Asthma predictive index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea

Early Prediction of Asthma

The clinical manifestations of asthma in children are highly variable, are associated with different molecular and cellular mechanisms, and are characterized by common symptoms that may diversify in frequency and intensity throughout life. It is a disease that generally begins in the first five years of life, and it is essential to promptly identify patients at high risk of developing asthma by using different prediction models. The aim of this review regarding the early prediction of asthma is to summarize predictive factors for the course of asthma, including lung function, allergic comorbidity, and relevant data from the patient's medical history, among other factors. This review also highlights the epigenetic factors that are involved, such as DNA methylation and asthma risk, microRNA expression, and histone modification. The different tools that have been developed in recent years for use in asthma prediction, including machine learning approaches, are presented and compared. In this review, emphasis is placed on molecular mechanisms and biomarkers that can be used as predictors of asthma in children.

Diagnosis and management of asthma in infants and preschoolers

Asthma is one of the most common chronic disease affecting children, and it often starts in infancy and preschool years. In previous birth cohorts, frequent wheezing in early life was associated with the development of asthma in later childhood and reduced lung function persisting into adulthood. Preschool wheezing is considered an umbrella term for distinctive diseases with different clinical features (phenotypes), each of which may be related to different underlying pathophysiologic mechanisms (endotypes). The classification of phenotypes of early wheezing is needed to identify children at high risk for developing asthma later who might benefit from early intervention. However, diagnosis of asthma in infants and preschoolers is particularly difficult because objective lung function tests cannot be performed and definitive biomarkers are lacking. Moreover, management of early asthma is challenging because of its different phenotypic presentations. Many prediction models and asthma guidelines have been developed to provide useful information for physicians to assess young children with recurrent wheezing and manage them appropriately. Many recent studies have investigated the application of personalized medicine for early asthma by identifying specific phenotypes and biomarkers. Further researches, including genetic and molecular studies, are needed to establish a clear definition of asthma and develop more targeted therapeutic approaches in this age group.

Bronchoalveolar lavage profiles in uncontrolled wheezy children compared by asthma predictive index

OBJECTIVE

The asthma predictive index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive (API+)/negative (API-) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API+ and neutrophils in API- groups respectively. The main objective of this study is to compare bronchoalveolar lavage (BAL) cell profiles in API+/API- children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS).

DESIGN

Retrospective analysis of BAL in 43 children, 3-36 months (median: 14 months) receiving ICS (31 API+, 12 API-). BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages were analyzed. Cell counts presented as median (range).

RESULTS

Neutrophil percentages were increased in both groups (API- 16% [1%-76%]; API+ 42% [1%-95%]; p = NS). Cell percentages were similar for lymphocytes (API- 12% [1%-30%]; API+ 7% [1%-37%]), and macrophages (API- 67.5% [12%-97%]; API+ 41% [2%-94%]). Eosinophil percentages were low in both groups (API- 1% [1%-2%]; API+ 1% [1%-11%]). There was no difference in cellular distributions using absolute cell counts comparing API groups. Bacterial cultures were positive in 18 (60%) API+ and 5 (41%) API- patients (p = 0.10).

CONCLUSION

Cell profiles do not differ between API groups in children ≤36 months with recurrent wheezing unresponsive to ICS. Neutrophil percentages and total granulocyte count correlate with positive bacterial cultures independent of API status. Persistent bacterial bronchitis likely plays an important role in the persistence of symptoms unresponsive to ICS therapy regardless of API status with a trend to more positive cultures in API positive children.

Atopic dermatitis: Correlation of severity with allergic sensitization and eosinophilia

Background: It is widely acknowledged that food sensitization is related to atopic dermatitis in infants and young children. Objective: To investigate the association of aeroallergen sensitization with increased rates and severity of atopic dermatitis in school children. Methods: We enrolled 576 children (mean age, 9.4 ± 1.8 years) from six elementary schools. Atopic dermatitis was diagnosed by questionnaires, and severity was rated by physical examinations graded by using the Scoring Atopic Dermatitis (SCORAD) index. Skin-prick tests to 22 common allergens (6 aeroallergens and 16 food allergens) were conducted. Logistic and linear regression analyses were performed by using two models: model I adjusted for age, sex, and body mass index z score; and model II adjusted for all model I factors plus asthma and allergic rhinitis. Results: We diagnosed atopic dermatitis in 22.4% (n = 129) of the children, sensitization to foods in 48.3% (n = 278), and sensitization to aeroallergens in 11.3% (n = 65). A total of 26.2% of the children (n = 149) had mild and 6.5% had moderate-to-severe symptoms and signs of atopic dermatitis (n = 37). Atopic dermatitis was associated with sensitization to aeroallergens and eosinophilia (model I), but this risk was no longer significant after additional adjustment for current allergic status (model II). However, the relationship of the total SCORAD score with aeroallergen sensitization and eosinophilia was significant in model I and model II. Conclusion: The severity of atopic dermatitis correlated with the extent of allergic sensitization and eosinophilia. Analysis of our results suggests that more sensitization to dust mites and eosinophilia are related to increased rates and high severity scores of atopic dermatitis.