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Klain A, Giovannini M, Pecoraro L, Barni S, Mori F, Liotti L, Mastrorilli C, Saretta F, Castagnoli R, Arasi S, Caminiti L, Gelsomino M, Indolfi C, Del Giudice MM, Novembre E. Exercise-induced bronchoconstriction, allergy and sports in children. Ital J Pediatr 2024; 50:47. [PMID: 38475842 DOI: 10.1186/s13052-024-01594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors. Holistic management of EIB in children necessitates a correct diagnosis and a combination of pharmacological and non-pharmacological interventions. This review delves into the latest evidence concerning EIB in the pediatric population, exploring its associations with atopy and sports, and emphasizing the appropriate diagnostic and therapeutic approaches by highlighting various clinical scenarios.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy.
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126, Verona, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Lucia Liotti
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, 60123, Ancona, Italy
| | - Carla Mastrorilli
- Pediatric and Emergency Department, Pediatric Hospital Giovanni XXIII, AOU Policlinic of Bari, 70126, Bari, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100, Udine, Italy
| | - Riccardo Castagnoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98124, Messina, Italy
| | - Mariannita Gelsomino
- Department of Life Sciences and Public Health, Pediatric Allergy Unit, University Foundation Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Elio Novembre
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
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Dickinson J, Gowers W, Sturridge S, Williams N, Kippelen P, Simpson A, Jackson A, Hull JH, Price OJ. Fractional exhaled nitric oxide in the assessment of exercise-induced bronchoconstriction: A multicenter retrospective analysis of UK-based athletes. Scand J Med Sci Sports 2023. [PMID: 37051807 DOI: 10.1111/sms.14367] [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] [Received: 09/30/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Exercise-induced bronchoconstriction (EIB) is not only highly prevalent in people with asthma, but can also occur independently, particularly in athletes. Fractional exhaled nitric oxide (FeNO) is an indirect biomarker of type 2 airway inflammation that has an established role in the assessment and management of asthma. The aim was to evaluate the value of FeNO in the assessment of EIB in athletes. METHOD Multicenter retrospective analysis. In total, 488 athletes (male: 76%) performed baseline FeNO, and spirometry pre- and post-indirect bronchial provocation via eucapnic voluntary hyperpnea (EVH). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for established FeNO thresholds-that is, intermediate (≥25 ppb) and high FeNO (≥40 ppb and ≥ 50 ppb)-and were evaluated against objective evidence of EIB (≥10% fall in FEV1 ). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC-AUC). RESULTS Thirty-nine percent of the athletes had a post-EVH fall in FEV1 consistent with EIB. FeNO values ≥25 ppb, ≥40 ppb, and ≥ 50 ppb were observed in 42%, 23%, and 17% of the cohort, respectively. The sensitivity of FeNO ≥25 ppb was 55%, which decreased to 37% and 27% at ≥40 ppb and ≥ 50 ppb, respectively. The specificity of FeNO ≥25 ppb, ≥40 ppb, and ≥ 50 ppb was 66%, 86%, and 89%, respectively. The ROC-AUC for FeNO was 0.656. CONCLUSIONS FeNO ≥40 ppb provides good specificity, that is, the ability to rule-in a diagnosis of EIB. However, due to the poor sensitivity and predictive values, FeNO should not be employed as a replacement for indirect bronchial provocation in athletes.
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Affiliation(s)
- John Dickinson
- School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
| | - William Gowers
- School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
| | - Savannah Sturridge
- School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
| | - Neil Williams
- SHAPE Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Pascale Kippelen
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Andrew Simpson
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, UK
| | | | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
- Institute of Sport, Exercise and Health (ISEH), Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Dreßler M, Donath H, Quang TU, Hutter M, Trischler J, Zielen S, Schulze J, Blümchen K. Evaluating Children and Adolescents with Suspected Exercise Induced Asthma: Real Life Data. KLINISCHE PADIATRIE 2022; 234:267-276. [PMID: 35114701 DOI: 10.1055/a-1717-2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Exercise-induced bronchoconstriction (EIB) occurs frequently in children and adolescents and may be a sign of insufficient asthma control. EIB is often evaluated by respiratory symptoms, spirometry, eNO measurement and methacholine testing (MCT) instead of time consuming exercise test. Aim of this study was to analyse the amount of patients for which an exercise challenge in a cold chamber (ECC) was needed for a clear EIB diagnosis, to characterize EIB phenotypes and the incidence of exercise induced laryngeal obstruction (EILO) in a large cohort of patients with EIB. METHODS A retrospective analysis was performed in 595 children and adolescents (mean age 12.1 years) with suspected EIB from January 2014 to December 2018. Complete data sets of skin prick test, spirometry, eNO and MCT were available from 336 patients. RESULTS An ECC to confirm the EIB diagnosis was performed in 125 (37.2%) of patients. Three EIB phenotypes were detected: group 1: EIB without allergic sensitization (n=159); group 2: EIB with other than house dust mite (HDM) sensitization (n=87) and group 3: EIB with HDM sensitization (n=90). MCT and eNO showed significant differences between the subgroups: An eNO>46 ppb and/or a MCT<0.1 mg was found in 23.9% vs. 50.6% vs. 57.8% in group 1-3, respectively. Significantly more patients suffered from EILO in group 1 compared to group 2 and 3 (n=13 vs. n=1). CONCLUSION EIB without sensitization is as often as EIB with sensitization. In patients without sensitization, EILO has to be considered as a possible cause of symptoms during exercise.
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Affiliation(s)
- Melanie Dreßler
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Helena Donath
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Thao Uyen Quang
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Martin Hutter
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Jordis Trischler
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Stefan Zielen
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Johannes Schulze
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Katharina Blümchen
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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Klain A, Indolfi C, Dinardo G, Contieri M, Decimo F, Miraglia Del Giudice M. Exercise-Induced Bronchoconstriction in Children. Front Med (Lausanne) 2022; 8:814976. [PMID: 35047536 PMCID: PMC8761949 DOI: 10.3389/fmed.2021.814976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is a transient airflow obstruction, typically 5-15 min after physical activity. The pathophysiology of EIB is related to the thermal and osmotic changes of the bronchial mucosa, which cause the release of mediators and the development of bronchoconstriction in the airways. EIB in children often causes an important limitation to physical activities and sports. However, by taking appropriate precautions and through adequate pharmacological control of the condition, routine exercise is extremely safe in children. This review aims to raise awareness of EIB by proposing an update, based on the latest studies, on pathological mechanisms, diagnosis, and therapeutic approaches in children.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcella Contieri
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Dreßler M, Fussbroich D, Böhler L, Herrmann E, Benker N, Tytyk M, Schulze J, Schubert R, Beermann C, Zielen S. Oil supplementation with a special combination of n-3 and n-6 long-chain polyunsaturated fatty acids does not protect for exercise induced asthma: a double-blind placebo-controlled trial. Lipids Health Dis 2020; 19:167. [PMID: 32660564 PMCID: PMC7359229 DOI: 10.1186/s12944-020-01343-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients suffering from exercise-induced asthma (EIA) have normal lung function at rest and show symptoms and a decline in FEV1 when they do sports or during exercise-challenge. It has been described that long-chain polyunsaturated fatty acids (LCPUFA) could exert a protective effect on EIA. METHODS In this study the protective effect of supplementation with a special combination of n-3 and n-6 LCPUFA (sc-LCPUFA) (total 1.19 g/ day) were investigated in an EIA cold air provocation model. PRIMARY OUTCOME MEASURE Decrease in FEV1 after exercise challenge and secondary outcome measure: anti-inflammatory effects monitored by exhaled NO (eNO) before and after sc-LCPUFA supplementation versus placebo. RESULTS Ninety-nine patients with exercise-induced symptoms aged 10 to 45 were screened by a standardized exercise challenge in a cold air chamber at 4 °C. Seventy-three patients fulfilled the inclusion criteria of a FEV1 decrease > 15% and were treated double-blind placebo-controlled for 4 weeks either with sc-LCPUFA or placebo. Thirty-two patients in each group completed the study. Mean FEV1 decrease after cold air exercise challenge and eNO were unchanged after 4 weeks sc-LCPUFA supplementation. CONCLUSION Supplementation with sc-LCPUFA at a dose of 1.19 g/d did not have any broncho-protective and anti-inflammatory effects on EIA. TRIAL REGISTRATION Clinical trial registration number: NCT02410096. Registered 7 February 2015 at Clinicaltrial.gov.
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Affiliation(s)
- M Dreßler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - D Fussbroich
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany.,Department of Food Technology, University of Applied Science, Fulda, Germany.,Faculty of Biological Sciences, Goethe-University, Frankfurt/Main, Germany
| | - L Böhler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - E Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt/Main, Germany
| | - N Benker
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - M Tytyk
- Department of Food Technology, University of Applied Science, Fulda, Germany
| | - J Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - R Schubert
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - C Beermann
- Department of Food Technology, University of Applied Science, Fulda, Germany
| | - S Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany.
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Dreßler M, Friedrich T, Lasowski N, Herrmann E, Zielen S, Schulze J. Predictors and reproducibility of exercise-induced bronchoconstriction in cold air. BMC Pulm Med 2019; 19:94. [PMID: 31097027 PMCID: PMC6524332 DOI: 10.1186/s12890-019-0845-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/11/2019] [Indexed: 01/23/2023] Open
Abstract
Background Physical activity is an important part of life, and hence exercise-induced bronchoconstriction (EIB) can reduce the quality of life. A standardized test is needed to diagnose EIB. The American Thoracic Society (ATS) guidelines recommend an exercise challenge in combination with dry air. We investigated the feasibility of a new, ATS guidelines conform exercise challenge in a cold chamber (ECC) to detect EIB. The aim of this study was to investigate the surrogate marker reaction to methacholine, ECC and exercise challenge in ambient temperature for the prediction of a positive reaction and to re-evaluate the reproducibility of the response to an ECC. Methods Seventy-eight subjects aged 6 to 40 years with suspected EIB were recruited for the study. The subjects performed one methacholine challenge, two ECCs, and one exercise challenge at an ambient temperature. To define the sensitivity and specificity of the predictor, a receiver-operating characteristic curve was plotted. The repeatability was evaluated using the method described by Bland and Altman (95% Limits of agreement). Results The following cut-off values showed the best combination of sensitivity and specificity: the provocation dose causing a 20% decrease in the forced expiratory volume in 1 s (PD20FEV1) of methacholine: 1.36 mg (AUC 0.69, p < 0.05), the maximal decrease in FEV1 during the ECC: 8.5% (AUC 0.78, p < 0.001) and exercise challenges at ambient temperatures: FEV1 5.2% (AUC 0.64, p = 0.13). The median decline in FEV1 was 14.5% (0.0–64.2) during the first ECC and 10.7% (0.0–52.5) during the second ECC. In the comparison of both ECCs, the Spearman rank correlation of the FEV1 decrease was r = 0.58 (p < 0.001). The 95% limits of agreement (95% LOAs) for the FEV1 decrease were − 17.7 to 26.4%. Conclusions The surrogate markers PD20FEV1 of methacholine and maximal decrease in FEV1 during ECC can predict a positive reaction in another ECC, whereas the maximal FEV1 decrease in an exercise challenge at an ambient temperature was not predictive. Compared with previous studies, we can achieve a similar reproducibility with an ECC. Clinical trial registration NCT02026492 (retrospectively registered 03/Jan/2014).
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Affiliation(s)
- Melanie Dreßler
- Division of Pulmonology, Allergy and Cystic Fibrosis, Department of Paediatric and Adolescent medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Theresa Friedrich
- Division of Pulmonology, Allergy and Cystic Fibrosis, Department of Paediatric and Adolescent medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Natali Lasowski
- Division of Pulmonology, Allergy and Cystic Fibrosis, Department of Paediatric and Adolescent medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt, Germany
| | - Stefan Zielen
- Division of Pulmonology, Allergy and Cystic Fibrosis, Department of Paediatric and Adolescent medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Johannes Schulze
- Division of Pulmonology, Allergy and Cystic Fibrosis, Department of Paediatric and Adolescent medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Dreßler M, Salzmann-Manrique E, Zielen S, Schulze J. Exhaled NO as a predictor of exercise-induced asthma in cold air. Nitric Oxide 2018. [PMID: 29526567 DOI: 10.1016/j.niox.2018.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Physical activity is an important part of life, and exercise-induced asthma (EIA) can reduce the quality of life. A standardized exercise challenge is needed to diagnose EIA, but this is a time consuming, effortful and expensive method. Exhaled nitric oxide (eNO) as a marker of eosinophil inflammation is determined rapidly and easily. The aim of this study was to investigate eNO as surrogate marker for predicting a positive reaction in an exercise challenge in a cold chamber (ECC). METHODS A total of 143 subjects aged 6-45 years with suspected EIA were recruited for the study. The subjects underwent an eNO measurement, an ECC and a skin prick test (SPT). To define the sensitivity and specificity of eNO as predictor, a receiver-operating characteristic (ROC) curve was plotted. The individual probability of the occurrence of a positive reaction after ECC based on an eNO value was calculated using a logistic regression model. RESULTS An eNO cut-off value of 18.5 ppb (area under the curve (AUC) 0.71, p < 0.001) showed the best combination of sensitivity and specificity for a positive reaction (forced expiratory volume in 1 s (FEV1) decrease ≥ 10% after ECC) for the whole group. An eNO cut-off value of 46.0 ppb had a specificity of 100.0% to predict a significant FEV1 decrease and may save exercise testing in 22.4% of patients. A negative predictive level with a high sensitivity and negative predictive value (NPV) could not be defined. In the subgroup that was house dust might (HDM) allergy positive (HDM pos; n = 68, 45.5% of all subjects), an eNO cut-off value of 35.5 ppb (AUC 0.79, p < 0.01) showed the best combination of sensitivity and specificity for a positive reaction after the ECC with a specificity 100.0% and may save exercise testing in 45.6% of HDM pos patients. Using logistic regression, a 95% probability for a positive FEV1 decrease after ECC was estimated at 53 ppb for the whole group and at 47 ppb for the HDM pos subgroup. CONCLUSIONS Exhaled NO measurement is a screening tool for EIA, especially in HDM pos subjects. In a real-life setting, a cut-off value of 46.0 ppb detects EIA at 100% in all suspected patients, and a cut-off level of 35.5 ppb is valuable marker of EIA in patients with an HDM allergy. These levels can save time and costs in a large proportion of patients and will be helpful for clinicians.
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Affiliation(s)
- Melanie Dreßler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, Goethe University Hospital, Frankfurt, Germany.
| | - Emilia Salzmann-Manrique
- Institute of Biostatistics and Mathematical Modeling, Department of Medicine, Goethe University, Frankfurt, Germany.
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, Goethe University Hospital, Frankfurt, Germany.
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, Goethe University Hospital, Frankfurt, Germany.
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Arıkoglu T, Unlu A, Yıldırım DD, Kuyucu S. The airway hyperresponsiveness to methacholine may be predicted by impulse oscillometry and plethysmography in children with well-controlled asthma. J Asthma 2017; 55:1166-1173. [PMID: 29231775 DOI: 10.1080/02770903.2017.1407337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Airway hyperresponsiveness (AHR) is a hallmark of asthma. Methacholine challenge test which is mostly used to confirm AHR is not routinely available. The aim of this study was to investigate the predictive values of fractional exhaled nitric oxide (FeNO), impulse oscillometry (IOS), and plethysmography for the assessment of AHR in children with well-controlled asthma. METHODS 60 children with controlled allergic asthma aged 6-18 years participated in the study. FeNO measurement, spirometry, IOS, and plethysmography were performed. Methacholine challenge test was done to assess AHR. PC20 and dose response slope (DRS) of methacholine was calculated. RESULTS Mild to severe AHR with PC20 < 4 mg/ml was confirmed in 31 (51.7%) patients. Baseline FeNO and total specific airway resistance (SRtot)%pred and residual volume (RV)%pred levels in plethysmography were significantly higher and FEV1%pred, FEV1/FVC%pred, MMEF%pred values were lower in the group with PC20 < 4 mg/ml. FeNO, SRtot%pred, and RV%pred levels were found to be positively correlated with DRS methacholine. The higher baseline FeNO, frequency dependence of resistance (R5-R20) in IOS and SRtot%pred in plethysmography were found to be significantly related to DRS methacholine in linear regression analysis (β: 1.35, p = 0.046, β: 4.58, p = 0.002, and β: 0.78, p = 0.035, respectively). The cut-off points for FeNO and SRtot% for differentiating asthmatic children with PC20 < 4 mg/ml from those with PC20 ≥ 4 mg/ml were 28 ppb (sensitivity: 67.7%, specificity: 72.4%, p < 0.001) and 294.9% (sensitivity: 35.5%, specificity: 96.6%, p = 0.013), respectively. CONCLUSION IOS and plethysmography may serve as reliable and practical tools for prediction of mild to severe methacholine induced AHR in otherwise "seemingly well-controlled'' asthma.
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Affiliation(s)
- Tugba Arıkoglu
- a Department of Pediatric Allergy and Immunology, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - Ayyuce Unlu
- b Department of Pediatrics, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - Didem Derici Yıldırım
- c Department of Biostatistics, Faculty of Medicine , Mersin University , Mersin , Turkey
| | - Semanur Kuyucu
- a Department of Pediatric Allergy and Immunology, Faculty of Medicine , Mersin University , Mersin , Turkey
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Schoos AMM, Christiansen CF, Stokholm J, Bønnelykke K, Bisgaard H, Chawes BL. FeNO and Exercise Testing in Children at Risk of Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:855-862.e2. [PMID: 29133224 DOI: 10.1016/j.jaip.2017.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise testing is the gold standard for diagnosing exercise-induced bronchoconstriction in children, but requires considerable cooperation and medical resources. Therefore, fraction of exhaled nitric oxide (FeNO) has been proposed as a tool to predict the need for exercise testing. OBJECTIVE The objective of this study was to investigate the relationship between FeNO, exercise test results, and a history of respiratory symptoms during exercise in children at risk of asthma. METHODS FeNO measurement, exercise testing, and interview about respiratory symptoms during exercise were completed in 224 seven-year-old children from the at-risk Copenhagen Prospective Studies on Asthma in Childhood2000 birth cohort. The associations between FeNO, exercise test results, and reported respiratory symptoms during exercise were analyzed adjusting for gender, respiratory infections, and inhaled corticosteroid treatment. The associations were also analyzed stratified by asthma and atopic status. RESULTS Of the 224 children, 28 (13%) had an established asthma diagnosis and 58 (26%) had a positive exercise test (≥15% drop in forced expiratory volume in 1 second [FEV1] from baseline). FeNO and bronchial obstruction after exercise were linearly associated with a doubling of FeNO corresponding to a 2.4% drop in FEV1 (95% confidence interval, 0.8-4.1; P < .01). However, a receiver operating characteristic curve analysis showed that the best cutoff of FeNO for predicting exercise test outcome among children who reported respiratory symptoms during exercise was 17 ppb, which only had 74% negative predictive value. There was no association between FeNO and reported respiratory symptoms during exercise (odds ratio = 1.3 [0.8-1.9]; P = .29) or reported symptoms during exercise and exercise test results (odds ratio = 1.0 [1.0-1.1]; P = .12). CONCLUSIONS A history of respiratory symptoms during exercise was not associated with either elevated FeNO or a positive exercise test in children at risk of asthma. FeNO and exercise test results were linearly associated traits, but FeNO could not reliably be used dichotomized to predict the need of exercise testing.
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Affiliation(s)
- Ann-Marie Malby Schoos
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Figgé Christiansen
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Bo Lund Chawes
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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10
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Menou A, Babeanu D, Paruit HN, Ordureau A, Guillard S, Chambellan A. Normal values of offline exhaled and nasal nitric oxide in healthy children and teens using chemiluminescence. J Breath Res 2017; 11:036008. [PMID: 28579561 DOI: 10.1088/1752-7163/aa76ef] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nitric oxide (NO) can be used to detect respiratory or ciliary diseases. Fractional exhaled nitric oxide (FeNO) measurement can reflect ongoing eosinophilic airway inflammation and has a diagnostic utility as a test for asthma screening and follow-up while nasal nitric oxide (nNO) is a valuable screening tool for the diagnosis of primary ciliary dyskinesia. The possibility of collecting airway gas samples in an offline manner offers the advantage to extend these measures and improve the screening and management of these diseases, but normal values from healthy children and teens remain sparse. METHODS Samples were consecutively collected using the offline method for eNO and nNO chemiluminescence measurement in 88 and 31 healthy children and teens, respectively. Offline eNO measurement was also performed in 30 consecutive children with naïve asthma and/or respiratory allergy. RESULTS The normal offline eNO value was determined by the following regression equation -8.206 + 0.176 × height. The upper limit of the norm for the offline eNO value was 27.4 parts per billion (ppb). A separate analysis was performed in children, pre-teens and teens, for which offline eNO was 13.6 ± 4.7 ppb, 16.3 ± 13.7 ppb and 20.0 ± 7.2 ppb, respectively. The optimal cut-off value of the offline eNO to predict asthma or respiratory allergies was 23.3 ppb, with a sensitivity and specificity of 77% and 91%, respectively. Mean offline nNO was determined at 660 ppb with the lower limit of the norm at 197 ppb. CONCLUSION The use of offline eNO and nNO normal values should favour the widespread screening of respiratory diseases in children of school age in their usual environment.
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Affiliation(s)
- A Menou
- Faculte des Sciences, Université de Nantes, Nantes, France
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11
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Park YA, Park HB, Kim YH, Sul IS, Yoon SH, Kim HR, Kim KW, Kim KE, Sohn MH. Airway hyperresponsiveness to mannitol and methacholine and exhaled nitric oxide in children with asthma. J Asthma 2017; 54:644-651. [PMID: 28055271 DOI: 10.1080/02770903.2016.1255751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Asthma is characterized by airway hyperresponsiveness (AHR), inflammation, and obstruction. AHR to stimuli that indirectly cause bronchial smooth muscle (BSM) contractions via release of endogenous mediators is thought to better reflect airway inflammation than AHR to stimuli that act directly on BSM. Fractional exhaled nitric oxide (FeNO) is a useful parameter for noninvasive clinical airway inflammation assessments. Accordingly, this study aimed to examine the relationships of mannitol and methacholine challenge test outcomes with FeNO and the influence of inhaled corticosteroid treatment in children with asthma. METHODS One hundred thirty-four asthmatic children (89 males; ages: 5-17 years, median: 9 years) underwent spirometry, FeNO measurement, serum total/specific IgE testing, and blood eosinophil count. All subjects were challenged with mannitol dry powder (MDP; AridolH, Pharmaxis, Australia) and methacholine at 7-day intervals. Data of steroid-treated and steroid-naïve children were compared. RESULTS Positive responses to MDP and methacholine challenge tests were observed in 74.6% and 67.2% of total subject group, respectively, and 72 children had positive response to both challenge tests. The median FeNO level, response-dose ratio (RDR) of PC20 methacholine, and RDR of PD15 MDP were significantly higher in the steroid-treated group than in the steroid-naïve group (p < 0.001, 0.226, and 0.004, respectively). FeNO levels associated significantly with PD15 MDP and RDR PD15 MDP in total subject populations (p = 0.016 and 0.003, respectively); however, a significant correlation between FeNO and RDR PD15 MDP was observed only in the steroid-naïve group. CONCLUSIONS Compared with AHR to methacholine, AHR to MDP more closely reflected the level of FeNO in steroid-naïve asthmatic children.
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Affiliation(s)
- Young A Park
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Hyun Bin Park
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Yoon Hee Kim
- b Gangnam Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - In Sook Sul
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Seo Hee Yoon
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Hye Ran Kim
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Kyung Won Kim
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Kyu-Earn Kim
- b Gangnam Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Myung Hyun Sohn
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
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12
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Brito AF, Silva AS, Souza ILL, Pereira JC, Martins IRR, Silva BA. Intensity of swimming exercise influences tracheal reactivity in rats. J Smooth Muscle Res 2016; 51:70-81. [PMID: 26497013 PMCID: PMC5137269 DOI: 10.1540/jsmr.51.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Studies that evaluate the mechanisms for increased airway responsiveness are very sparse,
although there are reports of exercise-induced bronchospasm. Therefore, we have evaluated
the tracheal reactivity and the rate of lipid peroxidation after different intensities of
swimming exercise in rats. Thus, male Wistar rats (age 8 weeks; 250–300 g) underwent a
forced swimming exercise for 1 h whilst carrying attached loads of 3, 4, 5, 6 and 8% of
their body weight (groups G3, G4, G5, G6 and G8, respectively; n=5 each).
Immediately after the test, the trachea of each rat was removed and suspended in an organ
bath to evaluate contractile and relaxant responses. The rate of lipid peroxidation was
estimated by measuring malondialdehyde levels. According to a one-way ANOVA, all trained
groups showed a significant decrease in the relaxation induced by aminophylline
(10−12–10−1 M) (pD2=3.1, 3.2, 3.3, 3.3 and 3.2, respectively for
G3, G4, G5, G6 and G8) compared to the control group (pD2=4.6) and the Emax
values of G5, G6, G8 groups were reduced by 94.2, 88.0 and 77.0%, respectively.
Additionally, all trained groups showed a significant increase in contraction induced by
carbachol (10−9–10−3 M) (pD2=6.0, 6.5, 6.5, 7.2 and 7.3,
respectively for G3, G4, G5, G6 and G8) compared to the control group (pD2=5.7). Lipid
peroxidation levels of G3, G4 and G5 were similar in both the trachea and lung, however G6
and G8 presented an increased peroxidation in the trachea. In conclusion, a single bout of
swimming exercise acutely altered tracheal responsiveness in an intensity-related manner
and the elevation in lipid peroxidation indicates a degree of oxidative stress
involvement.
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Affiliation(s)
- Aline F Brito
- Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, Centro de Ciências da Saúde, Universidade Federal da Paraíba, Paraíba, Brasil
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13
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Attanasi M, Consilvio NP, Rapino D, Nicola MD, Scaparrotta A, Cingolani A, Petrosino MI, Filippo PD, Pillo SD, Chiarelli F. Bronchial hyperresponsiveness to mannitol, airway inflammation and Asthma Control Test in atopic asthmatic children. Arch Med Sci 2016; 12:137-44. [PMID: 26925129 PMCID: PMC4754374 DOI: 10.5114/aoms.2016.57589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/06/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the relationship between airway hyperresponsiveness (AHR) to mannitol and bronchial inflammation measured as exhaled nitric oxide (FeNO) and to assess whether asthma control correlates with AHR to mannitol and FeNO in atopic asthmatic children. MATERIAL AND METHODS Allergy evaluation, the mannitol challenge test, FeNO levels and the Asthma Control Test (ACT) questionnaire were assessed in 40 children with intermittent and mild persistent allergic asthma. RESULTS All the subjects showed positive AHR to mannitol. Pearson's correlation test revealed a significant inverse correlation between AHR (mannitol PD15) and FeNO (p = 0.020). There was also a significant positive correlation between ACT and PD15 (p = 0.020) and a significant negative correlation between ACT and FeNO levels (p = 0.003). The study population was divided into two groups according to FeNO levels (group A ≥ 16 ppb vs. group B < 16 ppb). In group A mannitol PD15 was significantly lower (p = 0.040) and ACT score values were significantly lower (p = 0.001) compared to group B. In group A, the ACT showed that 13.3% of subjects had well-controlled asthma, 80% had partially controlled asthma and 6.7% had uncontrolled asthma. In group B, the ACT showed that 72% of subjects had well-controlled asthma and 28% had partially controlled asthma. CONCLUSIONS Our findings indicate that the degree of AHR to mannitol correlates with the degree of airway inflammation in asthmatic atopic children; moreover, better control of asthma correlates with a lower degree of AHR to both mannitol and FeNO.
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Affiliation(s)
- Marina Attanasi
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Nicola P. Consilvio
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Daniele Rapino
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Experimental and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Alessandra Scaparrotta
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Anna Cingolani
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Marianna I. Petrosino
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Paola Di Filippo
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Sabrina Di Pillo
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
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14
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Perzanowski MS, Yoo Y. Exhaled Nitric Oxide and Airway Hyperresponsiveness to Adenosine 5'-monophosphate and Methacholine in Children with Asthma. Int Arch Allergy Immunol 2015; 166:107-13. [PMID: 25792296 DOI: 10.1159/000375237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is increasing interest in the role of indirect bronchial challenges because clinical studies have shown that indirect airway hyperresponsiveness (AHR) reflects underlying airway inflammation better than direct AHR. Fractional exhaled nitric oxide (FeNO) appears to be a useful clinical tool for assessing airway inflammation noninvasively. We examined whether FeNO is more closely related to AHR to indirect stimuli than AHR to direct stimuli in children with mild to moderate asthma. METHODS Fifty-nine asthmatic children aged 6-16 years without rhinitis, underwent spirometry, FeNO measurement and blood tests for serum total IgE, blood eosinophil count and serum eosinophil cationic protein (ECP). All subjects underwent methacholine and adenosine 5-monophosphate (AMP) challenge tests at intervals of 3 days. RESULTS In a univariate linear regression analysis, FeNO was significantly associated with both PC20 AMP (R(2) = 0.341, p < 0.001) and PC20 methacholine (R(2) = 0.188, p = 0.001). After adjustment for age, sex, serum total IgE and blood eosinophil count, the association between FeNO and PC20 AMP (β = -1.98, p = 0.001) was more robust than that between FeNO and PC20 methacholine (β = -0.87, p = 0.081). The significant correlation between FeNO and PC20 AMP was observed in the steroid-naïve group (β = -2.48, p = 0.001), but not in the steroid-treated group (β = 0.88, p = 0.463). CONCLUSIONS FeNO levels were more closely associated with PC20 AMP than with PC20 methacholine. This relationship could only be seen in the steroid-naïve subjects. These results suggest that FeNO levels in children with asthma may be more closely related to indirect AHR than to direct AHR.
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Affiliation(s)
- Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, N.Y., USA
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15
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Zhu G, Zhu J, Song L, Cai W, Wang J. Combined use of biomarkers for distinguishing between bacterial and viral etiologies in pediatric lower respiratory tract infections. Infect Dis (Lond) 2015; 47:289-93. [PMID: 25712729 DOI: 10.3109/00365548.2014.987163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In clinical practice it is often troublesome to discriminate bacterial etiologies from viral etiologies in pediatric lower respiratory tract infections (LRTIs). The aim of this study was to develop an accurate analytic method to improve diagnostic determination for bacterial and viral etiologies in pediatric LRTIs. METHODS A total of 45 children with confirmed bacterial LRTIs and 51 children with viral LRTIs were finally included after assessment of the children visiting the emergency department with a suspected infection and identification of pathogens. C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), CD35, and CD64 were assessed and then the areas under receiver operating characteristic (ROC) curves (AUC) of PCT, IL-6, CD35, and CD64 in combination with CRP were compared to the AUC of CRP alone in all subjects. RESULTS The levels of CRP, PCT, IL-6, CD45, and CD64 observed in children with bacterial LRTIs were statistically higher than for viral infections. The AUC of CRP combined with CD53 (0.963, 95% confidence interval (CI) 0.921-1.002) or CD64 (0.952, 95% CI 0.907-0.998) or CD35/CD64 (0.971, 95% CI 0.932-1.004) increased compared with that of the single biomarker. CONCLUSIONS The combined analysis improved diagnostic accuracy in children with bacterial and viral LRTIs.
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Affiliation(s)
- Guoji Zhu
- Department of Internal Medicine, Soochow University Affiliated Children's Hospital , Soochow , China
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Barreto M, Zambardi R, Villa MP. Exhaled nitric oxide and other exhaled biomarkers in bronchial challenge with exercise in asthmatic children: current knowledge. Paediatr Respir Rev 2015; 16:68-74. [PMID: 24368252 DOI: 10.1016/j.prrv.2013.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/23/2013] [Accepted: 11/15/2013] [Indexed: 12/31/2022]
Abstract
The fractional concentration of exhaled nitric oxide (FENO), a known marker of atopic-eosinophilic inflammation, may be used as a surrogate to assess exercise-induced bronchoconstriction (EIB) in asthmatic children. The predictive value of baseline FENO for EIB appears to be influenced by several factors, including age, atopy, current therapy with corticosteroids and measurement technique. Nonetheless, FENO cut-off values appear to be able to rule out EIB. FENO levels decrease during EIB, apparently through neural mechanisms rather than by decreased airway-epithelial surface. Partition of FENO into proximal and peripheral contributions of the respiratory tract may improve our understanding on NO exchange during exercise and help to screen subjects prone to EIB. Other biomarkers of inflammation and oxidative stress contained in exhaled gases and exhaled breath condensate (EBC) may shed light on the pathophysiology of EIB. Exhaled breath temperature is a promising real-time measurement whose routine use for assessing EIB warrants further investigation.
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Affiliation(s)
- Mario Barreto
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Rosanna Zambardi
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pia Villa
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Manna A, Caffarelli C, Varini M, Dascola CP, Montella S, Maglione M, Sperlì F, Santamaria F. Clinical application of exhaled nitric oxide measurement in pediatric lung diseases. Ital J Pediatr 2012; 38:74. [PMID: 23273317 PMCID: PMC3545741 DOI: 10.1186/1824-7288-38-74] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/19/2012] [Indexed: 12/18/2022] Open
Abstract
Fractional exhaled nitric oxide (FeNO) is a non invasive method for assessing the inflammatory status of children with airway disease. Different ways to measure FeNO levels are currently available. The possibility of measuring FeNO levels in an office setting even in young children, and the commercial availability of portable devices, support the routine use of FeNO determination in the daily pediatric practice. Although many confounding factors may affect its measurement, FeNO is now widely used in the management of children with asthma, and seems to provide significantly higher diagnostic accuracy than lung function or bronchial challenge tests. The role of FeNO in airway infection (e.g. viral bronchiolitis and common acquired pneumonia), in bronchiectasis, or in cases with diffuse lung disease is less clear. This review focuses on the most recent advances and the current clinical applications of FeNO measurement in pediatric lung disease.
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Affiliation(s)
- Angelo Manna
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Carlo Caffarelli
- Department of Pediatrics, University Hospital of Parma, Parma, Italy
| | - Margherita Varini
- Department of Pediatrics, University Hospital of Parma, Parma, Italy
| | | | - Silvia Montella
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Marco Maglione
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Francesco Sperlì
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Francesca Santamaria
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
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