Clinical and Pathologic Factors Predicting Future Asthma in Wheezing Children. A Longitudinal Study

Abstract

Wheeze is a common symptom in infants, but not all wheezers develop asthma. Indeed, up to 50% of wheezing children outgrow their symptoms by school age. How to predict if early wheeze will become asthma is still a matter of vivid debate. In this work, we sought to assess the clinical and pathological factors that might predict the future development of asthma in children. Eighty children (mean age 3.8 ± 1 yr) who underwent a clinically indicated bronchoscopy were followed prospectively for a median of 5 years. At baseline, clinical characteristics with a particular focus on wheezing and its presentation (episodic or multitrigger) were collected, and structural and inflammatory changes were quantified in bronchial biopsies. Follow-up data were available for 74 of the 80 children. Children who presented with multitrigger wheeze were more likely to have asthma at follow-up than those with episodic wheeze (P = 0.04) or without wheeze (P < 0.0001). Children with asthma also had lower birth weights (P = 0.02), a lower prevalence of breastfeeding (P = 0.02), and a trend for increased IgE (P = 0.07) at baseline than those with no asthma. Basement membrane thickness and airway eosinophils at baseline were increased in children who developed asthma at follow-up (P = 0.001 and P = 0.026, respectively). Multivariate analysis showed that among all clinical and pathological factors, multitrigger wheezing, basement membrane thickening, and reduced birth weight were predictive of future asthma development. We conclude that multitrigger wheeze and reduced birth weight are clinical predictors of asthma development. Basement membrane thickening in early childhood is closely associated with asthma development, highlighting the importance of airway remodeling in early life as a risk factor for future asthma.

High-Resolution Computed Tomography (HRCT) Reflects Disease Progression in Patients with Idiopathic Pulmonary Fibrosis (IPF): Relationship with Lung Pathology

“…Statistical analyses were performed as previously described [20] (Supplementary Materials). To compare clinical and pathological data between rapids and slows , Chi square test or Fisher’s exact test and Mann–Whitney U test were used when appropriate.…”

Cytokines and Chemokines as Biomarkers of Future Asthma

“…In a follow up study of infants with really severe wheeze who underwent airway biopsy at 30 months of age (20), increased airway smooth muscle, but not eosinophilic inflammation or reticular basement membrane thickening, was predictive of a school age asthma diagnosis (21). Another follow up study also failed to implicate eosinophilic inflammation as a marker of future asthma risk; there were insufficient biopsies for smooth muscle to be assessed, but reticular basement membrane thickness was predictive of a subsequent asthma diagnosis (22, 23).…”

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

“…When we performed a multivariate analysis, only RBM thickening remained a significant predictor of asthma persistence. Even when we limited our analysis to toddlers only (children under 3 years), RBM thickening at this early age remained a significant predictor of asthma later in life [70].…”