indirect hyperresponsiveness test: Randomized controlled trial

Ciółkowski¹,

Hydzik

Rachel

et al. 2023

Pediatric Pulmonology

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PurposeThe purpose of this study was to assess the usefulness of indirect airway hyperresponsiveness (AHR) test using hypertonic saline in determining the dose of inhaled corticosteroids (ICS) to maintain asthma control in children.MethodsA group of 104 patients (7–15 years) with mild–moderate atopic asthma were monitored for their asthma control and treatment for 1 year. Patients were randomly assigned to a symptom‐only monitored group and a group with therapy changes based on the symptoms and severity of AHR. Spirometry, exhaled nitric oxide, and blood eosinophils (BEos) were assessed on enrollment and every 3 months thereafter.ResultsDuring the study period, the number of mild exacerbations was lower in the AHR group (44 vs. 85; the absolute rate per patient 0.83 vs. 1.67; relative rate 0.49, 95% confidence interval: 0.346–0.717 (p < 0.001)]. Mean changes from baseline in clinical (except asthma control test), inflammatory, and lung function parameters were similar between groups. Baseline BEos correlated with AHR and was a risk factor for recurrent exacerbation in all patients. There was no significant difference in the final ICS dose between AHR and symptoms group: 287 (SD 255) vs. 243 (158) p = 0.092.ConclusionsAdding an indirect AHR test to clinical monitoring of childhood asthma reduced the number of mild exacerbations, with similar current clinical control and final ICS dose as in the symptom‐monitored group. The hypertonic saline test appears to be a simple, cheap, and safe tool for monitoring the treatment of mild‐to‐moderate asthma in children.

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