1
|
Elnady HG, Sherif LS, ElGindi HD, Shaaban FA, Abdelmohsen AM, Salah DA, Abdel-Latif GA, Fahmy RF. Assessment of Quality of Life of Primary Caregivers of Egyptian Asthmatic Children and Adolescents. Indian J Community Med 2020; 45:410-414. [PMID: 33623191 PMCID: PMC7877440 DOI: 10.4103/ijcm.ijcm_436_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Asthma as a serious public health problem worldwide exerts a serious load on children's health-related quality of life (HRQOL) and their families. Objective: We assess the HRQOL of the primary caregivers of Egyptian asthmatic children and adolescents and its relation to HRQOL of their children and asthma severity. Materials and Methods: A cross-sectional study was conducted on 128 pairs of asthmatic children (7–16 years) and their primary caregivers. Pediatric asthma quality of life (QOL) questionnaire, pediatric asthma caregiver's QOL questionnaire, and asthma control questionnaire were used. Results: Uncontrolled asthmatic patients had statistically significantly lower mean caregiver score compared to controlled asthmatic (P < 0.005). There was a statistically significant positive correlation between caregiver's individual and overall QOL scores and their children (individual and overall QOL scores) (P < 0.05). A statistically significant negative correlation between asthma severity and QOL scores of the caregivers of asthmatic children and adolescents was found (P < 0.05). Conclusion: The QOL of the primary caregivers of asthmatic children is significantly adversely affected by their children's illness severity.
Collapse
Affiliation(s)
- Hala G Elnady
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Lobna S Sherif
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Hala D ElGindi
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Fatma A Shaaban
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Aida M Abdelmohsen
- Community Medicine Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Dina A Salah
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Ghada A Abdel-Latif
- Community Medicine Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Reham F Fahmy
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| |
Collapse
|
2
|
Fontan FCDS, Duwe SW, Santos KD, Silva JD. QUALITY OF LIFE EVALUATION AND ASSOCIATED FACTORSIN ASTHMATIC CHILDREN AND ADOLESCENTS ATTENDED IN A SPECIALIZED OUTPATIENT CLINIC. ACTA ACUST UNITED AC 2020; 38:e2018172. [PMID: 31939508 PMCID: PMC6958536 DOI: 10.1590/1984-0462/2020/38/2018172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/08/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the quality of life and its association with disease control, severity, allergic comorbidities and adherence to treatment in children and adolescents with asthma. METHODS A cross-sectional study that included children and adolescents aged seven to 17. The Paediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to assess their quality of life. Sociodemographic and clinical data were obtained from the chart and from a questionnaire. Descriptive statistics were performed and chi-square or Fisher's exact tests were used to verify the existence of associations between quality of life and disease control, severity, comorbidities and adherence to treatment. The level of statistical significance was set at p<0.05. RESULTS 101 children/adolescents were evaluated (62.4% boys), with a mean age of 10.1 years. On average, the PAQLQ score was ≤5.9 points, indicating moderate / severe quality of life impairment. Higher levels of control, as well as higher disease severity, were associated with higher quality of life impairment, both in total PAQLQ score and domains (p<0.05). The presence of comorbidities was also associated with higher quality of life impairment (p=0.01), except in the emotional function domain. Adherence to treatment showed no association with quality of life. CONCLUSIONS Children and adolescents with asthma present impairment in their quality of life, and this is related to poorer control and severity of the disease, as well as to the presence of allergic comorbidities.
Collapse
Affiliation(s)
| | | | | | - Jane da Silva
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| |
Collapse
|
3
|
McDonald VM, Hiles SA, Jones KA, Clark VL, Yorke J. Health-related quality of life burden in severe asthma. Med J Aust 2019; 209:S28-S33. [PMID: 30453870 DOI: 10.5694/mja18.00207] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/30/2018] [Indexed: 01/02/2023]
Abstract
It is largely unrecognised that the impacts of asthma are different in patients with severe disease compared with patients with mild to moderate disease. Severe asthma is associated with a significant health-related quality of life (HRQoL) burden due to excessive symptoms, frequent and life-threatening attacks, increased comorbidity burden, and high pharmacological treatment requirements. Interventions aimed at improving HRQoL need to be specifically tested in populations with severe asthma, including multicomponent interventions targeting the many clinical characteristics associated with the disease. It is necessary to have patient-reported outcome measures developed specifically for severe asthma. Public health messages recognising the significant burden of severe asthma on quality of life are needed.
Collapse
Affiliation(s)
- Vanessa M McDonald
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW
| | - Sarah A Hiles
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW
| | - Kimberley A Jones
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW
| | - Vanessa L Clark
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW
| | | |
Collapse
|
4
|
Melgarejo González-Conde V, Pérez-Fernández V, Ruiz-Esteban C, Valverde-Molina J. Impact of Self-Efficacy on the Quality of Life of Children With Asthma and Their Caregivers. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.arbr.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
5
|
Melgarejo González-Conde V, Pérez-Fernández V, Ruiz-Esteban C, Valverde-Molina J. Impact of Self-Efficacy on The Quality of Life of Children With Asthma and Their Caregivers. Arch Bronconeumol 2018; 55:189-194. [PMID: 30119934 DOI: 10.1016/j.arbres.2018.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/08/2018] [Accepted: 07/13/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Health-related quality of life is an important outcome measurement in the monitoring of asthma control. Self-efficacy is a determinant of self-management behaviors that can contribute to the improvement of asthma control and quality of life. Our objective was to analyze the relationship between self-efficacy and quality of life in children with asthma and their caregivers. METHODS We included 176 patients aged 6-14 years with asthma, and determined their level of self-efficacy according to three groups (low, medium and high levels). Each child and their main caregiver completed the PAQLQ and PACQLQ questionnaires, respectively. RESULTS PAQLQ range=1-7: 5.61±1.11; PACQLQ range=1-7: 5.42±1.35; self-efficacy range=0-60: low level 28.44±4.58; average level 37.41±1.7, and high level 47.50±5.5. Significant differences were observed in quality of life according to low-medium vs. high levels of self-efficacy. Specific related domains: PAQLQ emotions and PAQLQ symptoms with self-efficacy in problem-solving skills related to asthma and treatment self-efficacy; PACQLQ emotions with self-efficacy in problem-solving skills related to asthma. CONCLUSIONS A high level of self-efficacy is associated with a better quality of life for children and their caregivers. Based on these results, the measurement of self-efficacy could be incorporated in the assessment of educational interventions in self-management targeted at the quality of life of the patient and his or her family.
Collapse
Affiliation(s)
| | - Virginia Pérez-Fernández
- Departamento de Cirugía, Pediatría, Obstetricia y Ginecología, IMIB, Facultad de Medicina, Universidad de Murcia , El Palmar, Murcia, España
| | - Cecilia Ruiz-Esteban
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Murcia, Espinardo, Murcia, España
| | - José Valverde-Molina
- Departamento de Cirugía, Pediatría, Obstetricia y Ginecología, IMIB, Facultad de Medicina, Universidad de Murcia , El Palmar, Murcia, España; Unidad de Neumología Pediátrica, Hospital Universitario Los Arcos del Mar Menor, San Javier, Murcia, España
| |
Collapse
|
6
|
Mirra V, Montella S, Santamaria F. Pediatric severe asthma: a case series report and perspectives on anti-IgE treatment. BMC Pediatr 2018; 18:73. [PMID: 29466963 PMCID: PMC5820802 DOI: 10.1186/s12887-018-1019-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/29/2018] [Indexed: 12/22/2022] Open
Abstract
Background The primary goal of asthma management is to achieve disease control for reducing the risk of future exacerbations and progressive loss of lung function. Asthma not responding to treatment may result in significant morbidity. In many children with uncontrolled symptoms, the diagnosis of asthma may be wrong or adherence to treatment may be poor. It is then crucial to distinguish these cases from the truly “severe therapy-resistant” asthmatics by a proper filtering process. Herein we report on four cases diagnosed as difficult asthma, detail the workup that resulted in the ultimate diagnosis, and provide the process that led to the prescription of omalizumab. Case presentation All children had been initially referred because of asthma not responding to long-term treatment with high-dose inhaled steroids, long-acting β2-agonists and leukotriene receptor antagonists. Definitive diagnosis was severe asthma. Three out four patients were treated with omalizumab, which improved asthma control and patients’ quality of life. We reviewed the current literature on the diagnostic approach to the disease and on the comorbidities associated with difficult asthma and presented the perspectives on omalizumab treatment in children and adolescents. Based on the evidence from the literature review, we also proposed an algorithm for the diagnosis of pediatric difficult-to-treat and severe asthma. Conclusions The management of asthma is becoming much more patient-specific, as more and more is learned about the biology behind the development and progression of asthma. The addition of omalizumab, the first targeted biological treatment approved for asthma, has led to renewed optimism in the management of children and adolescents with atopic severe asthma.
Collapse
Affiliation(s)
- Virginia Mirra
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
7
|
Nordlund B, James A, Ebersjö C, Hedlin G, Broström EB. Differences and similarities between bronchopulmonary dysplasia and asthma in schoolchildren. Pediatr Pulmonol 2017. [PMID: 28636794 DOI: 10.1002/ppul.23741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The long-term respiratory characteristics of ex-preterm children with bronchopulmonary dysplasia (BPD) are not established. The objective of this study was to describe hallmarks of BPD at school age in comparison to children with atopic asthma. METHODS This study was a cross-sectional descriptive comparative study in a hospital-based setting. Thirty schoolchildren diagnosed with BPD (10.4 years/born at 26.6 weeks' gestation) and 30 age- and sex-matched children with asthma and sensitized to airborne allergens (IgE >0.35 kUA /L) were analyzed. Measurements included fraction of exhaled nitric oxide (FENO, ppb), dynamic and static lung function, and bronchial provocation with methacholine (PD:20) and mannitol (PD:15), as well as an evaluation of respiratory symptoms using the asthma control test (C-ACT). RESULTS Lung function measures (FEV1% 77 vs 84, FEV1/FVC% 85 vs 91, FEF50% 61 vs 80) and carbon monoxide diffusion capacity (DLCO%, 81 vs 88) were all reduced in children with BPD compared to asthma (P values <0.042). FENO values were also significantly lower in children with BPD (12 vs 23, P = 0.019). The proportion of positive methacholine tests (74% vs 93%, P = 0.14) was comparable between BPD and asthma. However, less responsiveness towards mannitol (19% vs 61%, P = 0.007) and fewer self-reported symptoms (C-ACT, median 26 vs 24, P = 0.003) were found in the BPD group. CONCLUSION Respiratory hallmarks of BPD at school-age were reduced lung function, limited responsiveness towards indirectly acting mannitol but hyper-responsiveness towards direct acting methacholine and impairment in diffusion capacity. Children with BPD displayed less evidence of airway inflammation compared with atopic asthma.
Collapse
Affiliation(s)
- Björn Nordlund
- Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna James
- Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christina Ebersjö
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva B Broström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
8
|
Hashimoto N, Hashimoto H. The Association Between Maternal Employment and Prevalence of Asthma in Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2016; 29:143-148. [DOI: 10.1089/ped.2016.0641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naoya Hashimoto
- Department of Health and Social Behavior, The University of Tokyo School of Public Health, Tokyo, Japan
| | - Hideki Hashimoto
- Department of Health and Social Behavior, The University of Tokyo School of Public Health, Tokyo, Japan
| |
Collapse
|
9
|
Öborn H, Wettergren L, Herthelius M, Forinder U. Associations between lower urinary tract dysfunction and health-related quality of life in children with chronic kidney disease. Acta Paediatr 2016; 105:959-66. [PMID: 27127995 PMCID: PMC5089597 DOI: 10.1111/apa.13453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/01/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022]
Abstract
Aim Little is known about the health‐related quality of life (HRQoL) of children with lower urinary tract dysfunction (LUTD) and chronic kidney disease (CKD). We investigated LUTD and other possible predictors of impaired HRQoL in children with conservatively treated moderate‐to‐severe CKD or with a kidney transplant. Methods All 64 children with CKD or a kidney transplant treated at Karolinska University Hospital, Stockholm, Sweden, between June 2011 and December 2012 were approached and 59 children aged 8–18 were enrolled in the study. Lower urinary tract function was evaluated with voiding history, frequency and volume chart, uroflowmetry and postvoid ultrasound measurements. Self‐reported HRQoL was assessed with validated generic instruments. Results The HRQoL of the study cohort was as good as the general paediatric population, apart from the physical and psychological well‐being dimensions, and was no different to children with other chronic conditions. Urinary incontinence, but not LUTD in general, was associated with impaired HRQoL, as was having a kidney transplant and being female in some dimensions. Conclusion LUTD was common in children with CKD or a kidney transplant but did not affect their general HRQoL. Predictors of impaired HRQoL included incontinence, having had a kidney transplant and being female.
Collapse
Affiliation(s)
- Helena Öborn
- Department of Clinical Science, Technology and Intervention Division of Pediatrics Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society Division of Nursing Karolinska Institutet Stockholm Sweden
| | - Maria Herthelius
- Department of Clinical Science, Technology and Intervention Division of Pediatrics Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Ulla Forinder
- Department of Neurobiology, Care Sciences and Society Division of Social Work Karolinska Institutet Stockholm Sweden
- Department of Health and Working Life Division of Social Work and Psychology University of Gävle Gävle Sweden
| |
Collapse
|
10
|
Montella S, Baraldi E, Cazzato S, Aralla R, Berardi M, Brunetti LM, Cardinale F, Cutrera R, de Benedictis FM, di Palmo E, Di Pillo S, Fenu G, La Grutta S, Lombardi E, Piacentini G, Santamaria F, Ullmann N, Rusconi F. Severe asthma features in children: a case-control online survey. Ital J Pediatr 2016; 42:9. [PMID: 26796331 PMCID: PMC4722711 DOI: 10.1186/s13052-016-0217-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/14/2016] [Indexed: 11/20/2022] Open
Abstract
Background Very few studies have explored the distinguishing features of severe asthma in childhood in Europe, and only one study was conducted in Southern Europe. The aim of this study was to provide a detailed characterization of children with severe asthma treated in specialized pediatric asthma centers across Italy. Methods We conducted a web-based data collection of family, environmental, clinical and laboratory characteristics of 41 patients aged 6–17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients’ characteristics and severe asthma or non-severe persistent asthma. Results Features independently and significantly associated with severe asthma included lifetime sensitization to food allergens [Odds ratio (OR), 4.73; 95 % Confidence Interval (CI), 1.21–18.53; p = 0.03], lifetime hospitalization for asthma (OR, 3.71; 95 % CI, 1.11–12.33; p = 0.03), emergency-department visits for asthma during the past year (OR = 11.98; 95 % CI, 2.70–53.11; p = 0.001), and symptoms triggered by physical activity (OR = 12.78; 95 % CI, 2.66–61.40; p = 0.001). Quality-of-life score was worse in patients with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40 % of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56 % of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients’ comorbidities, adherence to therapy, exhaled nitric oxide values, and serum eosinophils and IgE . Conclusions As expected, children with severe asthma had more severe clinical course and worse lung function than peers with non-severe persistent asthma. Unlike previous reports, we found greater sensitization to food allergens and similar environmental and personal characteristics in patients with severe asthma compared to those with non-severe persistent asthma. Psychological aspects are compromised in a large number of cases and deserve further investigation. Electronic supplementary material The online version of this article (doi:10.1186/s13052-016-0217-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padua, Padua, Italy.
| | - Salvatore Cazzato
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Raffaele Aralla
- High Altitude Pediatric Asthma Center-Pio XII Institute, Misurina, Italy.
| | - Mariangela Berardi
- Women's and Children's Health Department, University of Padua, Padua, Italy.
| | | | - Fabio Cardinale
- Department of Pediatrics, Pediatric Hospital "Giovanni XXIII", University of Bari, Bari, Italy.
| | - Renato Cutrera
- Respiratory Unit, Department of Pediatric Medicine, Bambino Gesù Children Hospital, Rome, Italy.
| | | | - Emanuela di Palmo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | | | - Grazia Fenu
- Pediatric Pulmonary Unit, A. Meyer Children's University Hospital, Florence, Italy.
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology of National Research Council, University of Palermo, Palermo, Italy. .,Department of Science for Health Promotion and Mother and Child, University of Palermo, Palermo, Italy.
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, A. Meyer Children's University Hospital, Florence, Italy.
| | - Giorgio Piacentini
- Pediatric Section, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Nicola Ullmann
- Respiratory Unit, Department of Pediatric Medicine, Bambino Gesù Children Hospital, Rome, Italy.
| | - Franca Rusconi
- Epidemiology Unit, A. Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | | |
Collapse
|
11
|
Konradsen JR, Caffrey Osvald E, Hedlin G. Update on the current methods for the diagnosis and treatment of severe childhood asthma. Expert Rev Respir Med 2015; 9:769-77. [PMID: 26414277 DOI: 10.1586/17476348.2015.1091312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The level of asthma control is the key outcome towards which asthma management is evaluated. The majority of children with asthma can obtain adequate control of symptoms through avoidance of triggering factors and/or with the help of low to moderate doses of current available medications. However, there is still a group of children with poor symptom control despite intensive treatment. The current review will provide an overview of a standardized approach to characterize this heterogeneous group of severely sick children. Factors that attenuate the effect of the prescribed treatment and make asthma difficult to treat are discussed. In addition, the usefulness of current methods of assessing asthma severity, pulmonary function, allergy and airway inflammation is also described. Finally, an overview of therapeutic options for children with severe asthma is provided.
Collapse
Affiliation(s)
- Jon R Konradsen
- a 1 Department of Woman's and Children's Health, Karolinska Institutet, SE-17176 Stockholm, Sweden.,b 2 Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Emma Caffrey Osvald
- a 1 Department of Woman's and Children's Health, Karolinska Institutet, SE-17176 Stockholm, Sweden.,b 2 Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Hedlin
- a 1 Department of Woman's and Children's Health, Karolinska Institutet, SE-17176 Stockholm, Sweden.,b 2 Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
12
|
Fleming L, Murray C, Bansal AT, Hashimoto S, Bisgaard H, Bush A, Frey U, Hedlin G, Singer F, van Aalderen WM, Vissing NH, Zolkipli Z, Selby A, Fowler S, Shaw D, Chung KF, Sousa AR, Wagers S, Corfield J, Pandis I, Rowe A, Formaggio E, Sterk PJ, Roberts G. The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts. Eur Respir J 2015; 46:1322-33. [PMID: 26405287 DOI: 10.1183/13993003.00780-2015] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/23/2015] [Indexed: 11/05/2022]
Abstract
U-BIOPRED aims to characterise paediatric and adult severe asthma using conventional and innovative systems biology approaches. A total of 99 school-age children with severe asthma and 81 preschoolers with severe wheeze were compared with 49 school-age children with mild/moderate asthma and 53 preschoolers with mild/moderate wheeze in a cross-sectional study. Despite high-dose treatment, the severe cohorts had more severe exacerbations compared with the mild/moderate ones (annual medians: school-aged 3.0 versus 1.1, preschool 3.9 versus 1.8; p<0.001). Exhaled tobacco exposure was common in the severe wheeze cohort. Almost all participants in each cohort were atopic and had a normal body mass index. Asthma-related quality of life, as assessed by the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), was worse in the severe cohorts (mean±se school-age PAQLQ: 4.77±0.15 versus 5.80±0.19; preschool PACQLQ: 4.27±0.18 versus 6.04±0.18; both p≤0.001); however, mild/moderate cohorts also had significant morbidity. Impaired quality of life was associated with poor control and airway obstruction. Otherwise, the severe and mild/moderate cohorts were clinically very similar. Children with severe preschool wheeze or severe asthma are usually atopic and have impaired quality of life that is associated with poor control and airflow limitation: a very different phenotype from adult severe asthma. In-depth phenotyping of these children, integrating clinical data with high-dimensional biomarkers, may help to improve and tailor their clinical management.
Collapse
Affiliation(s)
- Louise Fleming
- National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK
| | - Clare Murray
- Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Aruna T Bansal
- Acclarogen Ltd, St John's Innovation Centre, Cambridge, UK
| | - Simone Hashimoto
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK Dept of Paediatrics, Imperial College London, London, UK Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Urs Frey
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Gunilla Hedlin
- Dept of Women's and Children's Health and Center for Allergy Research, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Florian Singer
- University Children's Hospital Zurich, Zurich, Switzerland University Children's Hospital Bern, Bern, Switzerland
| | - Wim M van Aalderen
- Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nadja H Vissing
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zaraquiza Zolkipli
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Anna Selby
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Stephen Fowler
- Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK Airways Clinic, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Dominick Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, UK
| | | | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden Areteva, Nottingham, UK
| | - Ioannis Pandis
- Data Science Institute, South Kensington Campus, Imperial College London, London, UK
| | | | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Graham Roberts
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | | |
Collapse
|
13
|
Braig S, Brandt S, Wabitsch M, Florath I, Brenner H, Rothenbacher D, Genuneit J. Age-specific influence of wheezing phenotypes on pre-adolescent and adolescent health-related quality of life. Pediatr Allergy Immunol 2014; 25:781-7. [PMID: 25229563 DOI: 10.1111/pai.12280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Asthma is associated with diminished health-related quality of life (HRQoL). Particularly in adolescence, asthma may be under-diagnosed and undertreated or poorly managed. Therefore, we aimed to determine the association between childhood wheezing phenotypes rather than asthma and adolescent HRQoL in children aged 10-17 yr. METHODS We analyzed the data from two prospective population-based cohort studies (n = 604 and n = 1804) conducted in southern Germany with baseline assessments in 2000 and 2006 and follow-ups at frequent intervals. Parent-reported wheeze was categorized into never, early transient, persistent, and late-onset wheeze. We assessed child-reported HRQoL in seven scales using the validated KINDL-R. Multivariate linear regression models were computed. RESULTS Participants with late-onset wheeze had significantly lower values in all HRQoL scales, but physical well-being compared to never wheezers. Early transient wheeze was negatively associated with three HRQoL scales only (family, school, and total). These effects were confined to the oldest age group (≥13.5 yr) in one study. Persistent wheeze was not associated with HRQoL. CONCLUSIONS In teenagers, late-onset wheezers seem to be particularly vulnerable for impairments in psychosocial aspects of health-related quality of life. They may therefore require particular attention with regard to education about asthma management and potentially family-based psychosocial intervention.
Collapse
Affiliation(s)
- Stefanie Braig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | | | | | | | | | | |
Collapse
|
14
|
Valverde-Molina J. Identifying severe asthma in pediatrics: the glass half full or half empty. Allergol Immunopathol (Madr) 2014; 42:507-9. [PMID: 25454925 DOI: 10.1016/j.aller.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/27/2014] [Indexed: 11/27/2022]
|
15
|
Nordlund B, Melén E, Schultz ES, Grönlund H, Hedlin G, Kull I. Prevalence of severe childhood asthma according to the WHO. Respir Med 2014; 108:1234-7. [PMID: 24939389 DOI: 10.1016/j.rmed.2014.05.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recently proposed a new definition of severe asthma to facilitate standardized characterization of patients, and enable more accurate estimations of the prevalence of severe asthma. The aim of this study was to estimate the prevalence of severe asthma according to the WHO definition in children aged 12 years, in Stockholm, Sweden. METHODS The birth cohort BAMSE enrolled 4089 children during 1994-96. Parental questionnaires provided information on asthma-related symptoms, diagnosis and medication from 3015 enrolled children at the age of 12 years. Severe asthma was defined as the presence of asthma, as well as continuous treatment with inhaled corticosteroids and long-acting beta-2 agonists, based on information from the Swedish prescribed drug register demonstrating prescriptions of at least 800 μg budesonide daily (or equivalent). RESULTS The prevalence of asthma was 11% among 12-year-olds (n = 329). Based on information from the Swedish prescribed drug register, seven children with asthma fulfilled the definition of severe asthma. The estimated prevalence corresponds to 0.23% (95% CI, 0.06-0.4) of the population, or 2.1% (95% CI, 0.5-3.7) of children with asthma. Based on assessed markers of asthma control, 3/7 with severe asthma were considered to have controlled asthma and 4/7 had partly or uncontrolled asthma. CONCLUSION Severe asthma appears rare both among 12-year-old schoolchildren with asthma and in the general population. Combining self-reported information from a population-based birth cohort with data from a drug register seems trustworthy in estimating severe asthma as defined by the WHO.
Collapse
Affiliation(s)
- Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Sachs' Children's Hospital, Södersjukhuset, Stockholm, Sweden
| | - Erica S Schultz
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Grönlund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Inger Kull
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Sachs' Children's Hospital, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Heart rate variability reflects the natural history of physiological development in healthy children and is not associated with quality of life. PLoS One 2014; 9:e91036. [PMID: 24625571 PMCID: PMC3953202 DOI: 10.1371/journal.pone.0091036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/10/2014] [Indexed: 01/13/2023] Open
Abstract
Background Quality of life (QoL), being the sum expression of diverse influencing factors, is not easy to determine. A clinically relevant option would be to identify and measure quality of life on the basis of physiological parameters which correlate plausibly and statistically with psychometrically measured QoL. Analysis of heart rate variability (HRV) offers readily measurable physiological parameters which could be of use here. A correlation of HRV with both course of disease and QoL has been reported in patients with chronic illness. Various psychometric instruments have been developed for use in paediatric oncology. The aim of this study was to obtain data on HRV and QoL and their correlations, initially in healthy children. Methods Holter ECG and quality of life were examined in 160 children and adolescents (72 male) aged between 8 and 18 years. QoL was determined with the established questionnaire PEDQoL. Standard parameters of HRV from the frequency domain were calculated and correlated with QoL domains using Spearman (nonparametric) correlation analysis. Results Minor but significant associations were revealed only with regard to the PEDQoL domain “autonomy” on the one hand and heart rate and HRV (e.g. MRR, MRRn, MRRd, HRV_ULF, SDNN) parameters which evidently reflect distinct physiological functions on the other. Conclusions In healthy children and adolescents we have a first indication that there is a correlation between parameters of HRV and QoL. However, to a greater extent, HRV reflects associated physiological processes of the autonomic nervous system. A higher correlation is more likely to be found in chronically ill children.
Collapse
|
17
|
Hedlin G. Management of severe asthma in childhood--state of the art and novel perspectives. Pediatr Allergy Immunol 2014; 25:111-21. [PMID: 24102748 DOI: 10.1111/pai.12112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/30/2022]
Abstract
The majority of children with asthma have mild or moderate disease and can obtain adequate control of symptoms through avoidance of triggering factors and/or with the help of medications. There is still a group of children with severe asthma in whom symptom control is poor depending either on identifiable aggravating factors or on true therapy resistance. These children have a poor quality of life and are limited by the severity of their disease. There is a need for a staged approach to the assessment and treatment of this small but vulnerable and resource-consuming group. The current review will provide an overview of a possible standardized approach to characterize this heterogeneous group of severely sick children including some newly developed ways of assessing asthma severity and potentialities of new asthma therapies. Furthermore, the umbrella term 'problematic severe asthma' is described. The term encompasses children whose severe asthma is due to identifiable exacerbating factors, as well as children who are resistant to any conventional therapeutic approach. Characteristics of these two groups of children are described, as are possible biomarkers and current and emerging diagnostic tools for allergy evaluation. Some recent advances and future possibilities for treatment of severe asthma are also presented in this review.
Collapse
Affiliation(s)
- Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
18
|
Petsios KT, Priftis KN, Hatziagorou E, Tsanakas JN, Antonogeorgos G, Matziou VN. Determinants of quality of life in children with asthma. Pediatr Pulmonol 2013; 48:1171-80. [PMID: 23401462 DOI: 10.1002/ppul.22768] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 11/19/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND HRQoL in children with asthma depends on multiple factors, among which asthma severity and level of control are believed to play a vital role. The determinants of the connection between asthma severity and asthma control with quality of life remain unclear. AIMS Primary aim of the study was to evaluate the HRQoL in children with asthma and to determine the factors that affect it. MATERIALS AND METHODS In total 504 children and one of their parents were recruited during a regular follow up visit in an outpatient asthma clinic. The measures used were the DISABKIDS smiley measure (DSmM), chronic generic measure-long form (DCGM-37) and the Condition-specific modules for asthma along with a special form for collecting demographic and clinical characteristics. RESULTS Three hundred fifteen children with mean age 5.35 years (Group A) and 189 with mean age 10.79 years (Group B), were recruited. Children with controlled asthma had significant higher mean score than the other asthma control groups (P < 0.001). Corticosteroid use, asthma severity, number of visits in doctor's office and lack of asthma control were significantly associated with the DCGM-37 scores as well as Impact Scale and Worry Scale. Lack of Asthma Control was the only factor that was associated with negative HRQoL in all the multiple regression models, controlling for the effect of the other covariates, in both age groups. CONCLUSIONS In conclusion, the evaluation of asthma HRQoL independently reflects the asthma control state and a dimension of its severity. These results highlight the need to modify asthma management strategy.
Collapse
Affiliation(s)
- Konstantinos Th Petsios
- Pediatric Cardiosurgical Intensive Care Unit, "Onassis" Cardiac Surgery Center, Athens, Greece; Faculty of Nursing, National & Kapodistrian University of Athens, Athens, Greece. ,
| | | | | | | | | | | |
Collapse
|
19
|
Gomes de Souza P, Couto Sant'anna C, B Pombo March MDF. Quality of life in children with asthma in Rio de Janeiro, Brazil. Indian J Pediatr 2013; 80:544-8. [PMID: 23263971 DOI: 10.1007/s12098-012-0930-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 11/22/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the impact of asthma on activity limitation, symptoms and emotional function in the health-related quality of life (HRQL) of asthmatic children. METHODS A cross-sectional study involving 59 children of 7 to 12 y of age. A standardized version of the Pediatric Asthma Quality of Life Questionnaire was used to evaluate HRQL and the current criteria for socioeconomic stratification in Brazil were used to assess socioeconomic status. Independent variables evaluated included clinical and sociodemographic characteristics. The association between mean HRQL scores and the independent variables was evaluated using the Mann-Whitney, Kruskal-Wallis and Dunn tests. Statistical significance was defined as a p-value < 0.05. RESULTS Thirty-two families (56.1 %) had a total household income of more than two minimum wages, while 37 families (62.7 %) were considered lower middle class. Mean overall HRQL score was 4.8 ± 1.3 (out of a maximum score of 7), suggesting reasonable HRQL. There was a weak association between independent variables and mean overall HRQL scores and the mean scores in the emotional function domain. Higher socioeconomic status was related to higher scores for the symptoms domain (p = 0.041). Furthermore, children exposed to indoor mould reported greater impairment in the symptoms domain(p = 0.022). The severity of asthma was associated with the activity limitation domain (p = 0.025). CONCLUSIONS These results showed a reasonable mean HRQL score and an association between the severity of asthma and the activity limitation domain.
Collapse
|
20
|
Verkleij M, van de Griendt EJ, Kaptein AA, van Essen-Zandvliet LEM, Duiverman EJ, Geenen R. The prospective association between behavioural problems and asthma outcome in young asthma patients. Acta Paediatr 2013; 102:504-9. [PMID: 23369003 DOI: 10.1111/apa.12179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 01/08/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
AIM The aim of this prospective study was to examine the association between behavioural problems and medical and psychological outcomes in clinically treated children and adolescents with asthma. METHODS Patients (n = 134) were recruited from two high-altitude asthma clinics in Switzerland and one asthma clinic in the Netherlands. Outcome measures were Asthma Control Test (ACT), Paediatric Asthma Quality of Life Questionnaire (PAQLQ(S)), forced expiratory volume in 1 sec (FEV1 ) and fractional concentration of exhaled nitric oxide (FeNO). Parents completed the Child Behaviour Checklist (CBCL) (predictor variable). Data were collected at the start and end of treatment. Multiple regression analysis was used while adjusting for demographic variables, clinic and length of stay. RESULTS More severe internalizing behavioural problems were associated with less improvement of total quality of life (t = -2.26, p = 0.03) and the domains symptoms (t = -2.04, p = 0.04) and emotions (t = -2.3, p = 0.02) after clinical treatment. Behavioural problems were not associated with a change of lung function measurements (FEV1 and FeNO) and asthma control (ACT) during treatment. CONCLUSION A focus of healthcare professionals on the treatment of internalizing behavioural problems may optimize the quality of life in clinically treated youth with asthma.
Collapse
Affiliation(s)
| | | | - Adrian A Kaptein
- Unit of Psychology; Leiden University Medical Centre; Leiden; the Netherlands
| | | | - Eric J Duiverman
- Department of Paediatrics; Division of Paediatric Pulmonology; University of Groningen; Beatrix Children's Hospital; University Medical Centre Groningen; GRIAC Research Institute Groningen; Groningen; the Netherlands
| | | |
Collapse
|
21
|
Nordlund B, Konradsen JR, Kull I, Borres MP, Önell A, Hedlin G, Grönlund H. IgE antibodies to animal-derived lipocalin, kallikrein and secretoglobin are markers of bronchial inflammation in severe childhood asthma. Allergy 2012; 67:661-9. [PMID: 22339365 DOI: 10.1111/j.1398-9995.2012.02797.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Component-resolved allergy diagnostics enables the detection of crossreactive or species-specific allergen components. This study analysed Immunoglobulin E (IgE) profiles to single allergen components in relation to bronchial inflammation in severe childhood asthma. METHODS Ninety-five schoolchildren were assessed, 39 with controlled mild-to-moderate asthma and 56 uncontrolled severe asthmatics. Allergen components (n = 111) of food allergens, pollen and perennial aeroallergens were analysed using an immunosolid-phase allergen chip. Blood eosinophils (10(9) × l(-1)), bronchial inflammation (FeNO, ppb), lung function (FEV(1)%) and bronchial hyper-responsiveness (BHR) (dose-response slope of methacholine challenge) were measured. RESULTS A specific IgE response to more than three animal-derived components--lipocalin (nMus m 1, rEqu c 1, Fel d 4, rCan f 1, 2), kallikrein (rCan f 5) and secretoglobin (rFel d 1)--was more common among severe asthmatics compared to children with controlled asthma (n = 14 vs n = 3, P = 0.030). These subjects also displayed higher blood eosinophils (0.65 vs 0.39, P = 0.021), higher Fractional exhaled nitric oxide (38 ppb vs 25 ppb, P = 0.021) and increased BHR (112 vs 28, P = 0.002) compared to other severe asthmatics positive to fewer lipocalin/kallikrein/secretoglobin components. Among all sensitized subjects, there were correlations between specific IgE levels for rFel d 4 and nMus m 1 (r = 0.751, P ≤ 0.001) and for rFel d 4 and rEqu c 1 (r = 0.850, P ≤ 0.001). CONCLUSION Multi-sensitization towards lipocalin, kallikrein and secretoglobin components is associated with increased bronchial inflammation in severe asthmatics. In addition, crossreactive patterns were observed between different lipocalin components.
Collapse
Affiliation(s)
| | | | | | - M. P. Borres
- Department of Scientific Affairs; Phadia AB; Uppsala; Sweden
| | - A. Önell
- Department of Scientific Affairs; Phadia AB; Uppsala; Sweden
| | | | | |
Collapse
|