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Määttä AM, Malmberg LP, Pelkonen AS, Mäkelä MJ. The link between early childhood lower airway symptoms, airway hyperresponsiveness, and school-age lung function. Ann Allergy Asthma Immunol 2024; 132:54-61.e5. [PMID: 37827387 DOI: 10.1016/j.anai.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The role of early airway hyperresponsiveness (AHR) in the lung function of school-age children is currently unclear. OBJECTIVE To conduct a prospective follow-up study of lung function in schoolchildren with a history of lower airway symptoms and AHR to methacholine in early childhood and to compare the findings to schoolchildren with no previous or current lung diseases. We also explored symptoms and markers of type 2 inflammation. METHODS In 2004 to 2011, data on atopic markers, lung function, and AHR to methacholine were obtained from 193 symptomatic children under 3 years old. In 2016 to 2018, a follow-up sample of 84 children (median age, 11 years; IQR, 11-12) underwent measurements of atopic parameters, lung function, and AHR to methacholine. Moreover, in 2017 to 2018, 40 controls (median age, 11 years; IQR, 9-12) participated in the study. RESULTS Schoolchildren with early childhood lower airway symptoms and increased AHR had more frequent blood eosinophilia than their peers without increased AHR and lower prebronchodilator forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity Z-scores than those without increased AHR and controls. Post-bronchodilator values were not significantly different between the two AHR groups. Atopy in early childhood (defined as atopic eczema and at least 1 positive skin prick test result) was associated with subsequent lung function and atopic markers, but not AHR. CONCLUSION In symptomatic young children, increased AHR was associated with subsequent obstructive lung function, which appeared reversible by bronchodilation, and blood eosinophilia, indicative of type 2 inflammation.
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Affiliation(s)
- Anette M Määttä
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - L Pekka Malmberg
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna S Pelkonen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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2
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Dou D, Bi M, Li X, Zhang N, Xu M, Guo A, Li F, Zhu W. ADP Ribosylation Factor 6 Relieves Airway Inflammation and Remodeling by Inhibiting Ovalbumin Induced-Epithelial Mesenchymal Transition in Experimental Asthma, Possibly by Regulating of E2F Transcription Factor 8. Immunol Invest 2023:1-18. [PMID: 37326141 DOI: 10.1080/08820139.2023.2222778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Childhood asthma is a major global health concern. ADP-ribosylation factor 6 (ARF6) is a low-molecular-weight GTPase; however, its role in childhood asthma remains unclear. METHODS Ovalbumin (OVA)-challenged neonatal mice and transforming growth factor-β1 (TGF-β1)-induced BEAS-2B cells were used as in vivo and in vitro models of childhood asthma, respectively. RESULTS Upon OVA stimulation, ARF6 expression was upregulated in the lung tissue. Neonatal mice administered SehinH3 (an ARF6 inhibitor) exhibited improved pulmonary pathological injury, along with reduced inflammatory cell infiltration in the lungs and cytokine release in bronchial alveolar lavage fluid and serum (interleukin [IL]-3, IL-5, IL-13, IgE, and OVA-specific IgE). SehinH3 treatment restrained epithelial - mesenchymal transition (EMT) in the lungs of asthmatic mice, as evidenced by increased E-cadherin and decreased N-cadherin and α-smooth muscle actin expression. Different TGF-β1 exposures to BEAS-2B cells induced a time- and dose-dependent increase in ARF6 expression in vitro. Upon TGF-β1 stimulation, ARF6 knockdown repressed EMT and SehinH3 treatment caused similar results in BEAS-2B cells. The transcription factor E2F8 is involved in diverse biological functions and its increased expression was confirmed in vivo and in vitro. Dual-luciferase assays confirmed that E2F8 binds to the ARF6 promoter and promotes its transcriptional activity. In vitro results revealed that E2F8 silencing suppressed EMT, whereas rescue experiments showed that ARF6 overexpression partly reversed these phenomena. CONCLUSION Our study showed that ARF6 is associated with childhood asthma progression and may be positively regulated by E2F8. These results provide insight into the pathogenesis and treatment of childhood asthma.
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Affiliation(s)
- Dongdong Dou
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Meirong Bi
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Xiuyun Li
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Nan Zhang
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Mi Xu
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Aili Guo
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Feng Li
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Weiwei Zhu
- Department of Pediatrics, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
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3
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Koefoed HJL, Vonk JM, Koppelman GH. Predicting the course of asthma from childhood until early adulthood. Curr Opin Allergy Clin Immunol 2022; 22:115-122. [PMID: 35197433 PMCID: PMC8915994 DOI: 10.1097/aci.0000000000000810] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To communicate recent insights about the natural history of childhood asthma, with a focus on prediction of persistence and remission of childhood asthma, up to early adulthood. RECENT FINDINGS Lung function around the age of 8-9 years is the strongest predictor: obstructive lung function predicts asthma persistence up to early adulthood, whereas normal lung function predicts remission. The ability to predict asthma remission improves when lung function is combined with blood eosinophil levels and degree of bronchial hyperresponsiveness. Interventions, such as inhaled corticosteroids and immunotherapy do not appear to alter the course of asthma. Epigenetic studies have revealed potential novel biomarkers of asthma remission, such as micro-RNA patterns in blood. Specifically, lower serum levels of mi-R221-5p, which is associated with lower IL-6 release and eosinophilic inflammation, predict remission. Higher levels of blood DNA-methylation of a CpG site in Peroxisomal Biogenesis Factor 11 Beta were associated with asthma remission. SUMMARY Lung function, allergic comorbidity and polysensitization in childhood predict the course of asthma. Recent epigenetic studies have provided a better understanding of underlying pathological processes in asthma remission, which may be used to improve prediction or develop novel treatments aimed at altering the course of asthma.
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Affiliation(s)
- Hans Jacob L. Koefoed
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital
- Groningen Research Institute for Asthma and COPD (GRIAC)
| | - Judith M. Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC)
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital
- Groningen Research Institute for Asthma and COPD (GRIAC)
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4
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Clinical form of asthma and vaccine immunity in preschoolers. Postepy Dermatol Alergol 2021; 38:123-130. [PMID: 34408578 PMCID: PMC8362791 DOI: 10.5114/ada.2021.104287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/09/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction Asthma is the most common chronic disease in children. Its exacerbation results from allergic and infectious diseases. Aim To assess the influence of a clinical form of asthma on preschoolers’ vaccine immunity following 3 years after the completion of the mandatory vaccination programme. Material and methods The study encompassed 172 preschool children with asthma being newly diagnosed, including 140 patients with mild asthma and 32 with moderate asthma, whose vaccine immunity (level of IgG-specific antibodies) was assessed after the mandatory early vaccines had been administered in the early childhood. Monovalent vaccines (HBV + IPV + Hib) along with a three-component combined vaccine (DTwP) and MMR were given to 86 children while a six-component combined vaccine (DTaP + IPV + Hib + HBV) along with a three-component MMR vaccine were administered to the remaining 86 children. The immunity class for particular vaccinations was assessed according to the manufacturers’ instructions. Results Children suffering from mild asthma had considerably more frequently vaccinations administered on time (p < 0.001) and the type of vaccines (monovalent or highly-combined) administered did not have a significant influence on the clinical form of asthma in the children examined (p = 0.6951). Apart from the vaccines against hepatitis B and rubella where considerably more frequently a high level of antibodies occurred in children with mild asthma, the antibody levels to other vaccines, namely diphtheria, tetanus, pertussis, Hib and mumps, were not associated with the severity of asthma. Conclusions Moderate asthma may have a negative impact on remote vaccine immunity to HBV and rubella.
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Koefoed HJL, Zwitserloot AM, Vonk JM, Koppelman GH. Asthma, bronchial hyperresponsiveness, allergy and lung function development until early adulthood: A systematic literature review. Pediatr Allergy Immunol 2021; 32:1238-1254. [PMID: 33835532 PMCID: PMC8453965 DOI: 10.1111/pai.13516] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is unclear in which periods of life lung function deficits develop, and whether these are affected by risk factors such as asthma, bronchial hyper-responsiveness (BHR) and allergic comorbidity. The goal of this systematic review was to identify temporal associations of asthma, BHR and allergic comorbidity with large and small lung function development from birth until peak function in early adulthood. METHODS We searched MEDLINE, EMBASE, Web of Science and CINAHL for papers published before 01.01.2020 on risk factors and lung function measurements of large and small airways. Studies were required to report lung function at any time point or interval from birth until peak lung function (age 21-26) and include at least one candidate risk factor. RESULTS Of the 45 papers identified, 44 investigated cohorts and one was a clinical trial with follow-up. Asthma, wheezing, BHR and allergic sensitization early in life and to multiple allergens were associated with a lower lung function growth of large and small airways during early childhood compared with the control populations. Lung function development after childhood in subjects with asthma or persistent wheeze, although continuing to grow at a lower level, largely tracked parallel to non-affected individuals until peak function was attained. CLINICAL IMPLICATIONS AND FUTURE RESEARCH Deficits in lung function growth develop in early childhood, and children with asthma, BHR and early-life IgE (poly)sensitization are at risk. This period is possibly a critical window of opportunity to identify at-risk subjects and provide treatment aimed at preventing long-term sequelae of lung function.
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Affiliation(s)
- Hans Jacob L. Koefoed
- Department of Pediatric Pulmonology and Pediatric AllergologyBeatrix Children’s HospitalUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Annelies M. Zwitserloot
- Department of Pediatric Pulmonology and Pediatric AllergologyBeatrix Children’s HospitalUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Judith M. Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric AllergologyBeatrix Children’s HospitalUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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6
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Guerra S, Lombardi E, Stern DA, Sherrill DL, Gilbertson-Dahdal D, Wheatley-Guy CM, Snyder EM, Wright AL, Martinez FD, Morgan WJ. Fetal Origins of Asthma: A Longitudinal Study from Birth to Age 36 Years. Am J Respir Crit Care Med 2021; 202:1646-1655. [PMID: 32649838 DOI: 10.1164/rccm.202001-0194oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Deficits in infant lung function-including the ratio of the time to reach peak tidal expiratory flow to the total expiratory time (tptef/te) and maximal expiratory flow at FRC (V̇maxFRC)-have been linked to increased risk for childhood asthma.Objectives: To examine the individual and combined effects of tptef/te and V̇maxFRC in infancy on risk for asthma and abnormalities of airway structure into mid-adult life.Methods: One hundred eighty participants in the Tucson Children's Respiratory Study birth cohort had lung function measured by the chest-compression technique in infancy (mean age ± SD: 2.0 ± 1.2 mo). Active asthma was assessed in up to 12 questionnaires between ages 6 and 36 years. Spirometry and chest high-resolution computed tomographic (HRCT) imaging were completed in a subset of participants at age 26. The relations of infant tptef/te and V̇maxFRC to active asthma and airway structural abnormalities into adult life were tested in multivariable mixed models.Measurements and Main Results: After adjustment for covariates, a 1-SD decrease in infant tptef/te and V̇maxFRC was associated with a 70% (P = 0.001) and 55% (P = 0.005) increased risk of active asthma, respectively. These effects were partly independent, and two out of three infants who were in the lowest tertile for both tptef/te and V̇maxFRC developed active asthma by mid-adult life. Infant V̇maxFRC predicted reduced airflow and infant tptef/te reduced HRCT airway caliber at age 26.Conclusions: These findings underscore the long-lasting effects of the fetal origins of asthma, support independent contributions by infant tptef/te and V̇maxFRC to development of asthma, and link deficits at birth in tptef/te with HRCT-assessed structural airway abnormalities in adult life.
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Affiliation(s)
- Stefano Guerra
- Asthma and Airway Disease Research Center.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, College of Medicine - Tucson.,Mel and Enid Zuckerman College of Public Health
| | - Enrico Lombardi
- Asthma and Airway Disease Research Center.,Department of Medical Imaging, College of Medicine - Tucson, and
| | | | - Duane L Sherrill
- Asthma and Airway Disease Research Center.,Department of Pediatrics, University of Arizona, Tucson, Arizona
| | | | | | - Eric M Snyder
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona; and
| | | | | | - Wayne J Morgan
- Asthma and Airway Disease Research Center.,Geneticure, Rochester, Minnesota
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7
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Lezmi G, Lejeune S, Pin I, Blanchon S, Bouazza N, Jolaine V, Marguet C, Houdoin V, Berger P, Fayon M, Dubus JC, Reix P, Pellan M, Brouard J, Chiron R, Giovannini-Chami L, Deschildre A, de Blic J. Factors Associated with Asthma Severity in Children: Data from the French COBRAPed Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1969-1979. [PMID: 33359443 DOI: 10.1016/j.jaip.2020.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Severe asthma (SA) in children is a complex, heterogeneous disease, associated with a considerable burden. However, factors influencing asthma severity are poorly described and may differ according to age. OBJECTIVE To determine whether factors associated with asthma severity differ between preschoolers with severe recurrent wheeze (SRW) and school-age children with SA. METHODS Data from the French multicenter prospective observational cohort of preschool (3-6 years) children with SRW and nonsevere recurrent wheeze (NSRW) and school-age (7-11 years) children with SA and nonsevere asthma (NSA) (Pediatric Cohort of Bronchial Obstruction and Asthma) were analyzed. RESULTS A total of 131 preschool children (92 SRW and 49 NSRW) and 207 school-age children (92 SA and 115 NSA) were included. In both univariable and multivariable analysis, SRW was associated with second-hand smoke exposure (multivariable analysis: odds ratio [95% CI], 29.8 [3.57-3910]) and exposure to mold/dampness at home (multivariable analysis: odds ratio [95% CI], 4.22 [1.25-18.2]) compared with NSRW. At school-age, history of atopic dermatitis and food allergy was more frequent in children with SA than in those with NSA. Multivariable analysis confirmed that SA was associated with a history of food allergy (odds ratio [95% CI], 5.01 [2.23-11.9]). CONCLUSIONS Our data suggest that factors influencing asthma severity may differ according to age. In preschool children with SRW, second-hand smoke and exposure to mold are predominant, whereas associated allergic disorders are mainly involved in SA at school-age.
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Affiliation(s)
- Guillaume Lezmi
- Université de Paris, Institut Necker-Enfants Malades, Equipe Immunorégulation et Immunopathologie, Inserm UMR1151, CNRS UMR8253, Paris, France; Service de Pneumologie et Allergologie Pédiatriques, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Stéphanie Lejeune
- Univ. Lille, CHU Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France; Univ. Lille, LIRIC UMR 995 Inserm, Clinical Investigation Center, CIC-1403-Inserm-CHU, Lille, France
| | - Isabelle Pin
- Pédiatrie, CHU Grenoble Alpes, INSERM, Institute for Advanced Biosciences, Université Grenoble Alpes, Grenoble, France
| | - Sylvain Blanchon
- Children Hospital, Pediatric Pulmonology and Allergology Unit, CHU Toulouse, Toulouse, France
| | - Naïm Bouazza
- Paris Descartes Necker, Cochin Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Valérie Jolaine
- Paris Descartes Necker, Cochin Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Marguet
- EA3830-GHRV, Rouen University, Pediatric Respiratory and Allergic Diseases, CF Reference Center, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - Véronique Houdoin
- Robert Debré Hospital, Pediatric Pulmonology and Allergology, University of Paris, Paris, France; University of Paris Diderot, Sorbonne Paris Cité, INSERM UMR S976, Paris, France
| | - Patrick Berger
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
| | - Michael Fayon
- CHU de Bordeaux, Unité de pneumologie pédiatrique, Centre d'Investigation Clinique (CIC 1401), Bordeaux, France
| | - Jean-Christophe Dubus
- Unité de pneumopédiatrie CHU Timone-Enfants, Aix-Marseille Université, IRD MEPHI, IHU Méditerranée-Infection, Marseille, France
| | - Philippe Reix
- Service de Pneumologie, Allergologie et Mucoviscidose Pédiatrique, CHU de Lyon, Lyon, France; UMR 5558 (EMET), CNRS, LBBE, Université de Lyon, Villeurbanne, France
| | | | - Jacques Brouard
- Service de Pédiatrie Médicale, CHU Caen, Caen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, Caen, France
| | - Raphael Chiron
- Pediatric Department, Montpellier University Hospital, Montpellier, France
| | | | - Antoine Deschildre
- Univ. Lille, CHU Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France; Univ. Lille, LIRIC UMR 995 Inserm, Clinical Investigation Center, CIC-1403-Inserm-CHU, Lille, France
| | - Jacques de Blic
- Université de Paris, Institut Necker-Enfants Malades, Equipe Immunorégulation et Immunopathologie, Inserm UMR1151, CNRS UMR8253, Paris, France; Service de Pneumologie et Allergologie Pédiatriques, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
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8
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De Queiroz Andrade E, Da Silva Sena CR, Collison A, Murphy VE, Gould GS, Bonevski B, Mattes J. Association between active tobacco use during pregnancy and infant respiratory health: a systematic review and meta-analysis. BMJ Open 2020; 10:e037819. [PMID: 32998922 PMCID: PMC7528360 DOI: 10.1136/bmjopen-2020-037819] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/27/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate what is known about active tobacco use during pregnancy and the association with infant respiratory health. DESIGN Systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES MEDLINE, EMBASE, Cochrane, CINAHL, and Maternity and Infant Care were searched thoroughly until June 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included case-control and cohort studies estimating the association between active tobacco use during pregnancy and infant respiratory health (wheezing and apnoea) and lung function parameters in the first 12 months of life. DATA EXTRACTION AND SYNTHESIS Extraction and risk of bias assessment were conducted by two independent reviewers. The odds ratio, relative risk and mean differences were pooled with a 95% CI using the generic inverse variance method. Heterogeneity was assessed and expressed by percentage using I2. RESULTS We identified 4423 abstracts, and 21 publications met the eligibility criteria. Pooled OR showed an increase in wheezing episodes in infants born to mothers who were active tobacco users during pregnancy (OR 1.50, 95% CI 1.27 to 1.77, p<0.01). Mixed results were found on lung function parameters, and a meta-analysis including two studies with comparable methodology showed a trend towards reduced maximum flow rate at functional residual capacity of -34.59 mL/s (95% CI -72.81 to 3.63, p=0.08) in 1-month-old infants born to women who smoked during pregnancy. A higher risk of apnoea was described for infants born to mothers who used smokeless tobacco during pregnancy, while the results in infants born to women who actively smoked tobacco during pregnancy were non-conclusive. CONCLUSION Infants born to mothers who actively smoked during pregnancy are at higher odds of having wheeze and may have lower lung function. Smokeless tobacco use in pregnancy may increase the risk of apnoea in infancy. PROSPERO REGISTRATION NUMBER CRD42018083936.
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Affiliation(s)
- Ediane De Queiroz Andrade
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carla Rebeca Da Silva Sena
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Adam Collison
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa E Murphy
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gillian Sandra Gould
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Joerg Mattes
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Paediatric Respiratory & Sleep Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
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9
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Anthracopoulos MB, Everard ML. Asthma: A Loss of Post-natal Homeostatic Control of Airways Smooth Muscle With Regression Toward a Pre-natal State. Front Pediatr 2020; 8:95. [PMID: 32373557 PMCID: PMC7176812 DOI: 10.3389/fped.2020.00095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
The defining feature of asthma is loss of normal post-natal homeostatic control of airways smooth muscle (ASM). This is the key feature that distinguishes asthma from all other forms of respiratory disease. Failure to focus on impaired ASM homeostasis largely explains our failure to find a cure and contributes to the widespread excessive morbidity associated with the condition despite the presence of effective therapies. The mechanisms responsible for destabilizing the normal tight control of ASM and hence airways caliber in post-natal life are unknown but it is clear that atopic inflammation is neither necessary nor sufficient. Loss of homeostasis results in excessive ASM contraction which, in those with poor control, is manifest by variations in airflow resistance over short periods of time. During viral exacerbations, the ability to respond to bronchodilators is partially or almost completely lost, resulting in ASM being "locked down" in a contracted state. Corticosteroids appear to restore normal or near normal homeostasis in those with poor control and restore bronchodilator responsiveness during exacerbations. The mechanism of action of corticosteroids is unknown and the assumption that their action is solely due to "anti-inflammatory" effects needs to be challenged. ASM, in evolutionary terms, dates to the earliest land dwelling creatures that required muscle to empty primitive lungs. ASM appears very early in embryonic development and active peristalsis is essential for the formation of the lungs. However, in post-natal life its only role appears to be to maintain airways in a configuration that minimizes resistance to airflow and dead space. In health, significant constriction is actively prevented, presumably through classic negative feedback loops. Disruption of this robust homeostatic control can develop at any age and results in asthma. In order to develop a cure, we need to move from our current focus on immunology and inflammatory pathways to work that will lead to an understanding of the mechanisms that contribute to ASM stability in health and how this is disrupted to cause asthma. This requires a radical change in the focus of most of "asthma research."
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Affiliation(s)
| | - Mark L. Everard
- Division of Paediatrics & Child Health, Perth Children's Hospital, University of Western Australia, Perth, WA, Australia
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10
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Malmström K, Lohi J, Malmberg LP, Kotaniemi-Syrjänen A, Lindahl H, Sarna S, Pelkonen AS, Mäkelä MJ. Airway hyperresponsiveness, remodeling and inflammation in infants with wheeze. Clin Exp Allergy 2020; 50:558-566. [PMID: 32159879 DOI: 10.1111/cea.13598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/23/2020] [Accepted: 03/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The relationship of airway hyperresponsiveness to airway remodeling and inflammation in infants with wheeze is unclear. OBJECTIVE To investigate airway hyperresponsiveness, remodeling and inflammation in infants with wheeze and troublesome breathing. METHODS Inclusion criteria were as follows: full-term, 3-23 months of age; doctor -diagnosed wheeze and persistent recurrent troublesome breathing; without obvious structural defect, suspicion of ciliary dyskinesia, cystic fibrosis, immune deficiency or specified use of corticosteroids. Airway hyperresponsiveness (AHR) was evaluated by performing a methacholine bronchial challenge test combined with whole body plethysmography and rapid thoracoabdominal compression. Endobronchial biopsies were analysed for remodeling (thickness of reticular basement membrane and amount of airway smooth muscle) and for inflammation (numbers of inflammatory cells). Correlation analyses were performed. RESULTS Forty-nine infants fulfilled the inclusion criteria for the present study. Median age was 1.06 years (IQR 0.6; 1.5). Lung function was impaired in 39/49 (80%) children, at the median age of 1.1 years. Methacholine challenge was successfully performed in 38/49 children. Impaired baseline lung function was correlated with AHR (P = .047, Spearman). In children with the most sensitive quartile of AHR, the percentage of median bronchial airway smooth muscle % and the number of bronchial mast cells in airway smooth muscle were not significantly higher compared to others (P = .057 and 0.056, respectively). No association was found between AHR and thickness of reticular basement membrane or inflammatory cells. Only a small group of children with both atopy and AHR (the most reactive quartile) had thicker airway smooth muscle area than non-atopics with AHR (P = .031). CONCLUSIONS AND CLINICAL RELEVANCE These findings do not support the concept that AHR in very young children with wheeze is determined by eosinophilic inflammation or clear-cut remodeling although it is associated with impaired baseline lung function. The possible association of increased airway smooth muscle area among atopic children with AHR remains to be confirmed.
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Affiliation(s)
- Kristiina Malmström
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Dept. of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leo Pekka Malmberg
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Kotaniemi-Syrjänen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harry Lindahl
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Sarna
- Dept. of Public Health, University of Helsinki, Helsinki, Finland
| | - Anna S Pelkonen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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11
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Bonato M, Tiné M, Bazzan E, Biondini D, Saetta M, Baraldo S. Early Airway Pathological Changes in Children: New Insights into the Natural History of Wheezing. J Clin Med 2019; 8:jcm8081180. [PMID: 31394827 PMCID: PMC6723918 DOI: 10.3390/jcm8081180] [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: 07/03/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 01/09/2023] Open
Abstract
Asthma is a heterogeneous condition characterized by reversible airflow limitation, with different phenotypes and clinical expressions. Although it is known that asthma is influenced by age, gender, genetic background, and environmental exposure, the natural history of the disease is still incompletely understood. Our current knowledge of the factors determining the evolution from wheezing in early childhood to persistent asthma later in life originates mainly from epidemiological studies. The underlying pathophysiological mechanisms are still poorly understood. The aim of this review is to converge epidemiological and pathological evidence early in the natural history of asthma to gain insight into the mechanisms of disease and their clinical expression.
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Affiliation(s)
- Matteo Bonato
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Mariaenrica Tiné
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Erica Bazzan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Davide Biondini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Marina Saetta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy.
| | - Simonetta Baraldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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12
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Jiang C, Guo Y, Yu H, Lu S, Meng L. Pleiotropic microRNA-21 in pulmonary remodeling: novel insights for molecular mechanism and present advancements. Allergy Asthma Clin Immunol 2019; 15:33. [PMID: 31139230 PMCID: PMC6528201 DOI: 10.1186/s13223-019-0345-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/08/2019] [Indexed: 12/29/2022] Open
Abstract
MicroRNA-21 (miR-21), probably one of the most studied miRNAs to date, is found pleiotropic in various biological events. Its emerging role in pulmonary remodeling has attracted extensive attention. This review summarizes the genomic information of its primary transcript and various transcriptional regulations on its promoter. In addition, the role of miR-21 in pulmonary remodeling related signaling such as transforming growth factor β (TGF-β), bone morphogenetic protein (BMP), epidermal growth factor receptor (EGFR) and Notch signaling is discussed. Various validated miR-21 target genes participate in controlling of the overactive cell accumulation, smooth muscle contraction, inflammatory stress (trigger for lung epithelium damage), extracellular matrix deposition and hypoxia-induced disorders. Moreover, we focus on its particular implication in events including inflammatory stress-driven epithelium damage, epithelial-to-mesenchymal transition (EMT), transdifferentiation of fibroblasts into myofibroblasts, hypoxia stimuli and ROS response, as well as some other pulmonary remodeling related events such as overactive fibroblast (myofibroblast) accumulation, extracellular matrix deposition, and angiogenesis. Here, we summarize the strong potential of miR-21 in pulmonary remodeling and provide novel clues for further research in this area.
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Affiliation(s)
- Congshan Jiang
- 1Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, West Yanta Road No.76, Xi'an, Shaanxi People's Republic of China.,Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi People's Republic of China
| | - Yuanxu Guo
- 1Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, West Yanta Road No.76, Xi'an, Shaanxi People's Republic of China.,Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi People's Republic of China
| | - Hongchuan Yu
- Department of Respiratory Medicine, Xi'an Children Hospital, Xi'an, Shaanxi People's Republic of China
| | - Shemin Lu
- 1Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, West Yanta Road No.76, Xi'an, Shaanxi People's Republic of China.,Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi People's Republic of China
| | - Liesu Meng
- 1Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, West Yanta Road No.76, Xi'an, Shaanxi People's Republic of China.,Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi People's Republic of China
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13
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Bonato M, Bazzan E, Snijders D, Tinè M, Biondini D, Turato G, Balestro E, Papi A, Cosio MG, Barbato A, Baraldo S, Saetta M. Clinical and Pathologic Factors Predicting Future Asthma in Wheezing Children. A Longitudinal Study. Am J Respir Cell Mol Biol 2019; 59:458-466. [PMID: 29812990 DOI: 10.1165/rcmb.2018-0009oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Wheeze is a common symptom in infants, but not all wheezers develop asthma. Indeed, up to 50% of wheezing children outgrow their symptoms by school age. How to predict if early wheeze will become asthma is still a matter of vivid debate. In this work, we sought to assess the clinical and pathological factors that might predict the future development of asthma in children. Eighty children (mean age 3.8 ± 1 yr) who underwent a clinically indicated bronchoscopy were followed prospectively for a median of 5 years. At baseline, clinical characteristics with a particular focus on wheezing and its presentation (episodic or multitrigger) were collected, and structural and inflammatory changes were quantified in bronchial biopsies. Follow-up data were available for 74 of the 80 children. Children who presented with multitrigger wheeze were more likely to have asthma at follow-up than those with episodic wheeze (P = 0.04) or without wheeze (P < 0.0001). Children with asthma also had lower birth weights (P = 0.02), a lower prevalence of breastfeeding (P = 0.02), and a trend for increased IgE (P = 0.07) at baseline than those with no asthma. Basement membrane thickness and airway eosinophils at baseline were increased in children who developed asthma at follow-up (P = 0.001 and P = 0.026, respectively). Multivariate analysis showed that among all clinical and pathological factors, multitrigger wheezing, basement membrane thickening, and reduced birth weight were predictive of future asthma development. We conclude that multitrigger wheeze and reduced birth weight are clinical predictors of asthma development. Basement membrane thickening in early childhood is closely associated with asthma development, highlighting the importance of airway remodeling in early life as a risk factor for future asthma.
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Affiliation(s)
- Matteo Bonato
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
| | - Erica Bazzan
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
| | - Deborah Snijders
- 2 Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Mariaenrica Tinè
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
| | - Davide Biondini
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
| | - Graziella Turato
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
| | - Elisabetta Balestro
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
| | - Alberto Papi
- 3 Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy; and
| | - Manuel G Cosio
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy.,4 Meakins-Christie Laboratories, Respiratory Division, McGill University, Montreal, Québec, Canada
| | - Angelo Barbato
- 2 Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Simonetta Baraldo
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
| | - Marina Saetta
- 1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova and Padova City Hospital, Padova, Italy
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14
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Bush A, Saglani S. Structurally Unsound? Why Airways Become Asthmatic. Am J Respir Cell Mol Biol 2019; 59:405-406. [PMID: 29953256 DOI: 10.1165/rcmb.2018-0181ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Andrew Bush
- 1 Department of Paediatric Respiratory Medicine Imperial College and Royal Brompton Hospital London, United Kingdom
| | - Sejal Saglani
- 1 Department of Paediatric Respiratory Medicine Imperial College and Royal Brompton Hospital London, United Kingdom
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15
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Abstract
Asthmatic adults with lower lung function have been described as having had this worse condition early in life. Lung function is reduced in children with persistent asthma and continues low throughout adult life. The challenge is to know if impaired lung function is a risk factor of asthma, as a consequence of special congenital characteristics of the airways, or whether asthmatic patients suffer a loss in lung function as early as 9 years of age as a consequence of very precocious remodeling of the airways. The loss is so early in life that it is probably a congenital characteristic, however there is not a cut-off point with clinical interest to predict risk of asthma later in life. There are contradictory results regarding whether asthmatic children lose lung function as a consequence of the airway remodeling by the illness itself. This aspect seemed to be shown for children at risk-the offspring of asthmatic mothers. The early BHR seems to be very frequent even in healthy infants, but is probably not a risk factor for asthma years later; except in the offspring of asthmatic mothers in which it has been shown. There are still many uncertainties in this field; so, more research is needed in order to better understand the pathophysiology of asthma, the early risk factors and to design new therapeutic targets and early interventions to change the natural history of the disease.
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Affiliation(s)
- Manuel Sánchez-Solís
- Department of Pediatric, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Biomedical Research Institute of Murcia (IMIB), Palmar, Spain.,Department of Surgery, Pediatric, Obstetric and Gynaecology, University of Murcia, Murcia, Spain
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16
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Fibroblast gene expression following asthmatic bronchial epithelial cell conditioning correlates with epithelial donor lung function and exacerbation history. Sci Rep 2018; 8:15768. [PMID: 30361541 PMCID: PMC6202408 DOI: 10.1038/s41598-018-34021-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/06/2018] [Indexed: 11/08/2022] Open
Abstract
Airway remodeling may contribute to decreased lung function in asthmatic children. Bronchial epithelial cells (BECs) may regulate fibroblast expression of extracellular matrix (ECM) constituents and fibroblast-to-myofibroblast transition (FMT). Our objective was to determine if human lung fibroblast (HLF) expression of collagen I (COL1A1), hyaluronan synthase 2 (HAS2), and the FMT marker alpha-smooth muscle actin (α-SMA) by HLFs conditioned by BECs from asthmatic and healthy children correlate with lung function measures and exacerbation history among BEC donors. BECs from asthmatic (n = 23) and healthy children (n = 15) were differentiated at an air-liquid interface (ALI) and then co-cultured with HLFs for 96 hours. Expression of COL1A1, HAS2, and α-SMA by HLFs was determined by quantitative polymerase chain reaction (qPCR). FMT was quantified by measuring HLF cytoskeletal α-SMA by flow cytometry. Pro-collagen Iα1, hyaluronan (HA), and PGE2 were measured in BEC-HLF supernatant. Correlations between lung function measures of BEC donors, and COL1A1, HAS2, and α-SMA gene expression, as well as supernatant concentrations of HA, pro-collagen Iα1, hyaluronan (HA), and PGE2 were assessed. We observed that expression of α-SMA and COL1A1 by HLFs co-cultured with asthmatic BECs was negatively correlated with BEC donor lung function. BEC-HLF supernatant concentrations of pro-collagen Iα1 were negatively correlated, and PGE2 concentrations positively correlated, with asthmatic BEC donor lung function. Expression of HAS2, but not α-SMA or COL1A1, was greater by HLFs co-cultured with asthmatic BECs from donors with a history of severe exacerbations than by HLFs co-cultured with BECs from donors who lacked a history of severe exacerbations. In conclusion, α-SMA and COL1A1 expression by HLFs co-cultured with BECs from asthmatic children were negatively correlated with lung function measures, supporting our hypothesis that epithelial regulation of HLFs and airway deposition of ECM constituents by HLFs contributes to lung function deficits among asthmatic children. Furthermore, epithelial regulation of airway HAS2 may influence the susceptibility of children with asthma to experience severe exacerbations. Finally, epithelial-derived PGE2 is a potential regulator of airway FMT and HLF production of collagen I that should be investigated further in future studies.
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17
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Nwokoro C, Grigg J. Preschool wheeze, genes and treatment. Paediatr Respir Rev 2018; 28:47-54. [PMID: 29361392 DOI: 10.1016/j.prrv.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023]
Abstract
Preschool wheeze is a common but poorly understood cause of respiratory morbidity that is both distinct from and overlaps with infantile bronchiolitis and school age asthma. Attempts at classification by epidemiology, pathophysiology, therapeutic response and clinical phenotype are imperfect and yet fundamental to both treatment choice and research design. The four main therapeutic classes for preschool wheeze, namely beta2 agonists, anticholinergics, corticosteroids and leukotriene modifiers are employed with variable and often scanty evidence base, with evidence for a genetic influence on response variations. The article will discuss the pharmacogenetics of the various options, summarise current treatment recommendations, and explore future research directions.
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Affiliation(s)
- Chinedu Nwokoro
- Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary, University of London, United Kingdom.
| | - Jonathan Grigg
- Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary, University of London, United Kingdom
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18
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Lezmi G, Deschildre A, Abou Taam R, Fayon M, Blanchon S, Troussier F, Mallinger P, Mahut B, Gosset P, de Blic J. Remodelling and inflammation in preschoolers with severe recurrent wheeze and asthma outcome at school age. Clin Exp Allergy 2018; 48:806-813. [PMID: 29603800 DOI: 10.1111/cea.13143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/24/2018] [Accepted: 03/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The influence of airway remodelling and inflammation in preschoolers with severe recurrent wheeze on asthma outcomes is poorly understood. OBJECTIVE To assess their association with asthma symptoms and lung function at school age. METHODS Preschoolers (38.4 months) initially investigated with bronchial biopsies were re-assessed for asthma symptoms and lung function at school age. RESULTS Thirty-six of 49 preschoolers (73.5%) were assessed at 10.9 years. Twenty-six (72.2%) had persistent asthma. Submucosal eosinophil counts were higher in children with severe exacerbations at school age than in those without (16/0.1 mm2 [11.2-30.4] vs 8/0.1 mm2 [2.4-17.6], P = .02), and correlated with the number of severe exacerbations (P = .04, r = .35). Submucosal neutrophil counts correlated with FEV1/FVC (P < .01, r = .47) and FEF25-75% predicted (P = .02, r = .43). Airway smooth muscle (ASM) area correlated with FEV1/FVC (P < .01, r = .51). Vessel numbers negatively correlated with FEV1% predicted and FEV1/FVC (P = .03, r = -.42; P = .04, r = -.41; respectively) and FEF25-75% predicted (P = .02, r = -.46). CONCLUSION Eosinophilic inflammation in preschoolers with severe recurrent wheeze might be predictive of future severe exacerbations, neutrophilia might be associated with better lung function. Changes in ASM and vascularity might affect lung function at school age.
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Affiliation(s)
- G Lezmi
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Université Paris Descartes, Paris, France
| | - A Deschildre
- Unité de Pneumologie-Allergologie Pédiatrique, Clinique de Pédiatrie Jeanne de Flandre, CHRU de Lille, Université Nord de France, Lille, France
| | - R Abou Taam
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - M Fayon
- Centre de Recherche Cardio-thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Centre d'Investigation Clinique (CIC 1401), Bordeaux, France
| | - S Blanchon
- Unité de Pneumologie et Allergologie Pédiatrique, Centre de Compétences des Maladies Respiratoires Rares, Hôpitaux Universitaire de Toulouse, Toulouse, France
| | - F Troussier
- Centre de Ressources et de Compétences en Mucoviscidose Enfants, Service de Pédiatrie, Centre Hospitalier Universitaire, Angers, France
| | - P Mallinger
- Cabinet de Pneumologie et d'Allergologie des Sardières, Bourg-en-Bresse, France
| | - B Mahut
- Cabinet La Berma, Antony, France
| | - P Gosset
- Centre d'Infection et d'Immunité de Lille, Institut Pasteur de Lille, Lille, France.,Centre National de la Recherche Scientifique, Lille, France.,Institut National de la Santé et de la Recherche Médicale, Lille, France.,Institut Fédératif de la Recherche 142, Lille, France
| | - J de Blic
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Université Paris Descartes, Paris, France
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19
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Airway remodeling in asthma: what really matters. Cell Tissue Res 2017; 367:551-569. [PMID: 28190087 PMCID: PMC5320023 DOI: 10.1007/s00441-016-2566-8] [Citation(s) in RCA: 247] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/21/2016] [Indexed: 12/21/2022]
Abstract
Airway remodeling is generally quite broadly defined as any change in composition, distribution, thickness, mass or volume and/or number of structural components observed in the airway wall of patients relative to healthy individuals. However, two types of airway remodeling should be distinguished more clearly: (1) physiological airway remodeling, which encompasses structural changes that occur regularly during normal lung development and growth leading to a normal mature airway wall or as an acute and transient response to injury and/or inflammation, which ultimately results in restoration of a normal airway structures; and (2) pathological airway remodeling, which comprises those structural alterations that occur as a result of either disturbed lung development or as a response to chronic injury and/or inflammation leading to persistently altered airway wall structures and function. This review will address a few major aspects: (1) what are reliable quantitative approaches to assess airway remodeling? (2) Are there any indications supporting the notion that airway remodeling can occur as a primary event, i.e., before any inflammatory process was initiated? (3) What is known about airway remodeling being a secondary event to inflammation? And (4), what can we learn from the different animal models ranging from invertebrate to primate models in the study of airway remodeling? Future studies are required addressing particularly pheno-/endotype-specific aspects of airway remodeling using both endotype-specific animal models and “endotyped” human asthmatics. Hopefully, novel in vivo imaging techniques will be further advanced to allow monitoring development, growth and inflammation of the airways already at a very early stage in life.
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20
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Gutierrez MJ, Gomez JL, Perez GF, Pancham K, Val S, Pillai DK, Giri M, Ferrante S, Freishtat R, Rose MC, Preciado D, Nino G. Airway Secretory microRNAome Changes during Rhinovirus Infection in Early Childhood. PLoS One 2016; 11:e0162244. [PMID: 27643599 PMCID: PMC5028059 DOI: 10.1371/journal.pone.0162244] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/21/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Innate immune responses are fine-tuned by small noncoding RNA molecules termed microRNAs (miRs) that modify gene expression in response to the environment. During acute infections, miRs can be secreted in extracellular vesicles (EV) to facilitate cell-to-cell genetic communication. The purpose of this study was to characterize the baseline population of miRs secreted in EVs in the airways of young children (airway secretory microRNAome) and examine the changes during rhinovirus (RV) infection, the most common cause of asthma exacerbations and the most important early risk factor for the development of asthma beyond childhood. METHODS Nasal airway secretions were obtained from children (≤3 yrs. old) during PCR-confirmed RV infections (n = 10) and age-matched controls (n = 10). Nasal EVs were isolated with polymer-based precipitation and global miR profiles generated using NanoString microarrays. We validated our in vivo airway secretory miR data in an in vitro airway epithelium model using apical secretions from primary human bronchial epithelial cells (HBEC) differentiated at air-liquid interface (ALI). Bioinformatics tools were used to determine the unified (nasal and bronchial) signature airway secretory miRNAome and changes during RV infection in children. RESULTS Multiscale analysis identified four signature miRs comprising the baseline airway secretory miRNAome: hsa-miR-630, hsa-miR-302d-3p, hsa- miR-320e, hsa-miR-612. We identified hsa-miR-155 as the main change in the baseline miRNAome during RV infection in young children. We investigated the potential biological relevance of the airway secretion of hsa-mir-155 using in silico models derived from gene datasets of experimental in vivo human RV infection. These analyses confirmed that hsa-miR-155 targetome is an overrepresented pathway in the upper airways of individuals infected with RV. CONCLUSIONS Comparative analysis of the airway secretory microRNAome in children indicates that RV infection is associated with airway secretion of EVs containing miR-155, which is predicted in silico to regulate antiviral immunity. Further characterization of the airway secretory microRNAome during health and disease may lead to completely new strategies to treat and monitor respiratory conditions in all ages.
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Affiliation(s)
- Maria J. Gutierrez
- Division of Pediatric Allergy Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jose L. Gomez
- Division of Pediatric Pulmonology, University of Kentucky, Lexington, Kentucky, United States of America
| | - Geovanny F. Perez
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC, United States of America
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
- Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, United States of America
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, United States of America
| | - Krishna Pancham
- Division of Pediatric Pulmonology, University of Kentucky, Lexington, Kentucky, United States of America
| | - Stephanie Val
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Children’s National Medical Center, Washington, DC, United States of America
| | - Dinesh K. Pillai
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC, United States of America
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
- Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, United States of America
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, United States of America
| | - Mamta Giri
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, United States of America
| | - Sarah Ferrante
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, United States of America
| | - Robert Freishtat
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
- Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, United States of America
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, United States of America
- Division of Emergency Medicine, Children’s National Medical Center, Washington, DC, United States of America
| | - Mary C. Rose
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC, United States of America
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
- Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, United States of America
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, United States of America
| | - Diego Preciado
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Children’s National Medical Center, Washington, DC, United States of America
| | - Gustavo Nino
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, Washington, DC, United States of America
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
- Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, United States of America
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC, United States of America
- * E-mail:
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21
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Dietz K, de Los Reyes Jiménez M, Gollwitzer ES, Chaker AM, Zissler UM, Rådmark OP, Baarsma HA, Königshoff M, Schmidt-Weber CB, Marsland BJ, Esser-von Bieren J. Age dictates a steroid-resistant cascade of Wnt5a, transglutaminase 2, and leukotrienes in inflamed airways. J Allergy Clin Immunol 2016; 139:1343-1354.e6. [PMID: 27554815 DOI: 10.1016/j.jaci.2016.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/12/2016] [Accepted: 07/26/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Airway remodeling is a detrimental and refractory process showing age-dependent clinical manifestations that are mechanistically undefined. The leukotriene (LT) and wingless/integrase (Wnt) pathways have been implicated in remodeling, but age-specific expression profiles and common regulators remained elusive. OBJECTIVE We sought to study the activation of the LT and Wnt pathways during early- or late-onset allergic airway inflammation and to address regulatory mechanisms and clinical relevance in normal human bronchial epithelial cells (NHBEs) and nasal polyp tissues. METHODS Mice were sensitized with house dust mite (HDM) allergens from days 3, 15, or 60 after birth. Remodeling factors in murine bronchoalveolar lavage fluid, lung tissue, or human nasal polyp tissue were analyzed by means of Western blotting, immunoassays, or histology. Regulatory mechanisms were studied in cytokine/HDM-stimulated NHBEs and macrophages. RESULTS Bronchoalveolar lavage fluid LT levels were increased in neonatal and adult but reduced in juvenile HDM-sensitized mice. Lungs of neonatally sensitized mice showed increased 5-lipoxygenase levels, whereas adult mice expressed more group 10 secretory phospholipase A2, Wnt5a, and transglutaminase 2 (Tgm2). Older mice showed colocalization of Wnt5a and LT enzymes in the epithelium, a pattern also observed in human nasal polyps. IL-4 promoted epithelial Wnt5a secretion, which upregulated macrophage Tgm2 expression, and Tgm2 inhibition in turn reduced LT release. Tgm2, group 10 secretory phospholipase A2, and LT enzymes in NHBEs and nasal polyps were refractory to corticosteroids. CONCLUSION Our findings reveal age differences in LT and Wnt pathways during airway inflammation and identify a steroid-resistant cascade of Wnt5a, Tgm2, and LTs, which might represent a therapeutic target for airway inflammation and remodeling.
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Affiliation(s)
- Katharina Dietz
- Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Marta de Los Reyes Jiménez
- Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Eva S Gollwitzer
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Adam M Chaker
- Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University of Munich and Helmholtz Center Munich, Munich, Germany; Department of Otolaryngology, Allergy Section, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulrich M Zissler
- Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Olof P Rådmark
- Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Hoeke A Baarsma
- Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL) and Ludwig-Maximilians-Universität, University Hospital Grosshadern, Munich, Germany
| | - Melanie Königshoff
- Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL) and Ludwig-Maximilians-Universität, University Hospital Grosshadern, Munich, Germany
| | - Carsten B Schmidt-Weber
- Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Benjamin J Marsland
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Julia Esser-von Bieren
- Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University of Munich and Helmholtz Center Munich, Munich, Germany.
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22
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Federico MJ, Hoch HE, Anderson WC, Spahn JD, Szefler SJ. Asthma Management for Children: Risk Identification and Prevention. Adv Pediatr 2016; 63:103-26. [PMID: 27426897 DOI: 10.1016/j.yapd.2016.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Monica J Federico
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Heather E Hoch
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - William C Anderson
- Pediatric Allergy & Immunology, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Joseph D Spahn
- Pediatric Allergy & Immunology, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
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Marshall GD, Grayson MH, Ellis AK, Hsieh FH, Oppenheimer J, Desai M, Lieberman JA, Greenhawt M, Montanaro A, Bielory L. The year in review: the best of 2015 in the Annals. Ann Allergy Asthma Immunol 2016; 116:2-8. [PMID: 26707769 DOI: 10.1016/j.anai.2015.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 11/27/2022]
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Associations of wheezing phenotypes with late asthma outcomes in the Avon Longitudinal Study of Parents and Children: A population-based birth cohort. J Allergy Clin Immunol 2016; 138:1060-1070.e11. [PMID: 27106203 PMCID: PMC5052126 DOI: 10.1016/j.jaci.2016.01.046] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/20/2015] [Accepted: 01/21/2016] [Indexed: 12/25/2022]
Abstract
Background Variable patterns of childhood wheezing might indicate differences in the cause and prognosis of respiratory illnesses. Better understanding of these patterns could facilitate identification of modifiable factors related to development of asthma. Objectives We characterized childhood wheezing phenotypes from infancy to adolescence and their associations with asthma outcomes. Methods Latent class analysis was used to derive phenotypes based on patterns of wheezing recorded at up to 14 time points from birth to 16½ years among 12,303 participants from the Avon Longitudinal Study of Parents and Children. Measures of lung function (FEV1, forced vital capacity [FVC], and forced expiratory flow between 25% and 75% [FEF25-75]) and fraction of exhaled nitric oxide (Feno) were made at 14 to 15 years of age. Results Six wheezing phenotypes were identified: never/infrequent, preschool-onset remitting, midchildhood-onset remitting, school age–onset persisting, late childhood–onset persisting, and continuous wheeze. The 3 persistent phenotypes were associated with bronchodilator reversibility of 12% or greater (BDR) from baseline (odds ratio [OR] range, 2.14-3.34), a Feno value of 35 ppb or greater (OR range, 3.82-6.24), and lung function decrements (mean range of differences: −0.22 to −0.27 SD units (SDU) for FEV1/FVC ratio and −0.21 to −0.33 SDU for FEF25-75) compared with never/infrequent wheeze. Midchildhood-onset (4½ years) remitting wheeze was associated with BDR (OR, 1.77; 95% CI, 1.11-2.82), a Feno value of 35 ppb or greater (OR, 1.72; 95% CI, 1.14-2.59), FEV1/FVC ratio decrements (OR, −0.22 SDU; 95% CI, −0.36 to −0.08 SDU), and FEF25-75 decrements (OR, −0.16 SDU; 95% CI, −0.30 to −0.01 SDU). Preschool-onset (18 months) remitting wheeze was only associated with FEV1/FVC ratio decrements (OR, −0.15 SDU; 95% CI, −0.25 to −0.05 SDU) and FEF25-75 decrements (OR, −0.14 SDU; 95% CI, −0.24 to −0.04 SDU). The persisting phenotypes showed evidence of sex stratification during adolescence. Conclusions Early childhood–onset wheezing that persists into adolescence represents the clearest target group for interventions to maximize lung function outcomes.
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Do all asthmatic patients have the same disease? Ann Allergy Asthma Immunol 2015; 114:78-9. [PMID: 25624126 DOI: 10.1016/j.anai.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/11/2014] [Indexed: 11/24/2022]
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