IL-1β and iNOS can drive the asthmatic comorbidities and decrease of lung function in perennial allergic rhinitis children

BACKGROUND

Allergic asthma and rhinitis (AR) are closely linked, with a significant proportion of AR patients developing asthma. Identification of the early signs of comorbidity of AR and asthma can enable prompt treatment and prevent asthma progression.

OBJECTIVES AND METHODS

This study investigated the role of interleukin-1β (IL-1β), a pro-inflammatory cytokine, and inducible nitric oxide synthase (iNOS) in the comorbidity of AR and asthma and lung function in Korean children with perennial AR (PAR). A cohort of 240 subjects (6 to 10 years old) with PAR (PAR alone: 113 children, PAR and asthma: 127 children) was analyzed for various biomarkers, including IL-1β, iNOS, and epithelial-mesenchymal transition (EMT) markers in serum. The blood levels of eosinophils and immunoglobulin E (IgE) were examined. IL-1β, CCL-24, E-cadherin, and vimentin were measured by enzyme-linked immunosorbent assay (ELISA). Epithelial iNOS was measured by the NOS kit.

RESULTS

Elevated levels of IL-1β, iNOS, and vimentin in the serum were identified as significant indicators of the likelihood of comorbidity of PAR and asthma in children. Furthermore, higher concentrations of IL-1β, iNOS, and vimentin have been linked to reduced lung function in PAR children. Notably, IL-1β expression shows a relationship with the levels of E-cadherin, vimentin, and CCL-24. However, no correlation was found between IL-1β and iNOS expressions.

CONCLUSIONS

This study suggests that IL-1β and iNOS can be biomarkers in the progression of PAR and asthma and decreased lung function, suggesting potential targets for early intervention and treatment.

Reduced forced expiratory flow between 25% and 75% of vital capacity in children with allergic rhinitis without asthmatic symptoms

INTRODUCTION

Allergic rhinitis (AR) and asthma are closely associated in children. Reduced FEF_25%-75% which reflects small airway airflow limitation is frequently observed in asthma. This study aimed to examine the proportion of small airway dysfunction in children with AR and to determine its associated factors.Methods: The medical records of 144 aged 6-18-year children with AR without overt asthmatic symptoms were retrospectively reviewed. Subjects were divided into 2 groups according to the FEF_25%-75% values; normal FEF_25%-75% group (n = 129) and reduced FEF_25%-75% group (n = 15). Clinical data, allergen sensitization profile, exhaled nitric oxide, spirometry, and methacholine provocation test results were compared between the two groups.Results: The mean FEV₁ and FEF_25%-75% values in the reduced FEF_25%-75% group (73.5 ± 9.4%pred and 56.0 ± 7.7%pred, respectively) were significantly lower than in the normal FEF_25%-75% group (87.0 ± 12.5%pred and 99.1 ± 21.4%pred, respectively). The mean disease duration was significantly longer in the reduced FEF_25%-75% group than in the normal FEF_25%-75% group (5.39 ± 1.85 y vs 3.14 ± 1.80 y, p < 0.001). Subjects with positive bronchial hyperresponsiveness (MChPC₂₀<16 mg/mL) were more frequently detected in the reduced FEF_25%-75% group than in the normal FEF_25%-75% group (26.7% vs 8.52%, p = 0.013). Long disease duration and severity of AR were significantly associated with impaired FEF_25%-75% values.Conclusions: Subjects with AR alone may have impaired FEF_25%-75% values which is considered as a marker of early bronchial involvement. Longer disease duration and severity of AR are important risk factors for progressive declines in small airway function. Physicians should be aware of need for the measurement of FEF_25%-75% values for early detection of small airway dysfunction, particularly in children with severe long-lasting allergic rhinitis.

Lung Function Predicts Outcome in Children With Obstructive Lung Disease After Hematopoietic Stem Cell Transplantation

Obstructive lung disease (OLD) that develops after hematopoietic stem cell transplantation (HSCT) has a significant impact on morbidity and mortality. We investigated the role of pulmonary function tests (PFTs) in the prediction of prognosis of OLD in children who have undergone HSCT. We retrospectively reviewed 538 patients who underwent allogenic HSCT in the Department of Pediatrics, Seoul St. Mary's Hospital, South Korea, from April 2009 to July 2017. OLD was identified on PFTs or chest computed tomography scans obtained from 3 months after HSCT onwards. OLD developed after HSCT in 46 patients (28 male individuals, median age: 11.2 y). The group that developed OLD with an unfavorable prognosis (n=23) had a lower forced vital capacity (FVC) (% of predicted, 78.53±24.00 vs. 97.71±16.96, P=0.01), forced expiratory volume in 1 second (FEV1) (% of predicted, 52.54±31.77 vs. 84.44±18.59, P=0.00), FEV1/FVC (%, 59.28±18.68 vs. 79.94±9.77, P=0.00), and forced expiratory flow at 25% to 75% of forced vital capacity (FEF25-75) (% of predicted, 30.95±39.92 vs. 57.82±25.71, P=0.00) at diagnosis than the group that developed OLD with a favorable prognosis (n=23). The group that developed OLD with an unfavorable prognosis had significant reductions in FVC, FEV1, FEV1/FVC, and FEF25-75 at 2 years after diagnosis. Children who develop OLD with an unfavorable prognosis after HSCT already have poor lung function at the time of diagnosis. Additional treatment should be considered in patients who develop OLD after HSCT according to their PFTs at diagnosis.

Normal Predicted Reference Values for Spirometry in Korean Children and Adolescents

Pulmonary function tests are useful to evaluate airway obstructions and bronchial responsiveness. We aimed to determine the reference values applicable to Korean children and adolescents. In total, 5590 (2607 males, 2983 females) healthy children aged 4 to 17 years old were recruited from three regions in Korea. Simple and multiple regression analyses were applied using age, height, and weight as variables to predict the forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), maximum mid-expiratory flow (MMEF) and the peak expiratory flow rate (PEFR). There were significant correlations between the variables and parameters (P < 0.001). The coefficient of determination (R²) values of polynomial equations with two variables were lower than those with two variables but higher than those of monomial equations based on height. The prediction equations by height were obtained, and the R² value of the FEV₁ was the highest. The predicted spirometric values for males were higher than those for females except for the MMEF. The R² values for the FEV1 and FVC were higher than previous studies except for the R² value of the FVC for males in European data. This study provided updated regression equations of normal predicted values for spirometry applicable to Korean children and adolescents.

Metabolic syndrome and lung function in Korean children and adolescents: A cross-sectional study

This study aimed to investigate whether obesity and metabolic syndrome (MetS) are associated with pulmonary function in Korean children and adolescents. Data from the 2009–2011 Korea National Health and Nutrition Examination Survey which is cross-sectional, nationwide, and representative survey were used. Adjusted regression analysis was performed to evaluate the association of obesity and MetS with lung function in children and adolescents. A total of 763 children and adolescents aged 10–18 years were evaluated. We found no significant difference in FEV₁% predicted, FVC% predicted, and FEV₁/FVC ratio among the obesity groups. Subjects with MetS showed a significantly lower FEV₁ predicted (91.54 ± 0.74% vs 94.64 ± 0.73%, P = 0.004), lower FVC% predicted (91.86 ± 0.63% vs 95.20 ± 0.63%, P < 0.001), and lower FEV₁/FVC ratio (76.76 ± 0.43% vs 80.13 ± 0.43%, P < 0.001) than those without MetS. Elevated waist circumference (WC), systolic blood pressure, fasting glucose, and lower high-density lipoprotein cholesterol (HDL-C) were independently associated with lower FEV₁/FVC ratio (all P < 0.05, respectively). Among MetS components, increased WC was the most important factor influencing lower FEV₁/FVC ratio. In conclusion, lung function in MetS patients was significantly lower, and the MetS component was independently associated.

Transition Patterns of Weight Status and Their Associated Factors among Elementary School Children: A Longitudinal Cohort Study Using Multistate Markov Model

Background: Childhood obesity is a recognized public health concern worldwide. It is essential to study the natural progression of obesity in the interest of prevention. This study aimed to describe the dynamic changes in weight status among elementary school children and identify the significant factors influencing the progression or regression of weight status. Methods: This study involved 928 elementary school children who were followed up annually during their elementary school years. Heights, weights, and vital capacity (VC) were measured each school year. A multistate Markov model containing three weight states was fit to longitudinal weight status data. Results: Children with healthy weight and obesity tended to stay in their preceding weight state. Children with overweight, in contrast, were more likely to move to the other two states. The mean sojourn time in obesity and in overweight states was 5.15 years (95% confidence interval [CI]: 4.22-6.3) and 2 years (95% CI: 1.76-2.28), respectively. Children in lower grades, those with a lower VC index, those with a higher initial BMI, those with a higher annual weight increment, and boys were at increased risk of progression to overweight or obesity, with a decreased probability of regression. Conclusions: Children with obesity were more resistant to recovery than those with overweight. Prevention and intervention measures should be adopted early when abnormal weight onset occurs. The multistate Markov model was an advanced tool to analyze dynamic changes in status and identify significant factors for progression and regression and helped to develop prevention and intervention targeting strategies.

Correlation between basic physical fitness and pulmonary function in Korean children and adolescents: a cross-sectional survey

[Purpose] The purpose of the present study was to determine whether there was a correlation between basic physical fitness and pulmonary function in Korean school students, to present an alternative method for improving their pulmonary function. [Subjects and Methods] Two hundred forty healthy students aged 6-17 years performed physical fitness tests of hand-grip strength, sit and reach, Sargent jump, single leg stance, and pulmonary function tests of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) using a Quark PFT. [Results] Muscle strength and power of boys improved in the late period of elementary school and middle school. Muscle strength of girls improved in the late period of elementary school. Analysis of factors affecting pulmonary function revealed that height, weight, BMI, and body fat significantly correlated with spirometric parameters. Right hand-grip strength, left hand-grip strength, and Sargent jump also significantly correlated with FVC and FEV1. [Conclusion] In order to improve the pulmonary function of children and adolescents, aerobic exercise and an exercise program to increase muscle strength and power is needed, and it should start in the late period of elementary school when muscle strength and power are rapidly increasing.