1
|
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.
Collapse
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
| |
Collapse
|
2
|
Martín-Muñoz M, Pineda F, Muiños T, Fontan M, Nevot S, Bosque M, Jurado Palomo J, Torredemer A, Valdesoiro L, Martinez Cañavate A, Pedemonte Marco C. Changes in IL-10 and specific antibodies associated to successful Dermatophagoides pteronyssinus immunotherapy in children during the first year of treatment. Allergol Immunopathol (Madr) 2013; 41:4-10. [PMID: 22321665 DOI: 10.1016/j.aller.2011.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 11/29/2011] [Accepted: 12/01/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy (SIT) is a long-term treatment of respiratory allergy. OBJECTIVE To look for early predictors of the effectiveness of Dermatophagoides pteronyssinus SIT. METHODS A prospective multi-centre study was carried out in Spain. Children with D. pteronyssinus rhinitis or asthma were invited to participate. The study was divided into times: T0 (recruitment); T1 (inclusion); T2 a-f (immunotherapy times) and T3 (the end of study). Efficacy of SIT was assessed by clinical scores, visual analogue scales (VAS) and lung function tests. We performed D. pteronyssinus skin tests at T1 and T3, and determined specific serum IgE, IgG4 and IL-10 at T1, T2f and T3. Data were analysed using Mann-Whitney and Kruskal-Wallis tests, compared using Wilcoxon and Chi-square tests, and correlated to Spearman test. All tests had a significance level of 0.05. RESULTS Thirty-eight children completed the study. At T1 all had rhinitis and 34 also had asthma. At T3, 30 patients had improved, six experienced no changes and two worsened. Improvement was associated to FEV1/FVC and VAS improvement; to a reduction in D. pteronyssinus skin prick test; to a progressive increase in serum levels of D. pteronyssinus IgE, and D. pteronyssinus, Der p1 and Der p2 IgG4. IL-10 levels showed an early increase at T2f (the end of initial build-up immunotherapy phase), and then a reduction at T3 (the end of a year of immunotherapy). Improvement associated to an early increase in IL-10 and was correlated with VAS and specific IgG4 evolution.
Collapse
|
3
|
Sasagawa M, Hasegawa T, Kazama JIJ, Koya T, Sakagami T, Suzuki K, Hara K, Satoh H, Fujimori K, Yoshimine F, Satoh K, Narita I, Arakawa M, Gejyo F, Suzuki E. Assessment of bone status in inhaled corticosteroid user asthmatic patients with an ultrasound measurement method. Allergol Int 2011; 60:459-65. [PMID: 21681018 DOI: 10.2332/allergolint.10-oa-0276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 02/01/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The effect of inhaled corticosteroid (ICS) on the bone status of asthmatic patients is still uncertain, because it can differ by race and because there have been few cases in Japan. In this study, the bone status of ICS users with asthma was evaluated in an actual clinical setting in Japan. METHODS In 7 participating hospitals, ICS users with asthma and control subjects were age- and gender-matched and recruited into this study. To assess bone status, ultrasound measurements of each individual's calcaneus were made using an AOS-100. The ratio of the osteo sono-assessment index (OSI) to the average OSI corrected for age and gender was denoted as %OSI and used for quantitative assessment. The second %OSI measurement was performed 6 months after the first %OSI one. During the study period, individual treatment remained unchanged. RESULTS There were no significant differences in the 1st and 2nd %OSI between the ICS users and control subjects. However, the 2nd %OSI significantly decreased compared with 1st %OSI in female ICS users, although there were no significant changes in the male and female control subjects and male ICS users. CONCLUSIONS The 6 month management of asthma in the actual clinical setting, including regular ICS use, might have a harmful influence on the bone status of female asthmatic patients. It may be necessary to manage and treat female patients for potent corticosteroid-induced osteoporosis, although further analyses of bone status in asthma patient ICS users will be required.
Collapse
Affiliation(s)
- Mayumi Sasagawa
- Department of Respiratory Medicine, Nanbugo General Hospital, Niigata, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Pérez-Yarza EG, Badía X, Badiola C, Cobos N, Garde J, Ibero M, Villa JR. Development and validation of a questionnaire to assess asthma control in pediatrics. Pediatr Pulmonol 2009; 44:54-63. [PMID: 19061230 DOI: 10.1002/ppul.20929] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop and validate a questionnaire to assess asthma control in children (CAN). DESIGN Two versions of the CAN (for carers and children) were developed. Both versions were validated in an observational, prospective, multicenter study performed in 38 hospital outpatient clinics throughout Spain. Four hundred fifteen patients and their carers agreed to participate. Of these, 414 patients under 14 years old with frequent episodic or persistent (moderate to severe) asthma completed the questionnaire on 3 occasions (baseline, week 2, and week 12). For patients aged 2-8 the questionnaire was only completed by the carers, but for patients aged 9-14 the questionnaire was completed by the carers and the children. Clinician ratings of asthma control were used as a gold standard to assess the sensitivity, specificity, PPV and NPV of the new measure. RESULTS Evaluable responses were obtained from 215 carers for children aged 2-8 years and 199 children aged 9-14 years, and their parents. Using a questionnaire total score cut-off of 8 the patient version had a sensitivity of 76.3% and a specificity of 62.9%. For carer version these values were 73% and 69.7%, respectively. A cut point of 8 was selected to maximize the screening accuracy of the CAN questionnaire. Effect sizes in patients with clinician-rated improvements in asthma control were 0.33 and 0.57 for the carer and child versions, respectively. CONCLUSIONS The screening accuracy and validity of the CAN questionnaire make it suitable for use in research and clinical practice. The sensitivity and specificity were close to 70%, which is acceptable for the study objective: obtain a tool to measure the level of asthma control.
Collapse
Affiliation(s)
- E G Pérez-Yarza
- Department of Pediatrics, Division of Respiratory Medicine, Hospital Donostia, San Sebastián, Spain
| | | | | | | | | | | | | | | |
Collapse
|