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Färdig M, Hoyer A, Almqvist C, Bains KES, Carlsen KCL, Gudmundsdóttir HK, Granum B, Haugen GN, Hedlin G, Jonassen CM, Konradsen JR, Lie A, Rehbinder EM, Skjerven HO, Staff AC, Vettukattil R, Söderhäll C, Nordlund B. Infant lung function and early skin barrier impairment in the development of asthma at age 3 years. Allergy 2024; 79:667-678. [PMID: 38239099 DOI: 10.1111/all.16024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/08/2023] [Accepted: 12/17/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Largely 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. METHODS From 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). RESULTS Lower 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). CONCLUSION Lower lung function and impaired skin barrier function in infancy may increase the risk of asthma at age 3 years.
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Affiliation(s)
- Martin Färdig
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Angela Hoyer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Catarina Almqvist
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karen Eline S Bains
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Hrefna Katrín Gudmundsdóttir
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Berit Granum
- Department of Chemical Toxicology, Norwegian Institute of Public Health, Oslo, Norway
| | - Guttorm Nils Haugen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Christine Monceyron Jonassen
- Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anine Lie
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva Maria Rehbinder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Dermatology and Vaenerology, Oslo University Hospital, Oslo, Norway
| | - Håvard O Skjerven
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Cilla Söderhäll
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Nordlund
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Gulec Koksal Z, Uysal P. Beyond the Skin: Reduced Lung Function Associated With Atopic Dermatitis in Infants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2839-2847. [PMID: 37406805 DOI: 10.1016/j.jaip.2023.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Very few studies have examined lung function parameters using tidal breath analysis (TBA) in atopic dermatitis (AD) with its high potential for progression to asthma. OBJECTIVE To measure lung functions using TBA in infants with AD and in healthy controls (HCs), and to investigate the effects of disease severity, food sensitivity, and history of recurrent wheezing on TBA parameters in infants with AD. METHODS Two hundred thirty infants were included in this prospective cross-sectional study, including an AD group (n = 150) and an HC group (n = 80). Food sensitivity was assessed by means of food-specific IgE or the skin prick test. The severity of the disease was evaluated using the SCORing Atopic Dermatitis. Lung function was assessed using TBA. RESULTS The following TBA parameters were significantly lower in the AD group than in the HC group (P < .05): time to peak tidal expiratory flow, exhaled volume to peak tidal expiratory flow, ratio of time to peak tidal expiratory flow to expiratory time, ratio of exhaled volume to peak tidal expiratory flow to total expiratory volume, expiratory flow when 25% of tidal volume remains in the lungs, respiratory rate, and minute ventilation. No difference was observed in the AD group when TBA parameters were compared according to disease severity, food sensitivity, and history of recurrent wheezing (P > .05). The receiver-operating characteristic curve demonstrated by the ratio of time to peak tidal expiratory flow to expiratory time yielded an area under the curve of 0.826 (CI, 0.772-0.879), with a cutoff value of 31.65 or higher in differentiating AD, with a sensitivity of 78.7% and a specificity of 77.5%. CONCLUSIONS TBA curves can be a useful tool for demonstrating expiratory airway obstruction in AD and for providing objective information for the clinician. Bronchial obstruction was detected in young children with AD irrespective of the severity of the disease, food sensitivity, and history of recurrent wheezing.
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Affiliation(s)
- Zeynep Gulec Koksal
- Department of Pediatric Allergy and Immunology, Aydin Adnan Menderes University Faculty of Medicine, Aydin, Turkey.
| | - Pinar Uysal
- Department of Pediatric Allergy and Immunology, Aydin Adnan Menderes University Faculty of Medicine, Aydin, Turkey
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Zhang X, Liu J, Xu S, He F, Huang H, Wu B. Neonatal nutritional risk and pulmonary function. Medicine (Baltimore) 2022; 101:e29662. [PMID: 35960129 PMCID: PMC9371543 DOI: 10.1097/md.0000000000029662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The neonatal period is a critical initial stage of postnatal lung development and maturation. This study aimed to investigate the effects of the nutritional status on pulmonary function in late preterm and full-term neonates. METHODS A total of 172 newborns were included in the study. Nutritional risk screening, weight measurement, assessment of albumin and caloric intake, and a pulmonary function examination were conducted on the 7th day after birth. RESULTS There was a significant correlation between the nutritional risk and changes in body weight. Tidal volume (VT), minute ventilation (MV), VT per kg body weight (VT/kg), and MV per kg body weight (MV/kg) in the low nutritional risk group were significantly higher than those in the medium nutritional risk group (all P < .05). Albumin and caloric intake in the low nutritional risk group were significantly higher than those in the medium nutritional risk group (both P < .01). VT, VT/kg, MV, and MV/kg in the weight loss group were lower than those in the no weight loss group (all P < .05). CONCLUSIONS Changes in neonatal weight mainly affect lung volume (VT, VT/kg, MV, and MV/kg), suggesting that an improvement in the neonatal nutritional status is important for the development of lung volume.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Pediatrics and Neonatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Junhong Liu
- Department of Pediatrics and Neonatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuzheng Xu
- Department of Pediatrics and Neonatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fei He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Huanhuan Huang
- Department of Pediatrics and Neonatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bin Wu
- Department of Pediatrics and Neonatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- * Correspondence: Bin Wu, Pediatrics and Neonatology, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou City 350005, Fujian Province, China (e-mail: )
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Radics BL, Gyurkovits Z, Makan G, Gingl Z, Czövek D, Hantos Z. Respiratory Oscillometry in Newborn Infants: Conventional and Intra-Breath Approaches. Front Pediatr 2022; 10:867883. [PMID: 35444964 PMCID: PMC9013809 DOI: 10.3389/fped.2022.867883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oscillometry has been employed widely as a non-invasive and standardized measurement of respiratory function in children and adults; however, limited information is available on infants. AIMS To establish the within-session variability of respiratory impedance (Zrs), to characterize the degree and profile of intra-breath changes in Zrs and to assess their impact on conventional oscillometry in newborns. METHODS 109 healthy newborns were enrolled in the study conducted in the first 5 postpartum days during natural sleep. A custom-made wave-tube oscillometry setup was used, with an 8-48 Hz pseudorandom and a 16 Hz sinusoidal signal used for spectral and intra-breath oscillometry, respectively. A resistance-compliance-inertance (R-C-L) model was fitted to average Zrs spectra obtained from successive 30-s recordings. Intra-breath measures, such as resistance (Rrs) and reactance (Xrs) at the end-expiratory, end-inspiratory and maximum-flow points were estimated from three 90-s recordings. All natural and artifact-free breaths were included in the analysis. RESULTS Within-session changes in the mean R, C and L values, respectively, were large (mean coefficients of variation: 10.3, 20.3, and 26.6%); the fluctuations of the intra-breath measures were of similar degree (20-24%). Intra-breath analysis also revealed large swings in Rrs and Xrs within the breathing cycle: the peak-to-peak changes amounted to 93% (range: 32-218%) and 41% (9-212%), respectively, of the zero-flow Zrs magnitude. DISCUSSION Intra-breath tracking of Zrs provides new insight into the determinants of the dynamics of respiratory system, and highlights the biasing effects of mechanical non-linearities on the average Zrs data obtained from the conventional spectral oscillometry.
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Affiliation(s)
- Bence L Radics
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zita Gyurkovits
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Gergely Makan
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Dorottya Czövek
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Zoltán Hantos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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Perikleous E, Fouzas S, Karageorgiou A, Steiropoulos P, Nena E, Chatzimichael A, Tsalkidis A, Paraskakis E. Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis. World J Clin Pediatr 2021; 10:168-176. [PMID: 34868893 PMCID: PMC8603642 DOI: 10.5409/wjcp.v10.i6.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/30/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tidal breathing flow-volume (TBFV) analysis provides important information about lung mechanics in infants.
AIM To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.
METHODS In this cross-sectional study, TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge. The ratio of time to peak expiratory flow to total expiratory time (tPEF/tE) at baseline and after the administration of 400 mcg salbutamol was evaluated.
RESULTS A total of 56 infants (35 boys), aged 7.4 ± 2.8 mo, were included. Of them, 12.5% were exposed to tobacco smoke and 41.1% were breastfed less than 2 mo. There were no differences in baseline TBFV measurements between the breastfeeding groups; however, those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation (12% ± 10.4% vs 0.9% ± 7.1%; P < 0.001). Moreover, there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding (P < 0.001). In multivariate regression analysis, infants who breastfed less (regression coefficient -0.335, P = 0.010) or were exposed to cigarette smoke (regression coefficient 0.353, P = 0.007) showed a greater change in tPEF/tE after bronchodilation, independent of sex, prematurity, and family history of asthma or atopy.
CONCLUSION Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke, have TBFV measurements indicative of obstructive lung disease.
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Affiliation(s)
- Evanthia Perikleous
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Sotirios Fouzas
- Department of Paediatrics, University Hospital of Patras, University of Patras, Patra 26504, Greece
| | - Athina Karageorgiou
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Athanasios Chatzimichael
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Aggelos Tsalkidis
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, Heraklion 71500, Greece
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Eigenmann P. Comments on vitamin D and sensitization, asthma treatment, and lung function development. Pediatr Allergy Immunol 2021; 32:1137-1140. [PMID: 34333802 DOI: 10.1111/pai.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Pediatrics Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
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