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Yu Y, Meng W, Zhu X, Li B, Yang J, Zhang Y, Wang X, Luo J, Wang Y, Xuan Y. Tidal breathing lung function analysis of wheezing and non-wheezing infants with pneumonia: A retrospective observational study. Medicine (Baltimore) 2023; 102:e33507. [PMID: 37058014 PMCID: PMC10101276 DOI: 10.1097/md.0000000000033507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
To compare lung function in wheezing and non-wheezing infants with pneumonia through tidal breathing analysis and explore the correlation between tidal breathing lung function and clinical characteristics. This retrospective observational study included infants with pneumonia hospitalized in the Affiliated Hospital of Guizhou Medical University between January 2018 and December 2018. Medical records were used to obtain the demographic characteristics, clinical characteristics, tidal breathing lung function results before and after a bronchodilator test, and positive remission rates after the bronchodilator test for each patient. Eighty-six wheezing infants (64 males, aged 6.5 [4.8, 9] months) and 27 non-wheezing infants (18 males, aged 7 [5, 12] months) were included. Non-wheezing infants were more likely to have normal airway function compared to wheezing infants (44.4% vs 23.3%, P = .033). Peak tidal expiration flow/tidal expiratory flow (TEF)25 in wheezing infants was significantly higher than that in non-wheezing infants (162.4 [141.2, 200.7] vs 143.3 [131, 178.8], P = .037). The positive remission rate of tidal inspiratory flow (TIF50)/TEF50 (53.5% vs 29.6%, P = .03) and TEF50 (58.1% vs 33.3%, P = .024) were significantly higher in the wheezing infants compared to non-wheezing infants (P = .03 and P = .024, respectively). Furthermore, respiratory rate, tidal volume, peak expiration flow, TEF25, TEF50, and TEF75 were significantly correlated to the age, height, weight, and platelet counts of infants in both the wheezing and non-wheezing infants (all P < .05). Wheezing infants with pneumonia were more likely to have worse tidal breathing lung function compared to non-wheezing infants with pneumonia. The tidal breathing lung function parameter (respiratory rate, tidal volume, peak expiration flow, TEF25, TEF50, and TEF75) were correlated to the age, height, weight, and platelet counts of both wheezing and non-wheezing infants.
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Affiliation(s)
- Yiyi Yu
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Wenjuan Meng
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xiaoping Zhu
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Bo Li
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jun Yang
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yali Zhang
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xuesong Wang
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jing Luo
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Youyan Wang
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yingying Xuan
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Bacterial composition and colony structure of the lower respiratory tract in infants and children with recurrent wheezing: a case-control study. Ital J Pediatr 2022; 48:120. [PMID: 35854266 PMCID: PMC9297564 DOI: 10.1186/s13052-022-01279-6] [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: 11/05/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The bacterial load of the human lower respiratory tract is at least several times lower than that of the other parts of the body. This study aimed to identify the bacterial composition and colony structure of the lower respiratory tract in infants and children with recurrent wheezing compared with those of children with a bronchial foreign body and clarify whether the length of wheezing in infants can contribute to differences in the lower respiratory tract's bacterial colony structure. METHODS We collected specimens of alveolar lavage fluid from 48 infants and children who underwent fiberoptic bronchoscopy and were divided into groups: A1 (multiple wheezing: wheezing more than three times in < 1 month), A2 (persistent wheezing: > 1 month), and B (bronchial foreign body; control group). We analyzed the bacterial community structure of alveolar lavage fluid using high-throughput sequencing. The richness and diversity of the microbial communities were assessed by α and β diversity analyses. RESULTS A total of 6,644 operational taxonomic units (OTUs) were obtained based on the Illumina Nova sequencing platform and clustered according to those that met the 97% identity threshold, followed by species annotation of the OTU sequences. In the annotation results, 2,608 (39.25%) OTUs were annotated at the genus level. At the genus level, Sphingomonas and Phyllobacterium were significantly higher in group A1 than in group B. There were significantly more Phyllobacterium in group A2 than in group B. Prevotella, Neisseria, and Haemophilus were higher in group B than in groups A1 and A2. The differences in the between-group α and β diversity analyses were statistically significant. The microbial diversity in groups A1 and A2 was significantly less than that in group B, but there was no statistical difference in bacterial community diversity between groups A1 and A2. CONCLUSION Recurrent wheezing in infants and children is more likely due to alterations in the overall bacterial microecology and disruption of host respiration and immune homeostasis than the effects of a single bacterium.
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Falah S, Mukhlif SF, Degan A. Prevalence of Recurrent Hospital Admission in Children with Recurrent Wheezing in Babylon Province. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Occurring of recurrent wheezing attacks signify a significant healthcare problem and considered one of the most common causes of emergency unit admission and hospitalizations.
AIM: The aim of study is to determine the associations of recurrent hospital admissions in children with recurrent wheezing.
METHODS: Cross-sectional descriptive study of 102 children with recurrent wheezy chest. Data collected from admitted patients with recurrent wheezing by direct interview with the patients’ families. Patients were 6 months to 5 years old. Data collected including age, gender, place of living whether urban or rural, prematurity, no. of people at home, history of NCU admission, history of ICU admission, exclusive breast feeding for 1st 6 months, anemia, GERD, history of atopy, exposure to smoking, inhaler use, and CXR findings.
RESULTS: About 79.41% of children have 1-3 times admission in hospital, significant association between the no. of hospitalization and History of ICU admission, children with more than 3 times admission to hospital present with GERD with significant association. Significant association with more than 3 times admission to hospital have previous history of exposure to smoking, inhaler use and X-ray finding.
CONCLUSION: One to three years old children is the most common age they have recurrent wheezing, most children with recurrent wheezy chest have more than 3 times hospitalization, most babies have previous history of ICU admission, GERD and exposure to smoking.
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Safavi S, Dai R, Breton VL, Emmerson MN, Kowalik K, Lu Z, Lou W, Dubeau A, DeLorenzo S, Azad MB, Becker AB, Mandhane PJ, Turvey SE, Gustafsson P, Lefebvre DL, Sears MR, Moraes TJ, Subbarao P. Lung clearance index predicts persistence of preschool wheeze. Pediatr Allergy Immunol 2022; 33:e13713. [PMID: 34875116 DOI: 10.1111/pai.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The lung clearance index (LCI) is a measure of pulmonary function. Variable feasibility (50->80%) in preschool children has been reported. There are limited studies exploring its relationship to respiratory symptoms and how it predicts persistent wheeze. We aimed to assess the association with respiratory symptoms in preschool-aged children with LCI and determine its utility in predicting persistent wheeze. METHODS LCI was measured in a subcohort of the CHILD Cohort Study at age 3 years using SF6 multiple breath washout test mass spectrometry. Respiratory symptom phenotypes at age 3 were derived from children's respiratory symptoms reported by their parents. Responses were used to categorize children into 4 symptom groups: recurrent wheeze (3RW), recurrent cough (3RC), infrequent symptoms (IS), and no current symptoms (NCS). At age 5 years, these children were seen by a specialist clinician and assessed for persistent wheeze (PW). RESULTS At age 3 years, 69% (234/340) had feasible LCI. Excluding two children with missing data, 232 participants were categorized as follows: 33 (14%) 3RW; 28 (12%) 3RC; 17 (7%) IS; and 154 (66%) NCS. LCI z-score at age 3 years was highest in children with 3RW compared to 3RC (mean (SD): 1.14 (1.56) vs. 0.09 (0.95), p < .01), IS (mean (SD): -0.14 (0.59), p < .01), and NCS (mean (SD): -0.08 (1.06), p < .01). LCI z-score at age 3 was predictive of persistent wheeze at age 5 (PW) (AUROC: 0.87). CONCLUSIONS LCI at age 3 was strongly associated with recurrent wheeze at age 3, and predictive of its persistence to age 5.
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Affiliation(s)
- Shahideh Safavi
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Ruixue Dai
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Vanessa L Breton
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Melanie N Emmerson
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Krzysztof Kowalik
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Zihang Lu
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aimée Dubeau
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Stephanie DeLorenzo
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Per Gustafsson
- Department of Pediatrics, Central Hospital, Skövde, Sweden
| | - Diana L Lefebvre
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Ip BC, Li N, Jackson-Browne M, Eliot M, Xu Y, Chen A, Lanphear BP, Spanier AJ, Braun JM. Does fetal leptin and adiponectin influence children's lung function and risk of wheeze? J Dev Orig Health Dis 2021; 12:570-577. [PMID: 33106208 PMCID: PMC8076337 DOI: 10.1017/s2040174420000951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adipocytokines, which are secreted during fetal development by both mothers and fetuses, may influence fetal lung development, but little human data are available. We used data from the HOME Study to investigate the associations of cord blood adipocytokine concentrations with children's lung forced expiratory volume (FEV1; N = 160) and their risk of wheeze (N = 281). We measured umbilical cord serum adipocytokine concentrations using enzyme-linked immunosorbent assays and FEV1 using a portable spirometer at ages 4 and 5 to calculate the percent predicted FEV1 (%FEV1). Parents completed standardized questionnaires of their child's wheeze symptoms every 6 months from birth to age 5, then again at ages 6 and 8. We used multivariable linear mixed models and modified Poisson regression with generalized estimating equations to estimate associations of adipocytokine concentrations (log2-transformed) with children's %FEV1 and the risk of wheeze, respectively, adjusting for sociodemographic, perinatal, and child factors. Cord serum leptin was not associated with children's %FEV1. Higher cord serum adiponectin concentrations were associated with higher %FEV1 in girls (β = 3.1, 95% confidence interval [CI]: 0.6, 5.6), but not in boys (β = -1.3, 95% CI: -5.9, 3.3) (sex × adiponectin p-value = 0.05). Higher leptin was associated with lower risk of wheeze in girls (RR = 0.74, 95% CI: 0.66, 0.84), but not boys (RR = 0.87, 95% CI: 0.69, 1.11) (sex × leptin p-value = 0.01). In contrast, higher adiponectin concentrations were associated with lower risk of wheeze (RR = 0.84, 95% CI: 0.73, 0.96) in both boys and girls. These data suggest that fetal adipocytokines may impact lung development and function in early childhood. Future studies are needed to confirm these findings and explore the mechanisms underlying these associations.
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Affiliation(s)
- Blanche C Ip
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, RI, USA
| | - Nan Li
- Department of Epidemiology, Brown University, Providence, RI, USA
| | | | - Melissa Eliot
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Yingying Xu
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati, OH, USA
| | - Aimin Chen
- Division of Epidemiology, Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Child and Family Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Adam J Spanier
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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Ng JSK, Chau JPC, Chan AWK, Lui JKC, Cheng JWCH. A Nurse-Led Web-Based Home Asthma Education Program for Children and their Families: A Randomized Controlled Trial. J Pediatr Nurs 2021; 59:158-163. [PMID: 33894543 DOI: 10.1016/j.pedn.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Education is the most essential component for effective asthma control and is endorsed by guidelines worldwide. However, multiple caregivers are often jointly involved in child care, and educating them is often a challenging task. This study determines the effectiveness of a web-based asthma education program in enhancing knowledge, attitude and practice of caregivers and reducing unscheduled hospital visits of children for asthma. METHODS A two-arm, randomized controlled trial was carried out between November 2018 and December 2019. Child-parent dyads were recruited when the children (4-11 years of age) were admitted due to asthma exacerbations. A nurse-led web-based home asthma education program was developed and implemented before discharge. Outcomes included parents' knowledge, attitude and practice regarding asthma and frequency of unscheduled visits and readmissions in children. RESULTS 112 child-parent dyads were enrolled. The parents' knowledge, attitude and practice and the number of unscheduled visits of the children were found to be significantly different between two groups at different time points (Ps < 0.001) with a large effect size (Cohen's d > 0.8). CONCLUSION This intervention was shown to be an effective strategy to educate caregivers who are jointly involved in their child's asthma control after discharge from hospital. TRIAL REGISTRATION The Chinese Clinical Trial Registry, World Health Organization (ChiCTR1800019706).
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Affiliation(s)
- Juliet S K Ng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, HKSAR, China; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China.
| | - Janita P C Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
| | - Aileen W K Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
| | | | - James W C H Cheng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, HKSAR, China
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Lee DH, Kwon JW, Kim HY, Seo JH, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Jung YH, Hong SJ, Shim JY. Asthma predictive index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea. Clin Exp Pediatr 2020; 63:104-109. [PMID: 32024332 PMCID: PMC7073380 DOI: 10.3345/kjp.2019.00640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is challenging to diagnose asthma in preschool children. The asthma predictive index (API) has been used to predict asthma and decide whether to initiate treatment in preschool children. PURPOSE This study aimed to investigate the association between questionnaire-based current asthma with API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children. METHODS We performed a population-based cross-sectional study in 916 preschool children aged 4-6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the previous 12 months using a modified International Study of Asthma and Allergies in Childhood questionnaire. Clinical and laboratory parameters were compared between groups according to the presence of current asthma. RESULTS The prevalence of current asthma was 3.9% in the study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent API scores than children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no intergroup differences in spirometry results, methacholine provocation test results, FeNO level, or atopic sensitization rate were observed. CONCLUSION The questionnaire-based diagnosis of current asthma is associated with API, but not with spirometry, AHR, FeNO, or atopic sensitization in preschool children.
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Affiliation(s)
- Dong Hyeon Lee
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwang-Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Dae-Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Young-Ho Jung
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Evolution of Airway Inflammation in Preschoolers with Asthma-Results of a Two-Year Longitudinal Study. J Clin Med 2020; 9:jcm9010187. [PMID: 31936693 PMCID: PMC7020050 DOI: 10.3390/jcm9010187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/04/2020] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
Fractional exhaled nitric oxide (FeNO) is a non-invasive marker for eosinophilic airway inflammation and has been used for monitoring asthma. Here, we assess the characteristics of FeNO from preschool to school age, in parallel with asthma activity. A total of 167 asthmatic children and 66 healthy, age-matched controls were included in the 2-year prospective PreDicta study evaluating wheeze/asthma persistence in preschool-aged children. Information on asthma/rhinitis activity, infections and atopy was recorded at baseline. Follow-up visits were performed at 6-month intervals, as well as upon exacerbation/cold and 4–6 weeks later in the asthmatic group. We obtained 539 FeNO measurements from asthmatics and 42 from controls. At baseline, FeNO values did not differ between the two groups (median: 3.0 ppb vs. 2.0 ppb, respectively). FeNO values at 6, 12, 18 and 24 months (4.0, CI: 0.0–8.6; 6.0, CI: 2.8–12.0; 8.0, CI: 4.0–14.0; 8.5, CI: 4.4–14.5 ppb, respectively) increased with age (correlation p ≤ 0.001) and atopy (p = 0.03). FeNO was non-significantly increased from baseline to the symptomatic visit, while it decreased after convalescence (p = 0.007). Markers of disease activity, such as wheezing episodes and days with asthma were associated with increased FeNO values during the study (p < 0.05 for all). Age, atopy and disease activity were found to be important FeNO determinants in preschool children. Longitudinal and individualized FeNO assessment may be valuable in monitoring asthmatic children with recurrent wheezing or mild asthma.
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Ferraro VA, Zanconato S, Baraldi E, Carraro S. Nitric Oxide and Biological Mediators in Pediatric Chronic Rhinosinusitis and Asthma. J Clin Med 2019; 8:jcm8111783. [PMID: 31731479 PMCID: PMC6912805 DOI: 10.3390/jcm8111783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the context of the so-called unified airway theory, chronic rhinosinusitis (CRS) and asthma may coexist. The inflammation underlying these conditions can be studied through the aid of biomarkers. Main body: We described the main biological mediators that have been studied in pediatric CRS and asthma, and, according to the available literature, we reported their potential role in the diagnosis and management of these conditions. As for CRS, we discussed the studies that investigated nasal nitric oxide (nNO), pendrin, and periostin. As for asthma, we discussed the role of fractional exhaled nitric oxide (feNO), the role of periostin, and that of biological mediators measured in exhaled breath condensate (EBC) and exhaled air (volatile organic compounds, VOCs). CONCLUSION Among non-invasive biomarkers, nNO seems the most informative in CRS and feNO in asthma. Other biological mediators seem promising, but further studies are needed before they can be applied in clinical practice.
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Suh DI, Kang MJ, Park YM, Lee JK, Lee SY, Sheen YH, Kim KW, Ahn K, Hong SJ. The risk of preschool asthma at 2-4 years is not associated with leukocyte telomere length at birth or at 1 year of age. Asia Pac Allergy 2019; 9:e33. [PMID: 31720244 PMCID: PMC6826115 DOI: 10.5415/apallergy.2019.9.e33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022] Open
Abstract
Background Exposure to prenatal stress is associated with offspring allergic-disease development, and oxidative stress may mediate this relationship. Objective We aimed to evaluate whether leukocyte telomere length (LTL) shortening, a marker for exposure to oxidative stress, in early life is associated with increased risk of asthma development during the preschool period. Methods We assessed the follow-up clinical data of a subgroup from a birth cohort whose LTLs had been measured from cord-blood and 1-year peripheral-blood samples. We examined whether the LTLs would be associated with asthma development at the age of 2–4 years. Results The data of 84 subjects were analyzed. LTLs were measured from the cord-blood and 1-year peripheral blood of 75 and 79 subjects, respectively. Among them, 14 subjects (16.7%) developed bronchial asthma between 2–4 years old. Prenatally stressed subjects had marginally increased odds of developing asthma (p = 0.097). There was no significant difference in the odds of preschool-asthma development between the groups with shorter and longer cord-blood LTLs (odds ratio [OR], 0.651; 95% confidence interval [CI], 0.184–2.306) or in the odds between the groups with shorter and longer 1-year peripheral-blood LTLs (OR, 0.448; 95% CI, 0.135–1.483). Finally, subjects with both higher prenatal stress and shorter LTLs did not have significantly higher odds of preschool-asthma development (for cord-blood: OR, 1.242; 95% CI, 0.353–4.368; for 1-year peripheral-blood: OR, 1.451; 95% CI, 0.428–4.919). Conclusion There was no significant association between early life LTLs and higher risk of bronchial-asthma development during the preschool years.
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Affiliation(s)
- Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Jin Kang
- Department of Pediatrics, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Mee Park
- Department of Pediatrics, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Kyu Lee
- Department of Pediatrics, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea.,Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA University Gangnam CHA Hospital, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University Severance Children's Hospital, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Sungkyunkwan University Samsung Medical Center, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea.,Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chen W, Subbarao P, McGihon RE, Feldman LY, Zhu J, Lou W, Gershon AS, Abdullah K, Moraes TJ, Dubeau A, Sears MR, Lefebvre DL, Turvey SE, Mandhane PJ, Azad MB, To T. Patterns of health care use related to respiratory conditions in early life: A birth cohort study with linked administrative data. Pediatr Pulmonol 2019; 54:1267-1276. [PMID: 31172683 DOI: 10.1002/ppul.24381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify distinctive patterns of respiratory-related health services use (HSU) between birth and 3 years of age, and to examine associated symptom and risk profiles. METHODS This study included 729 mother and child pairs enrolled in the Toronto site of the Canadian Healthy Infant Longitudinal Development study in 2009-2012; they were linked to Ontario health administrative databases (2009-2016). A model-based cluster analysis was performed to identify distinct groups of children who followed a similar pattern of respiratory-related HSU between birth and 3 years of age, regarding hospitalization, emergency department (ED) and physician office visits for respiratory conditions and total health care costs (2016 Canadian dollars). RESULTS The majority (estimated cluster weight = 0.905) showed a pattern of low and stable respiratory care use (low HSU) while the remainder (weight = 0.095) showed a pattern of high use (high HSU). From 0 to 3 years of age, the low- and high-HSU groups differed in mean trajectories of total health care costs ($783 per 6 months decreased to $114, vs $1796 to $177, respectively). Compared to low-HSU, the high-HSU group was associated with a constant risk of hospitalizations, early high ED utilization and physician visits for respiratory problems. The two groups differed significantly in the timing of wheezing (late onset in low-HSU vs early in high-HSU) and future total costs (stable vs increased). CONCLUSIONS One in ten children had high respiratory care use in early life. Such information can help identify high-risk young children in a large population, monitor their long-term health, and inform resource allocation.
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Affiliation(s)
- Wenjia Chen
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Translational Medicine and Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rachel E McGihon
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Laura Y Feldman
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jingqin Zhu
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Wendy Lou
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea S Gershon
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kawsari Abdullah
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Theo J Moraes
- Translational Medicine and Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Aimée Dubeau
- Translational Medicine and Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan B Azad
- Department of Pediatrics & Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Teresa To
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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Guo J, Zhu W, Wang H, Holt PG, Zhang G, Liu C. Risk factors and prognosis of recurrent wheezing in Chinese young children: a prospective cohort study. Allergy Asthma Clin Immunol 2019; 15:38. [PMID: 31244890 PMCID: PMC6582479 DOI: 10.1186/s13223-019-0351-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 06/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background Nearly all the investigations into the risk factors for wheezing and asthma were conducted in developed countries with a high prevalence rate of asthma and allergy, but the studies in developing countries are limited. In this study, we aimed to investigate the risk factors for different wheezing phenotypes in Chinese young children and to explore the prognosis of recurrent wheezing. Methods This cohort study contained the recruitment stage and the follow-up stage conducted by phone questionnaire survey. According to the information collected at the follow-up for wheezing episodes and remission age, our cohort was divided into transient wheezing, persistent wheezing and late-onset wheezing. The wheezing symptoms and potential risk factors were compared between these three wheezing groups. Results From the initial 109 participants, 78.0% completed the follow-up survey. The frequency of current wheezing at followup was significantly reduced in all three groups compared to the recruitment stage (p < 0.01). We observe a trend that the rhinovirus (RV) and respiratory syncytial virus (RSV) infection rates were higher in the persistent wheezing group, and the overall infection rates appear to be the lowest in late-onset wheezing group at recruitment. At follow-up stage, the rates of rhinitis ever and current rhinitis were both higher in the persistent wheezing (63.0%, 50.0%) and late-onset wheezing groups (88.2%, 58.8%), compared to the transient wheezing group (14.3%, 14.3%). The incidence of current wheezing episodes increased cumulatively if the participant had concomitant risk factors of rhinitis ever, aeroallergens sensitization at recruitment, either alone or together with previous RV infection at the time of recruitment. Conclusion While the incidence of wheezing declined overall with age, but in addition to transient wheezers, additional subsets of children manifest persistent wheeze or late onset wheeze, and moreover the risk factors for wheezing display phenotypic variability between these subgroups. Rhinitis ever and aeroallergens sensitization, either alone or together with previous RV infection, were the most significant predictors for persistent wheezing in children in an eastern environment, such as in China.
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Affiliation(s)
- Jing Guo
- 1Department of Allergy, Children's Hospital of Capital Institute of Pediatrics, Beijing, China.,2School of Public Health, Curtin University, Perth, Australia.,The Curtin UWA Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, Curtin University, The University of Western Australia, Perth, Australia
| | - Wenjing Zhu
- 1Department of Allergy, Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Huimin Wang
- 1Department of Allergy, Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Patrick G Holt
- 4Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Guicheng Zhang
- 2School of Public Health, Curtin University, Perth, Australia.,The Curtin UWA Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, Curtin University, The University of Western Australia, Perth, Australia
| | - Chuanhe Liu
- 1Department of Allergy, Children's Hospital of Capital Institute of Pediatrics, Beijing, China
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13
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Abstract
Asthma-like symptoms like wheezing and dyspnea affect 1 in every 3 preschool children. An easily available biomarker that predicts later asthma or unfavorable lung growth in these children may be helpful in targeting the right child with the right drugs and avoiding exposure to potentially harmful drugs in others. The fraction of exhaled nitric oxide (FeNO) has been suggested as a marker of eosinophilic inflammation. FeNO can be measured in a standardized way from the age of 4 but several methods have been developed to measure FeNO also in younger children. Several studies have assessed the predictive value of FeNO in preschool wheezing children for asthma later in life. These studies have shown that FeNO may be helpful in defining different preschool wheezing phenotypes, and in assessing the risk of later asthma or impaired lung growth. However, data are conflicting on the added value over clinical parameters. In two studies in school children, high FeNO was predictive for asthma development during follow up and also predicted lower lung function growth. In school children with respiratory symptoms suggestive of asthma, particularly in atopic children, FeNO has diagnostic value for an asthma diagnosis, mostly for ruling in asthma. There are not enough data to assess if FeNO has a predictive value for lung development in school children.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, Netherlands
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14
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Fainardi V, Lombardi E. Lung function tests to monitor respiratory disease in preschool children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:148-156. [PMID: 29957746 PMCID: PMC6179029 DOI: 10.23750/abm.v89i2.7155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/06/2018] [Indexed: 01/22/2023]
Abstract
Pulmonary function tests are routinely used in the diagnosis and follow-up of respiratory diseases. In preschool children assessment and evaluation of lung function has always been challenging but improved techniques that require only minimal collaboration allowed obtaining reliable and useful results even in this group of patients. In this review we will describe the different techniques used in clinical practice to measure lung function in preschool children.(www.actabiomedica.it)
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Affiliation(s)
| | - Enrico Lombardi
- Paediatric Pulmonary Unit, "Anna Meyer" Paediatric University Hospital, Florence, Italy.
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