1
|
De Queiroz Andrade E, Sena CRDS, de Gouveia Belinelo P, Robinson PD, Blaxland A, Sly PD, Murphy VE, Gibson PG, Collison AM, Mattes J. In utero smoking exposure induces changes to lung clearance index and modifies risk of wheeze in infants. Pediatr Pulmonol 2024; 59:1686-1694. [PMID: 38501326 DOI: 10.1002/ppul.26975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/17/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Fetal exposure to tobacco smoking throughout pregnancy is associated with wheezing in infancy. We investigated the influence of in utero smoking exposure on lung ventilation homogeneity and the relationship between lung ventilation inhomogeneity at 7 weeks of age and wheezing in the first year of life. METHODS Maternal smoking was defined as self-reported smoking of tobacco or validated by exhaled (e)CO > 6 ppm. Lung function data from healthy infants (age 5-9 weeks) born to asthmatic mothers and parent-reported respiratory questionnaire data aged 12 months were collected in the Breathing for Life Trial (BLT) birth cohort. Tidal breathing analysis and SF6-based Multiple Breath Washout testing were performed in quiet sleep. Descriptive statistics and regression analysis were used to assess associations. RESULTS Data were collected on 423 participants. Infants born to women who self-reported smoking during pregnancy (n = 42) had higher lung clearance index (LCI) than those born to nonsmoking mothers (7.90 vs. 7.64; p = .030). Adjusted regression analyzes revealed interactions between self-reported smoking and LCI (RR: 1.98, 95% CI: 1.07-3.63, 0.028, for each unit increase in LCI) and between eCO > 6 ppm and LCI (RR: 2.25, 95% CI: 1.13-4.50, 0.022) for the risk of wheeze in the first year of life. CONCLUSION In utero tobacco smoke exposure induces lung ventilation inhomogeneities. Furthermore, an interaction between smoke exposure and lung ventilation inhomogeneities increases the risk of having a wheeze in the first year of life.
Collapse
Affiliation(s)
- Ediane De Queiroz Andrade
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Carla Rebeca Da Silva Sena
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Patricia de Gouveia Belinelo
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anneliese Blaxland
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G Gibson
- Priority Research Centre Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- Respiratory & Sleep Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Adam M Collison
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Joerg Mattes
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| |
Collapse
|
2
|
Kjellberg S, Olin AC, Schiöler L, Robinson PD. Detailed characterization and impact of small airway dysfunction in school-age asthma. J Asthma 2024:1-10. [PMID: 38747533 DOI: 10.1080/02770903.2024.2355231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Small airway dysfunction (SAD) is increasingly recognized as an important feature of pediatric asthma yet typically relies on spirometry-derived FEF25-75 to detect its presence. Multiple breath washout (MBW) and oscillometry potentially offer improved sensitivity for SAD detection, but their utility in comparison to FEF25-75, and correlations with clinical outcomes remains unclear for school-age asthma. We investigated SAD occurrence using these techniques, between-test correlation and links to clinical outcomes in 57 asthmatic children aged 8-18 years. METHODS MBW and spirometry abnormality were defined as z-scores above/below ± 1.96, generating MBW reference equations from contemporaneous controls (n = 69). Abnormal oscillometry was defined as > 97.5th percentile, also from contemporaneous controls (n = 146). Individuals with abnormal FEF25-75, MBW, or oscillometry were considered to have SAD. RESULTS Using these limits of normal, SAD was present on oscillometry in 63% (resistance at 5-20 Hz; R5-R20; >97.5th percentile), on MBW in 54% (Scond; z-scores> +1.96) and in spirometry FEF25-75 in 44% of participants (z-scores< -1.96). SAD, defined by oscillometry and/or MBW abnormality, occurred in 77%. Among those with abnormal R5-R20, Scond was abnormal in 71%. Correlations indicated both R5-R20 and Scond were linked to asthma medication burden, baseline FEV1 and reversibility. Additionally, Scond correlated with FENO and magnitude of bronchial hyper-responsiveness. SAD, detected by oscillometry and/or MBW, occurred in almost 80% of school-aged asthmatic children, surpassing FEF25-75 detection rates. CONCLUSIONS Discordant oscillometry and MBW abnormality suggests they reflect different aspects of SAD, serving as complementary tools. Key asthma clinical features, like reversibility, had stronger correlation with MBW-derived Scond than oscillometry-derived R5-R20.
Collapse
Affiliation(s)
- Sanna Kjellberg
- Department of Pediatrics, Skaraborg Central Hospital, Skövde, Sweden
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paul D Robinson
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
- Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Airway Physiology and Imaging Group, Woolcock Medical Research Institute, Sydney, NSW, Australia
| |
Collapse
|
3
|
Sena CRDS, Morten M, Collison AM, Shaar A, Andrade EDQ, Meredith J, Kepreotes E, Murphy VE, Sly PD, Whitehead B, Karmaus W, Gibson PG, Robinson PD, Mattes J. Bronchiolitis hospital admission in infancy is associated with later preschool ventilation inhomogeneity. Pediatr Pulmonol 2024; 59:632-641. [PMID: 38088225 DOI: 10.1002/ppul.26793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/08/2023] [Accepted: 11/25/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Rhinovirus (RV) positive bronchiolitis episodes in infancy confer a higher risk to develop asthma in later childhood with associated lung function impairments. We aimed to investigate the association between the type of virus causing a bronchiolitis hospitalization episode and lung ventilation inhomogeneities at preschool age. METHODS Infants hospitalized with a clinical diagnosis of moderate (ward admission) or severe (pediatric intensive care ward admission) bronchiolitis were prospectively followed-up at preschool age to assess nitrogen (N2 ) multiple breath washout (MBW). Lung clearance index (LCI), functional residual capacity (FRC), and concentration normalized phase III slope analysis (SnIII ) indices were reported from ≥2 technically acceptable trials. Differences between groups were calculated using logistic and linear regression and adjusted for confounders (sex, age at bronchiolitis admission, height at visit, maternal asthma, and doctor-diagnosed asthma, including interaction terms between the latter three). An interaction term was included in a regression model to test for an interaction between RV bronchiolitis severity and MBW parameters at preschool age. RESULTS One hundred and thirty-nine subjects attended preschool follow-up, of which 84 out of 103 (82%) performing MBW had technically acceptable data. Children with a history of RV positive bronchiolitis (n = 39) had increased LCI (adjusted β-coefficient [aβ] = 0.33, 95% confidence interval [CI] 0.02-0.65, p = 0.040) and conductive airways ventilation inhomogeneity [Scond ] (aβ = 0.016, CI 0.004-0.028, p = 0.011) when compared with those with a RV negative bronchiolitis history (n = 45). In addition, we found a statistical interaction between RV bronchiolitis and bronchiolitis severity strengthening the association with LCI (aβ = 0.93, CI 0.20-1.58, p = 0.006). CONCLUSION Children with a history of hospital admission for RV positive bronchiolitis in infancy might be at a higher risk of lung ventilation inhomogeneities at preschool age, arising from the peripheral conducting airways.
Collapse
Affiliation(s)
- Carla Rebeca Da Silva Sena
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre GrowUpWell®, Newcastle, New South Wales, Australia
| | - Matthew Morten
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre GrowUpWell®, Newcastle, New South Wales, Australia
| | - Adam M Collison
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre GrowUpWell®, Newcastle, New South Wales, Australia
| | - Aida Shaar
- The Children's Hospital at Westmead, Department of Respiratory Medicine, Sydney, New South Wales, Australia
| | - Ediane de Queiroz Andrade
- University of Sydney, Discipline of Paediatrics and Child Health, Sydney, New South Wales, Australia
| | - Joseph Meredith
- John Hunter Children's Hospital, Department of Paediatric Respiratory & Sleep Medicine, Newcastle, New South Wales, Australia
| | - Elizabeth Kepreotes
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre GrowUpWell®, Newcastle, New South Wales, Australia
- Far West Local Health District, NSW Local Health District, Broken Hill, New South Wales, Australia
| | - Vanessa E Murphy
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre Healthy Lungs, Newcastle, New South Wales, Australia
| | - Peter D Sly
- The University of Queensland, Child Health Research Centre, Brisbane, Queensland, Australia
| | - Bruce Whitehead
- John Hunter Children's Hospital, Department of Paediatric Respiratory & Sleep Medicine, Newcastle, New South Wales, Australia
| | - Wilfried Karmaus
- University of Memphis, School of Public Health, Memphis, Tennessee, USA
| | - Peter G Gibson
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre Healthy Lungs, Newcastle, New South Wales, Australia
| | - Paul D Robinson
- The Children's Hospital at Westmead, Department of Respiratory Medicine, Sydney, New South Wales, Australia
- University of Sydney, Discipline of Paediatrics and Child Health, Sydney, New South Wales, Australia
- Woolcock Medical Research Institute, Airway Imaging and Physiology Group, Sydney, New South Wales, Australia
| | - Joerg Mattes
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre GrowUpWell®, Newcastle, New South Wales, Australia
- John Hunter Children's Hospital, Department of Paediatric Respiratory & Sleep Medicine, Newcastle, New South Wales, Australia
| |
Collapse
|
4
|
Cherrez-Ojeda I, Robles-Velasco K, Osorio MF, Calderon JC, Bernstein JA. Current Needs Assessment for Using Lung Clearance Index for Asthma in Clinical Practice. Curr Allergy Asthma Rep 2022; 22:13-20. [DOI: 10.1007/s11882-022-01025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
|
5
|
Wang B, Wang N, Chen Z. Research on air quality forecast based on web text sentiment analysis. ECOL INFORM 2021. [DOI: 10.1016/j.ecoinf.2021.101354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Abstract
PURPOSE OF REVIEW Asthma is a chronic inflammatory airway disorder that can involve the entire bronchial tree. Increasing evidence shows that ventilation heterogeneity and small airway dysfunction are relevant factors in the pathogenesis of asthma and represent a hallmark in adults with persistent asthma. Little is known about the contribution of peripheral airway impairment in paediatric asthma, mainly due to the inaccessibility to evaluation by noninvasive techniques, which have only been widely available in recent years. RECENT FINDINGS Emerging evidence suggests that small airways are affected from the early stages of the disease in childhood-onset asthma. Conventional lung function measurement, using spirometry, is unable to sensitively evaluate small airway function and may become abnormal only once there is a significant burden of disease. Recent studies suggest that chronic inflammation and dysfunction in the small airways, as detected with new advanced techniques, are risk factors for asthma persistence, asthma severity, worse asthma control and loss of pulmonary function with age, both in adults and children. Knowing the extent of central and peripheral airway involvement is clinically relevant to achieve asthma control, reduce bronchial hyper-responsiveness and monitor response to asthma treatment. SUMMARY This review outlines the recent evidence on the role of small airway dysfunction in paediatric asthma development and control, and addresses how the use of new diagnostic techniques available in outpatient clinical settings, namely impulse oscillometry and multiple breath washout, could help in the early detection of small airway impairment in children with preschool wheezing and school-age asthma and potentially guide asthma treatment.
Collapse
|
7
|
Nuttall AG, Beardsmore CS, Gaillard EA. Ventilation heterogeneity in children with severe asthma. Eur J Pediatr 2021; 180:3399-3404. [PMID: 33987684 PMCID: PMC8502735 DOI: 10.1007/s00431-021-04101-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
Small airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We studied the relationship between VH, asthma severity, and spirometry in a cross-sectional observational cohort study involving children with stable mild-moderate and severe asthma by GINA classification and a group of healthy controls. Thirty-seven participants aged 5-16 years completed multiple breath nitrogen washout (MBNW) testing (seven controls, seven mild-moderate asthma, 23 severe asthma). The lung clearance index (LCI) was normal in control and mild-moderate asthmatics. LCI was abnormal in 5/23 (21%) of severe asthmatics. The LCI negatively correlated with FEV1 z-score.Conclusion: VH is present in asthmatic children and appears to be more common in severe asthma. The LCI was significantly higher in the cohort of children with severe asthma, despite no difference in FEV1 between the groups. This supports previous evidence that LCI is a more sensitive marker of airway disease than FEV1. MBNW shows potential as a useful tool to assess children with severe asthma and may help inform clinical decisions. What is Known: • Increased ventilation heterogeneity is present in some children with asthma • Spirometry is not sensitive enough to detect small airway involvement in asthma What is New • Lung clearance index is abnormal in a significant subgroup of children with severe asthma but rarely in children with mild-moderate asthma • Our data suggests that LCI monitoring should be considered in children with severe asthma.
Collapse
Affiliation(s)
- Amy G. Nuttall
- Department of Respiratory Sciences and Institute for Lung Health, Leicester NIHR Biomedical Research Centre – Respiratory Theme, Leicester Royal Infirmary, University of Leicester, PO Box 65, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX UK ,Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, Leicester Royal Infirmary, Leicester, UK
| | - Caroline S. Beardsmore
- Department of Respiratory Sciences and Institute for Lung Health, Leicester NIHR Biomedical Research Centre – Respiratory Theme, Leicester Royal Infirmary, University of Leicester, PO Box 65, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX UK ,Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, Leicester Royal Infirmary, Leicester, UK
| | - Erol A. Gaillard
- Department of Respiratory Sciences and Institute for Lung Health, Leicester NIHR Biomedical Research Centre – Respiratory Theme, Leicester Royal Infirmary, University of Leicester, PO Box 65, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX UK ,Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, Leicester Royal Infirmary, Leicester, UK
| |
Collapse
|
8
|
Schindel CS, Schiwe D, Heinzmann-Filho JP, Gheller MF, Campos NE, Pitrez PM, Donadio MVF. Determinants of exercise capacity in children and adolescents with severe therapy-resistant asthma. J Asthma 2020; 59:115-125. [PMID: 33026845 DOI: 10.1080/02770903.2020.1833915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the exercise capacity of children and adolescents with severe therapy resistant asthma (STRA) aiming to identify its main determinants. METHODS Cross-sectional study including individuals aged 6-18 years with a diagnosis of STRA. Clinical (age and gender), anthropometric (weight, height and body mass index) and disease control data were collected. Lung function (spirometry), cardiopulmonary exercise testing (CPET) and exercise-induced bronchoconstriction (EIB) test were performed. RESULTS Twenty-four patients aged 11.5 ± 2.6 years were included. The mean forced expiratory volume in one second (FEV1) was 91.3 ± 9.2%. EIB occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO2peak) was 34.1 ± 7.8 mL kg-1 min-1. A significant correlation between ventilatory reserve and FEV1 (r = 0.57; p = 0.003) was found. Similarly, there was a significant correlation between CPET and percent of FEV1 fall in the EIB test for both VE/VO2 (r = 0.47; p = 0.02) and VE/VCO2 (r = 0.46; p = 0.02). Patients with FEV1<80% had lower ventilatory reserve (p = 0.009). In addition, resting heart rate correlated with VO2peak (r=-0.40; p = 0.04), VE/VO2 (r = 0.46; p = 0.02) and VE/VCO2 (r = 0.48; p = 0.01). CONCLUSIONS Exercise capacity is impaired in approximately 30% of children and adolescents with STRA. The results indicate that different aspects of aerobic fitness are influenced by distinct determinants, including lung function and EIB.
Collapse
Affiliation(s)
- Cláudia Silva Schindel
- Laboratório de Atividade Física em Pediatria, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Daniele Schiwe
- Laboratório de Atividade Física em Pediatria, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - João Paulo Heinzmann-Filho
- Laboratório de Atividade Física em Pediatria, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Mailise Fátima Gheller
- Laboratório de Atividade Física em Pediatria, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Natália Evangelista Campos
- Laboratório de Atividade Física em Pediatria, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Paulo Márcio Pitrez
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) and Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Márcio Vinícius Fagundes Donadio
- Laboratório de Atividade Física em Pediatria, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| |
Collapse
|