Blood Eosinophils for Prediction of Exacerbation in Preschool Children With Recurrent Wheezing

Fitzpatrick, Anne M.; Grunwell, Jocelyn R.; Cottrill, Kirsten A.; Mutic, Abby; Mauger, David T.

doi:10.1016/j.jaip.2023.01.037

Cited by 13 publications

(15 citation statements)

References 48 publications

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“…The risk of exacerbations in preschool wheezers has also been associated with type-2 inflammation, highlighted by the presence of atopic dermatitis or allergic sensitizations, increased levels of blood eosinophils and/or exhaled NO levels (17)(18)(19)(20)(21). On the one hand, we do confirm, in the present study, that atopic dermatitis was an independent risk factor associated with the exacerbation frequency in severe preschool wheezers and that its prevalence was increased in the high exacerbation group in agreement with previous studies (17)(18)(19)21). However, the presence of atopic dermatitis was also associated with the no-exacerbation group.…”

Section: Discussionmentioning

confidence: 99%

Bronchial smooth muscle remodelling impacts the exacerbation frequency of severe preschool wheezers

Beaufils

Esteves

Enaud

et al. 2023

Preprint

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INTRODUCTION: Exacerbations in preschool wheezers increase the risk of impaired lung function and asthma persistence at school age. Bronchial remodelling-based latent classes identify severe preschool wheezers at increased risk of frequent exacerbations (>3) but failed to distinguish those without exacerbation from those with low exacerbations rate (1-2 exacerbations) in the year following bronchoscopy. We thus aimed to identify further independent factors associated with no, low or high exacerbation rates. METHODS: In this post-hoc analysis, 80 severe preschool wheezers from the “P’tit Asthme” and “RESPIRE” studies were divided into 3 groups: No-Ex (0 exacerbation in the year following the bronchoscopy, n=20), Low-Ex (1-2 exacerbations, n=27) and High-Ex (≥3 exacerbations, n=33). Associations between variables and groups were assessed using multinomial logistic regressions. RESULTS: Atopic dermatitis, age at the first wheezing episode, Haemophilus and Streptococcus genera in the bronchoalveolar lavage fluid (BALF), bronchial smooth muscle (BSM) area, reticular basement membrane (RBM) thickness and RBM-BSM distance were all significantly different between No-Ex and/or Low-Ex and/or High-Ex. However, only atopic dermatitis, age at first episode of wheezing, Haemophilus genus in the BALF, RBM-BSM distance and BSM area were significantly and independently associated with exacerbation frequency. Among them, the BSM area was the sole parameter independently associated with each group. CONCLUSION: While atopic dermatitis, age at the first episode of wheezing, Haemophilus in BALF, RBM-BSM distance and BSM area appeared to be relevant independent parameters associated with exacerbation susceptibility in severe preschool wheezers, only the increased BSM area discriminated between each of the three-exacerbation frequency-based groups.

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Section: Discussionmentioning

confidence: 99%

Bronchial smooth muscle remodelling impacts the exacerbation frequency of severe preschool wheezers

Beaufils

Esteves

Enaud

et al. 2023

Preprint

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“…Atopic dermatitis by age 3 years was defined as fulfilling the diagnostic criteria for AD at one of the clinical follow-up investigations through either United Kingdom Working Party (UKWP) (3,6,12, or 36 months) and/or Hanifin and Rajka (H&R) (12, 24, or 36 months) criteria. 32…”

Section: Atopic Dermatitismentioning

confidence: 99%

“…While the underlying causes of asthma remain undetermined, the roots likely origin from early life. 4 Atopic dermatitis (AD), a common inflammatory skin disorder in infancy, often precedes asthma development, 6 indicating a possible link between the allergic diseases in early childhood. 7 Impaired skin barrier function is hypothesized to contribute to the development of inflammatory disorders, including allergic conditions of the skin and the lungs.…”

Section: Introductionmentioning

confidence: 99%

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Infant lung function and early skin barrier impairment in the development of asthma at age 3 years

Färdig,

Hoyer,

Almqvist

et al. 2024

Allergy

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BackgroundLargely unexplored, we investigated if lower lung function, impaired skin barrier function by transepidermal water loss (TEWL), eczema, and filaggrin (FLG) mutations in infancy were associated with asthma in early childhood.MethodsFrom the factorially designed randomized controlled intervention study PreventADALL, we evaluated 1337/2394 children from all randomization groups with information on asthma at age 3 years, and at age 3 months either lung function, TEWL, eczema, and/or FLG mutations. Lower lung function was defined as the time to peak tidal expiratory flow to expiratory time (tPTEF/tE) <0.25, and skin barrier impairment as a high TEWL >9.50 g/m2/h. Eczema was clinically observed, and DNA genotyped for FLG mutations. Asthma was defined as asthma‐like symptoms (≥3 episodes of bronchial obstruction) between age 2–3 years as well as a history of doctor‐diagnosed asthma and/or asthma medication use. Associations were analyzed in logistic regression models, presented with adjusted ORs (aOR) and 95% confidence intervals (CI).ResultsLower lung function and skin barrier impairment were associated with asthma in general; aOR (95% CI) 5.4 (2.1, 13.7) and 1.6 (1.1, 2.5), while eczema and FLG mutations were associated with asthma in children with atopic dermatitis or allergic sensitization only. Stratifying for sex, the risk of asthma was only increased in boys with lower lung function; aOR (95% CI) 7.7 (2.5, 23.6), and in girls with FLG mutations; aOR (95% CI) 3.5 (1.5, 8.2).ConclusionLower lung function and impaired skin barrier function in infancy may increase the risk of asthma at age 3 years.

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“…The use of biomarkers was further explored in a meta-analysis 53 of three previously reported randomized controlled trials in 1074 children aged 12-71 months (Table 6). 27,35,40 Blood eosinophil count and aeroallergen sensitization were determined at the start of the trial.…”

Section: Tre Atment Approache S: Per Sonalizing Ther Apy Us Ing B Iom...mentioning

confidence: 99%

Basic clinical management of preschool wheeze

Bush

2023

Pediatric Allergy Immunology

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Preschool wheeze is very common and often difficult to treat. Most children do not require any investigations; only a detailed history and physical examination to ensure an alternative diagnosis is not being missed; and the differential diagnosis, and hence investigation protocols for the child in whom a major illness is suspected, shows geographical variation. The pattern of symptoms may be divided into episodic viral and multiple trigger to guide treatment, but the pattern of symptoms must be re‐assessed regularly. However, symptom patterns are a poor guide to underlying pathology. Attention to the proper use of spacers, and adverse environmental exposures such as tobacco smoke exposure, is essential. There are no disease‐modifying therapies, so therapy is symptomatic. This paper reviews recent advances in treatment, including new data on the place of leukotriene receptor antagonists, prednisolone for acute attacks of wheeze, and antibiotics, based on new attempts to understand the underlying pathology in a way that is clinically practical.

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Blood Eosinophils for Prediction of Exacerbation in Preschool Children With Recurrent Wheezing

Cited by 13 publications

References 48 publications

Bronchial smooth muscle remodelling impacts the exacerbation frequency of severe preschool wheezers

Bronchial smooth muscle remodelling impacts the exacerbation frequency of severe preschool wheezers

Infant lung function and early skin barrier impairment in the development of asthma at age 3 years

Basic clinical management of preschool wheeze

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