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Desormeau B, Smyrnova A, Drouin O, Ducharme FM. Oscillometry to support clinical assessment in asthmatic preschoolers: Real-life impact. Respir Med 2023; 209:107148. [PMID: 36754219 DOI: 10.1016/j.rmed.2023.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
In preschoolers, asthma control is assessed clinically using history and physical examination. In certain centres, oscillometry is used to support clinical assessment; yet its clinical utility for asthma management remains to be quantified. The objectives were to determine if oscillometry, as adjunct to clinical assessment, influences asthma assessment, management and control, compared to clinical assessment alone in preschoolers. We conducted a cross-sectional study in children aged 3-5 years with a confirmed asthma diagnosis. Oscillometry-tested preschoolers were matched by propensity score to untested children. The co-primary outcomes, the likelihood of a persistent asthma phenotype and a maintenance therapy prescription at the index visit, were examined by multivariable logistic regression. Asthma control over the next year was examined by cumulative logistic regression in the nested retrospective cohort with available drug claim data. The cohort comprised 726 (249 oscillometry-tested; 477 untested) children with 57.4% male (median age: 4.6 years). Propensity score matching resulted in comparable groups. Compared to controls, oscillometry-tested children were more frequently labelled with a persistent phenotype (67% vs. 50%; adjusted OR [95% CI]: 2.34 [1.66-3.34]) with no significant difference in maintenance therapy prescription (65% vs. 58%; 1.37 [0.98-1.92]); but experienced a lower likelihood of poor control over the next year (adjusted OR [95% CI]: 0.24 [0.08-0.74]). The association between the addition of oscillometry to clinical assessment with more persistent phenotype labelling and better asthma control supports its clinical utility; no significant impact on maintenance therapy prescription was observed at the index visit.
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Affiliation(s)
- Bennet Desormeau
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma (CRUCA), Research Centre, Sainte-Justine University Hospital Centre, Montreal, Quebec, CA, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, CA, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, CA, Canada.
| | - Anna Smyrnova
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma (CRUCA), Research Centre, Sainte-Justine University Hospital Centre, Montreal, Quebec, CA, Canada
| | - Olivier Drouin
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma (CRUCA), Research Centre, Sainte-Justine University Hospital Centre, Montreal, Quebec, CA, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, CA, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, CA, Canada
| | - Francine Monique Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma (CRUCA), Research Centre, Sainte-Justine University Hospital Centre, Montreal, Quebec, CA, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, CA, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, CA, Canada
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2
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Jackson DJ, Bacharier LB, Phipatanakul W, Sher L, Domingo C, Papadopoulos N, Modena B, Li N, Xia C, Kamal MA, Dillon M, Wolfe K, Gall R, Amin N, Mannent LP, Laws E, Rowe PJ, Jacob-Nara JA, Deniz Y, Lederer DJ, Hardin M, Xu C. Dupilumab pharmacokinetics and effect on type 2 biomarkers in children with moderate-to-severe asthma. Ann Allergy Asthma Immunol 2023:S1081-1206(23)00180-1. [PMID: 36958470 DOI: 10.1016/j.anai.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Type 2 inflammation is common in children with asthma. Dupilumab, a human antibody, blocks signaling of interleukin-4/-13, key and central drivers of type 2 inflammation. In the VOYAGE (NCT02948959) study, dupilumab reduced severe asthma exacerbations and improved lung function in children aged 6-11 years with uncontrolled, moderate-to-severe asthma. OBJECTIVE To assess pharmacokinetics of dupilumab and type 2 biomarker changes in children with type 2 asthma in VOYAGE. METHODS Patients were randomized to dupilumab 100 mg (≤30 kg) or 200 mg (>30 kg) or placebo every 2 weeks (q2w) for 52 weeks. Dupilumab concentrations and changes in type 2 biomarkers were assessed at each visit. RESULTS Dupilumab concentrations in serum reached steady state by Week 12, with mean concentrations of 51.2 mg/L and 79.4 mg/L in children receiving dupilumab 100 mg q2w and 200 mg q2w, respectively (therapeutic range in adults and adolescents: 29-80 mg/L). Reductions in type 2 biomarkers were comparable between regimens, and greater in patients treated with dupilumab vs placebo. In children treated with dupilumab 100 mg and 200 mg q2w, median percent changes (Q1, Q3) from baseline at Week 52 were, respectively, -78.6% (-86.3, -69.80) and -78.6% (-84.9, -70.1) for serum total IgE, -53.6% (-66.4, -34.6) and -43.7% (-58.6, -28.5) for TARC, -25.7% (-60.0, 27.6) and -33.3% (-60.6, 16.6) for blood eosinophils, and -47.7% (-73.8, 18.9) and -55.6% (-73.6, -20.0) for FeNO. CONCLUSION Weight-tiered dose regimens achieved mean concentrations within the dupilumab therapeutic range. Median decreases in type 2 biomarker levels were similar between dose regimens. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02948959.
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Affiliation(s)
- Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Leonard B Bacharier
- Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wanda Phipatanakul
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, California
| | - Christian Domingo
- Corporació Sanitària Parc Taulí, Sabadell, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | | | | | - Changming Xia
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | | | - Myles Dillon
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | | | - Rebecca Gall
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | | | | | | | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
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Standardization of Reporting Obstructive Airway Disease in Children: A National Delphi Process. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:187-194.e6. [PMID: 36108926 DOI: 10.1016/j.jaip.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/17/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways, and there is no consensus for standardized reporting. OBJECTIVE We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting. METHODS We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (eg, asthma) and features (eg, triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting. RESULTS Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label "asthma" for children older than 5 years and "obstructive bronchitis" or "suspected asthma" for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception. CONCLUSION We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.
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Chung HL. Diagnosis and management of asthma in infants and preschoolers. Clin Exp Pediatr 2022; 65:574-584. [PMID: 35436814 PMCID: PMC9742764 DOI: 10.3345/cep.2021.01746] [Citation(s) in RCA: 3] [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: 11/25/2021] [Accepted: 03/31/2022] [Indexed: 01/06/2023] Open
Abstract
Asthma is one of the most common chronic disease affecting children, and it often starts in infancy and preschool years. In previous birth cohorts, frequent wheezing in early life was associated with the development of asthma in later childhood and reduced lung function persisting into adulthood. Preschool wheezing is considered an umbrella term for distinctive diseases with different clinical features (phenotypes), each of which may be related to different underlying pathophysiologic mechanisms (endotypes). The classification of phenotypes of early wheezing is needed to identify children at high risk for developing asthma later who might benefit from early intervention. However, diagnosis of asthma in infants and preschoolers is particularly difficult because objective lung function tests cannot be performed and definitive biomarkers are lacking. Moreover, management of early asthma is challenging because of its different phenotypic presentations. Many prediction models and asthma guidelines have been developed to provide useful information for physicians to assess young children with recurrent wheezing and manage them appropriately. Many recent studies have investigated the application of personalized medicine for early asthma by identifying specific phenotypes and biomarkers. Further researches, including genetic and molecular studies, are needed to establish a clear definition of asthma and develop more targeted therapeutic approaches in this age group.
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Affiliation(s)
- Hai Lee Chung
- Department of Pediatrics, School of Medicine, Daegu Catholic University, Daegu, Korea
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Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group. J Clin Med 2022; 11:jcm11164763. [PMID: 36013002 PMCID: PMC9409690 DOI: 10.3390/jcm11164763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/20/2022] Open
Abstract
Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.
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Laubhahn K, Böck A, Zeber K, Unterschemmann S, Kunze S, Schedel M, Schaub B. 17q12-21 risk-variants influence cord blood immune regulation and multitrigger-wheeze. Pediatr Allergy Immunol 2022; 33:e13721. [PMID: 34919286 DOI: 10.1111/pai.13721] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood wheeze represents a first symptom of asthma. Early identification of children at risk for wheeze related to 17q12-21 variants and their underlying immunological mechanisms remain unknown. We aimed to assess the influence of 17q12-21 variants and mRNA expression at birth on the development of wheeze. METHODS Children were classified as multitrigger/viral/no wheeze until six years of age. The PAULINA/PAULCHEN birth cohorts were genotyped (n = 216; GSA-chip). mRNA expression of 17q21 and innate/adaptive genes was measured (qRT-PCR) in cord blood mononuclear cells. Expression quantitative trait loci (eQTL) and mediation analyses were performed. Genetic variation of 17q12-21 asthma-single nucleotide polymorphisms (SNPs) was summarized as the first principal component (PC1) and used to classify single SNP effects on gene expression as (locus)-dependent/independent eQTL SNPs. RESULTS Core region risk variants (IKZF3, ZPBP2, GSDMB, ORMDL3) were associated with multitrigger wheeze (OR: 3.05-5.43) and were locus-dependent eQTL SNPs with higher GSDMA, TLR2, TLR5, and lower TGFB1 expression. Increased risk of multitrigger wheeze with rs9303277 was in part mediated by TLR2 expression. Risk variants distal to the core region were mainly locus-independent eQTL SNPs with decreased CD209, CD86, TRAF6, RORA, and IL-9 expression. Distinct immune signatures in cord blood were associated either with multitrigger wheeze (increased innate genes, e.g., TLR2, IPS1, LY75) or viral wheeze (decreased NF-κB genes, e.g., TNFAIP3 and TNIP2). CONCLUSION Locus-dependent eQTL SNPs (core region) associated with increased inflammatory genes (primarily TLR2) at birth and subsequent multitrigger wheeze indicate that early priming and imbalance may be crucial for asthma pathophysiology. Locus-independent eQTL SNPs (mainly distal region, rs1007654) may be involved in the initiation of dendritic cell activation/maturation (TRAF6) and interaction with T cells (CD209, CD86). Identifying potential mechanistic pathways at birth may point to critical key points during early immune development predisposing to asthma.
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Affiliation(s)
- Kristina Laubhahn
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research - DZL, LMU Munich, Munich, Germany
| | - Andreas Böck
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.,Member of the CHildhood Allergy and tolerance consortium (CHAMP), LMU Munich, Munich, Germany
| | - Kathrin Zeber
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.,Member of the CHildhood Allergy and tolerance consortium (CHAMP), LMU Munich, Munich, Germany
| | - Sandra Unterschemmann
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Sonja Kunze
- Research Unit of Molecular Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Michaela Schedel
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany.,Department of Pulmonary Medicine, University Medicine Essen-University Hospital, Essen, Germany
| | - Bianca Schaub
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research - DZL, LMU Munich, Munich, Germany.,Member of the CHildhood Allergy and tolerance consortium (CHAMP), LMU Munich, Munich, Germany
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7
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Grasemann H, Holguin F. An association of the arginase 1 gene with preschool wheezing phenotypes. Pediatr Pulmonol 2021; 56:1821-1822. [PMID: 33823086 DOI: 10.1002/ppul.25392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/22/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Hartmut Grasemann
- Department of Paediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
| | - Fernando Holguin
- Department of Medicine, Pulmonary Sciences and Critical Care, School of Medicine, University of Colorado, Denver, Colorado, USA
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8
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Severcan EU, Bal CM, Gülen F, Tanaç R, Demir E. Identifying wheezing phenotypes in a pediatric Turkish cohort. J Asthma 2021; 59:1298-1304. [PMID: 33906564 DOI: 10.1080/02770903.2021.1922916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Characterization of wheezing phenotypes in children might help to identify the underlying mechanisms through which asthma occurs. In our study, we aimed to describe wheezing phenotypes in Turkish children and to identify risk factors according to phenotypes. METHODS 651 wheezy children were evaluated and 5 wheezing phenotypes were described according to age of onset, atopy and persistence at 6 years of age and risk factors were identified. RESULTS Distribution of wheezing phenotypes was transient early wheeze (TEW)(34.9%) non-atopic wheeze (NAW) (18%), atopic wheeze (AW) (22.3%), intermediate onset wheeze (IOW) (11.1%), late onset wheeze (LOW) (11.7%). LOW, AW, and IOW were associated with, father's, sibling's and family's atopy (p:0.001) whereas LOW and AW were associated with mother's asthma and atopy as well as family's asthma (p < 0.05). Atopic dermatitis and allergic rhinitis were common of patients with LOW, AW, and IOW (p < 0.05). İnfection was the major trigger for TEW and NAW whereas multiple triggers were common of AW, LOW, and IOW. Allergens were mostly associated with AW, IOW and LOW. Aeroallergen-specific IgE positivity was mostly with AW, IOW, and LOW phenotype. Skin prick tests showed multiple allergen sensitivity in IOW, LOW groups and mostly single allergen in AW phenotype. Modified asthma predictive index (mAPI) positivity was high in all groups except TEW and NAW. CONCLUSIONS With this study we classified five wheeze phenotypes and found that atopy and family's atopy history, maternal asthma were strongly associated with AW, LOW, and IOW phenotypes which were usually effected by allergens or multiple triggers.
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Affiliation(s)
- Ezgi Ulusoy Severcan
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cem Murat Bal
- Department of Pediatrics, Division of Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Figen Gülen
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Remziye Tanaç
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Esen Demir
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Ege University Faculty of Medicine, İzmir, Turkey
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9
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Phipatanakul W, Mauger DT, Guilbert TW, Bacharier LB, Durrani S, Jackson DJ, Martinez FD, Fitzpatrick AM, Cunningham A, Kunselman S, Wheatley LM, Bauer C, Davis CM, Geng B, Kloepfer KM, Lapin C, Liu AH, Pongracic JA, Teach SJ, Chmiel J, Gaffin JM, Greenhawt M, Gupta MR, Lai PS, Lemanske RF, Morgan WJ, Sheehan WJ, Stokes J, Thorne PS, Oettgen HC, Israel E. Preventing asthma in high risk kids (PARK) with omalizumab: Design, rationale, methods, lessons learned and adaptation. Contemp Clin Trials 2021; 100:106228. [PMID: 33242697 PMCID: PMC7887056 DOI: 10.1016/j.cct.2020.106228] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
Asthma remains one of the most important challenges to pediatric public health in the US. A large majority of children with persistent and chronic asthma demonstrate aeroallergen sensitization, which remains a pivotal risk factor associated with the development of persistent, progressive asthma throughout life. In individuals with a tendency toward Type 2 inflammation, sensitization and exposure to high concentrations of offending allergens is associated with increased risk for development of, and impairment from, asthma. The cascade of biological responses to allergens is primarily mediated through IgE antibodies and their production is further stimulated by IgE responses to antigen exposure. In addition, circulating IgE impairs innate anti-viral immune responses. The latter effect could magnify the effects of another early life exposure associated with increased risk of the development of asthma - viral infections. Omalizumab binds to circulating IgE and thus ablates antigen signaling through IgE-related mechanisms. Further, it has been shown restore IFN-α response to rhinovirus and to reduce asthma exacerbations during the viral season. We therefore hypothesized that early blockade of IgE and IgE mediated responses with omalizumab would prevent the development and reduce the severity of asthma in those at high risk for developing asthma. Herein, we describe a double-blind, placebo-controlled trial of omalizumab in 2-3 year old children at high risk for development of asthma to prevent the development and reduce the severity of asthma. We describe the rationale, methods, and lessons learned in implementing this potentially transformative trial aimed at prevention of asthma.
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Affiliation(s)
- Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - David T Mauger
- Pennsylvania State University, Hershey, PA, United States of America
| | - Theresa W Guilbert
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Leonard B Bacharier
- Washington University and St. Louis Children's Hospital, St. Louis, MO, United States of America
| | - Sandy Durrani
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | | | - Fernando D Martinez
- Asthma and Airway Research Center, University of Arizona, Tucson, AZ, United States of America
| | | | - Amparito Cunningham
- Boston Children's Hospital, Division of Allergy and Immunology, United States of America
| | - Susan Kunselman
- Pennsylvania State University, Hershey, PA, United States of America
| | - Lisa M Wheatley
- NIH/National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States of America
| | - Cindy Bauer
- Phoenix Children's Hospital, Phoenix, AZ, United States of America
| | - Carla M Davis
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States of America
| | - Bob Geng
- Rady Children's Hospital, UC San Diego, San Diego, CA, United States of America
| | - Kirsten M Kloepfer
- Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Craig Lapin
- Connecticut Children's Medical Center, Division of Pulmonary Hartford, CT, United States of America
| | - Andrew H Liu
- Children's Hospital Colorado, University of Colorado, Aurora, CO, United States of America
| | - Jacqueline A Pongracic
- Ann and Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Stephen J Teach
- Children's National Hospital, Washington, DC, United States of America
| | - James Chmiel
- NIH/National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States of America
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, MA, United States of America; Boston Children's Hospital, Division of Pulmonary Medicine, Boston, MA, United States of America
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado, Aurora, CO, United States of America
| | - Meera R Gupta
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States of America
| | - Peggy S Lai
- Harvard Medical School, Boston, MA, United States of America; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, MA, United States of America
| | | | - Wayne J Morgan
- Asthma and Airway Research Center, University of Arizona, Tucson, AZ, United States of America
| | - William J Sheehan
- Children's National Hospital, Washington, DC, United States of America
| | - Jeffrey Stokes
- Washington University and St. Louis Children's Hospital, St. Louis, MO, United States of America
| | - Peter S Thorne
- University of Iowa, College of Public Health, Department of Occupational and Environmental Health, Iowa City, IA, United States of America
| | - Hans C Oettgen
- Boston Children's Hospital, Division of Allergy and Immunology, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elliot Israel
- Harvard Medical School, Boston, MA, United States of America; Brigham and Women's Hospital, Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Boston, MA, United States of America
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10
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Tualzik L, Chandrasekaran V. Clinical Profile of Episodic Wheezing and Multiple Trigger Wheezing in Preschool Children: A Cross-Sectional Study. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1717140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe objectives of our study were to identify the relative frequency of episodic viral wheeze (EVW) and multiple trigger wheeze (MTW) in preschool children of 1 to 5 years of age with recurrent wheezing and to compare the relevant clinical and sociodemographic parameters in the above phenotypes. This cross-sectional study included 165 children aged 1 to 5 years with recurrent wheeze. Participants were categorized into EVW and MTW based on history according to European Respiratory Society Task Force recommendations 2008. Symptom control was assessed by Global Initiative for Asthma guidelines 2015. Of the total participants, EVW was seen in 55% and MTW in 45%. Children with MTW were significantly older than those with EVW, more atopic, and had higher eosinophil counts. The dominant phenotype seen in our study was EVW. The absence of ocular/nasal allergy and exclusive breastfeeding predicted well-controlled symptoms in EVW and in all preschool wheezers, respectively.
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Affiliation(s)
- Lalsiama Tualzik
- Department of Pediatrics, District Hospital Mamit, Mizoram, India
| | - Venkatesh Chandrasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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11
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Fainardi V, Santoro A, Caffarelli C. Preschool Wheezing: Trajectories and Long-Term Treatment. Front Pediatr 2020; 8:240. [PMID: 32478019 PMCID: PMC7235303 DOI: 10.3389/fped.2020.00240] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Wheezing is very common in infancy affecting one in three children during the first 3 years of life. Several wheeze phenotypes have been identified and most rely on temporal pattern of symptoms. Assessing the risk of asthma development is difficult. Factors predisposing to onset and persistence of wheezing such as breastfeeding, atopy, indoor allergen exposure, environmental tobacco smoke and viral infections are analyzed. Inhaled corticosteroids are recommended as first choice of controller treatment in all preschool children irrespective of phenotype, but they are particularly beneficial in terms of fewer exacerbations in atopic children. Other therapeutic options include the addition of montelukast or the intermittent use of inhaled corticosteroids. Overuse of inhaled steroids must be avoided. Therefore, adherence to treatment and correct administration of the medications need to be checked at every visit.
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Affiliation(s)
| | | | - Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
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12
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Abstract
The diagnosis of asthma can be particularly difficult in young children, in whom wheezing is not always synonym with asthma. It is also difficult to predict which preschool children with wheeze will go on to be true asthmatics. In this chapter, we will characterize preschool wheezing and asthma and discuss early risk factors for the development of severe asthma. We will also review risk factors for severe acute wheezing in young children. Finally, we will describe the natural history and prognosis of wheezing and some of the attempts at early identification of children who will develop severe asthma.
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Affiliation(s)
- Erick Forno
- Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA USA
| | - Sejal Saglani
- Imperial College London, National Heart & Lung Institute, London, UK
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13
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Schultz A. Is it time to move on from episodic viral wheeze and multiple trigger wheeze? Pediatr Pulmonol 2019; 54:1499-1450. [PMID: 31290271 DOI: 10.1002/ppul.24445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/19/2019] [Indexed: 11/07/2022]
Affiliation(s)
- André Schultz
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, Australia
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14
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Raaymakers MJA, Brand PLP, Landstra AM, Brouwer ML, Balemans WAF, Niers LEM, Merkus PJFM, Boehmer ALM, Kluytmans JAJW, de Jongste JC, Pijnenburg MWH, Vaessen-Verberne AAPH. Episodic viral wheeze and multiple-trigger wheeze in preschool children are neither distinct nor constant patterns. A prospective multicenter cohort study in secondary care. Pediatr Pulmonol 2019; 54:1439-1446. [PMID: 31211525 DOI: 10.1002/ppul.24411] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To evaluate whether episodic viral wheeze (EVW) and multiple-trigger wheeze (MTW) are clinically distinguishable and stable preschool wheezing phenotypes. METHODS Children of age 1 to 4 year with recurrent, pediatrician-confirmed wheeze were recruited from secondary care; 189 were included. Respiratory and viral upper respiratory tract infection (URTI) symptoms were recorded weekly by parents in an electronic diary during 12 months. Every 3 months, diary-based symptoms were classified as EVW or MTW and compared to phenotypes assigned by pediatricians based on clinical history. We collected nasal samples for respiratory virus PCR during URTI, respiratory symptoms and in absence of symptoms. RESULTS Of 660 3-month periods, the diary-based phenotype was EVW in 11%, MTW in 54% and 35% were free from respiratory episodes. Pediatrician-based classification showed 59% EVW and 26% MTW. The Kappa measure of agreement between diary-based and pediatrician-assigned phenotypes was very low (0.12, 95%CI, 0.07-0.17). Phenotypic instability was observed in 32% of cases. PCR was positive in 71% during URTI symptoms, 66% during respiratory symptoms and 38% in the absence of symptoms. CONCLUSION This study shows that EVW and MTW are variable over time within patients. Pediatrician classification of these phenotypes based on clinical history does not correspond to prospectively recorded symptom patterns. The applicability of these phenotypes as a basis for therapeutic decisions and prognosis should be questioned.
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Affiliation(s)
| | - Paul L P Brand
- Department of Pediatrics, Isala Hospital, Zwolle, The Netherlands.,Department of Pediatrics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke M Landstra
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marianne L Brouwer
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Laetitia E M Niers
- Department of Pediatrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Peter J F M Merkus
- Department of Pediatrics Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annemie L M Boehmer
- Department of Pediatrics, Maasstad Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics Pulmonology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Johan C de Jongste
- Department of Pediatrics Pulmonology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marielle W H Pijnenburg
- Department of Pediatrics Pulmonology, Erasmus University Medical Center, Rotterdam, The Netherlands
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15
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de Jong CCM, Pedersen ES, Goutaki M, Trachsel D, Barben J, Kuehni CE. Do clinical investigations predict long-term wheeze? A follow-up of pediatric respiratory outpatients. Pediatr Pulmonol 2019; 54:1156-1161. [PMID: 31026385 DOI: 10.1002/ppul.24347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/26/2019] [Accepted: 04/12/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The contribution of clinical investigations to prediction of long-term outcomes of children investigated for asthma is unclear. AIM We performed a broad range of clinical tests and investigated whether they helped to predict long-term wheeze among children referred for evaluation of possible asthma. METHODS We studied children aged 6 to 16 years referred to two Swiss pulmonary outpatient clinics with a history of wheeze, dyspnea, or cough in 2007. The initial assessment included spirometry, fractional exhaled nitric oxide, skin prick tests, and bronchial provocation tests by exercise, methacholine, and mannitol. Respiratory symptoms were assessed with questionnaires at baseline and at follow-up 7 years later. Associations between baseline factors and wheeze at follow-up were investigated by logistic regression. RESULTS At baseline, 111 children were examined in 2007. After 7 years, 85 (77%) completed the follow-up questionnaire, among whom 61 (72%) had wheeze at baseline, while at follow-up 39 (46%) reported wheeze. Adjusting for age and sex, the following characteristics predicted wheeze at adolescence: wheeze triggered by pets (odds ratio, 4.2; 95% CI, 1.2-14.8), pollen (2.8, 1.1-7.0), and exercise (3.1, 1.2-8.0). Of the clinical tests, only a positive exercise test (3.2, 1.1-9.7) predicted wheeze at adolescence. CONCLUSION Reported exercise-induced wheeze and wheeze triggered by pets or pollen were important predictors of wheeze persistence into adolescence. None of the clinical tests predicted wheeze more strongly than reported symptoms. Clinical tests might be important for asthma diagnosis but medical history is more helpful in predicting prognosis in children referred for asthma.
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Affiliation(s)
- Carmen C M de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eva Sl Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Daniel Trachsel
- Paediatric Respiratory Medicine, Children's University Hospital of Basel, Basel, Switzerland
| | - Juerg Barben
- Paediatric Respiratory Medicine, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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16
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Roberts G. Welcome to Clinical and Experimental Allergy in 2017. Clin Exp Allergy 2019; 47:4-5. [PMID: 28028876 DOI: 10.1111/cea.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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17
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Abstract
Wheeze in preschool children (5 years of age and younger) is common. The majority of severe episodes are triggered by viral colds. Unlike atopic asthma in adults and young people, the underlying pathology of this condition is poorly understood, and the label of “preschool wheeze” should therefore not be regarded as a diagnosis but a description of symptoms. It is important to consider other causes of wheeze, but, for the most part, serious conditions such as cystic fibrosis and foreign body aspiration are associated with atypical features on careful history and examination. There remain significant uncertainties about the optimal management of children with this condition. Short-acting bronchodilators are indicated for the acute treatment of wheeze, and current evidence suggests that daily inhaled corticosteroid therapy is an effective preventive therapy, at least in a subgroup of children. Some trials suggest that preemptive therapy with inhaled corticosteroids may be as effective as regular inhaled corticosteroids. Since wheeze is intermittent for the majority of children, preemptive therapy is a logical approach. However, more studies are needed to confirm whether preemptive inhaled corticosteroids are as, or more, effective than regular preventer therapy.
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18
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Grigg J, Nibber A, Paton JY, Chisholm A, Guilbert TW, Kaplan A, Turner S, Roche N, Hillyer EV, Price DB. Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks. J Asthma Allergy 2018; 11:309-321. [PMID: 30588038 PMCID: PMC6294169 DOI: 10.2147/jaa.s178531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background An inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA) may prevent wheezing/asthma attacks in preschoolers with recurrent wheeze when added to short-acting β-agonist (SABA). Objective The aim of this historical matched cohort study was to assess the effectiveness of these treatments for preventing wheezing/asthma attacks. Methods Electronic medical records from the Optimum Patient Care Research Database were used to characterize a UK preschool population (1–5 years old) with two or more episodes of wheezing during 1 baseline year before first prescription (index date) of ICS or LTRA, or repeat prescription of SABA. Children initiating ICS or LTRA on the index date were matched 1:4 to those prescribed only SABA for age, sex, year of index prescription, mean baseline SABA dose, baseline attacks, baseline antibiotic prescriptions, and eczema diagnosis. Wheezing/asthma attacks (defined as asthma-related emergency attendance, hospital admission, or acute oral corticosteroid prescription) during 1 outcome year were compared using conditional logistic regression. Results Matched ICS and SABA cohorts included 990 and 3,960 children, respectively (61% male; mean [SD] age 3.2 [1.3] years), and matched LTRA and SABA cohorts included 259 and 1,036 children, respectively (65% male; mean [SD] age 2.6 [1.2] years). We observed no significant difference between matched cohorts in the odds of a wheezing/asthma attack: ICS vs SABA, OR (95% CI) 1.01 (0.85–1.19) and LTRA vs SABA, OR (95% CI) 1.28 (0.96–1.72). Conclusion We found no evidence that initiation of ICS or LTRA therapy is associated with fewer attacks during 1 outcome year than SABA alone for a heterogeneous group of preschool children with recurrent wheeze in the real-life clinical setting.
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Affiliation(s)
- Jonathan Grigg
- Blizard Institute, Queen Mary University of London, London, UK,
| | | | - James Y Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Theresa W Guilbert
- Pulmonary Division, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
| | - Steve Turner
- Department of Child Health, Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, UK
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital Group, AP-HP, University of Paris Descartes (EA2511), Paris, France
| | - Elizabeth V Hillyer
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - David B Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
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19
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Roberts G. Immunotherapy, asthma and community allergic reactions to food. Clin Exp Allergy 2018; 46:780-1. [PMID: 27228569 DOI: 10.1111/cea.12752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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20
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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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21
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Brand PL, Schultz A. To track or not to track: wheeze phenotypes in preschool children. Eur Respir J 2018; 51:51/4/1800042. [DOI: 10.1183/13993003.00042-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/29/2018] [Indexed: 11/05/2022]
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22
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Caudri D. Multi-trigger and viral wheeze: describing symptoms or defining diseases? Eur Respir J 2017; 50:50/5/1701283. [PMID: 29097433 DOI: 10.1183/13993003.01283-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/31/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Daan Caudri
- Telethon Kids Institute, The University of Western Australia, Perth, Australia .,Dept of Pediatric Pulmonology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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23
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Spycher BD, Cochrane C, Granell R, Sterne JAC, Silverman M, Pedersen E, Gaillard EA, Henderson J, Kuehni CE. Temporal stability of multitrigger and episodic viral wheeze in early childhood. Eur Respir J 2017; 50:50/5/1700014. [PMID: 29097430 DOI: 10.1183/13993003.00014-2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/29/2017] [Indexed: 11/05/2022]
Abstract
The distinction between episodic viral wheeze (EVW) and multitrigger wheeze (MTW) is used to guide management of preschool wheeze. It has been questioned whether these phenotypes are stable over time. We examined the temporal stability of MTW and EVW in two large population-based cohorts.We classified children from the Avon Longitudinal Study of Parents and Children (n=10 970) and the Leicester Respiratory Cohorts ((LRCs), n=3263) into EVW, MTW and no wheeze at ages 2, 4 and 6 years based on parent-reported symptoms. Using multinomial regression, we estimated relative risk ratios for EVW and MTW at follow-up (no wheeze as reference category) with and without adjusting for wheeze severity.Although large proportions of children with EVW and MTW became asymptomatic, those that continued to wheeze showed a tendency to remain in the same phenotype: among children with MTW at 4 years in the LRCs, the adjusted relative risk ratio was 15.6 (95% CI 8.3-29.2) for MTW (stable phenotype) compared to 7.0 (95% CI 2.6-18.9) for EVW (phenotype switching) at 6 years. The tendency to persist was weaker for EVW and from 2-4 years. Results were similar across cohorts.This suggests that MTW, and to a lesser extent EVW, tend to persist regardless of wheeze severity.
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Affiliation(s)
- Ben D Spycher
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK .,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Cara Cochrane
- Paediatric Respiratory Dept, Bristol Royal Hospital for Children, Bristol, UK
| | - Raquel Granell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Eva Pedersen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Erol A Gaillard
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK.,Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK.,University Hospitals Leicester, Children's Hospital, Leicester, UK
| | - John Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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24
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Jurca M, Pescatore AM, Goutaki M, Spycher BD, Beardsmore CS, Kuehni CE. Age-related changes in childhood wheezing characteristics: A whole population study. Pediatr Pulmonol 2017; 52:1250-1259. [PMID: 28815996 DOI: 10.1002/ppul.23783] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/21/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Wheezing illnesses are characterized by phenotypic variability, which changes with age, but few studies report on a wide age range of children. We studied how prevalence, severity, and triggers of wheeze vary throughout childhood. METHODS We analyzed data from a large population-based cohort of children from Leicestershire, UK, who were followed from infancy through late adolescence using postal questionnaires. We used generalized estimating equations to describe age-related changes in prevalence of any wheeze: episodic viral and multiple trigger wheeze; wheeze triggered by exercise, aeroallergens, food/drinks, laughing/crying; and of severe wheeze (frequent attacks, shortness of breath, sleep disturbance, disturbance of daily activities) from age 1-18 years. We analyzed this in the entire cohort (absolute prevalence) and separately among children with wheeze (relative prevalence). RESULTS This study included 7670 children. Current wheeze was most common in 1-year-olds (36%) and then decreased in prevalence to reach 17% in children aged 14-17 years. Absolute prevalence of episodic viral wheeze (EVW) decreased with age (from 24% to 7%), while multiple trigger wheeze (MTW) remained relatively constant throughout childhood (8-12%). Among children with wheeze, the proportion with EVW decreased, and the proportion with MTW increased with age. In older children, wheeze triggered by exercise or aeroallergens, and wheeze accompanied by shortness of breath became more frequent, while wheeze triggered by food or laughter, and sleep disturbance decreased in prevalence. CONCLUSION Knowledge of these age-related changes in wheezing illness is informative for health care planning and the design of future research projects and questionnaires.
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Affiliation(s)
- Maja Jurca
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anina M Pescatore
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Caroline S Beardsmore
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, Bern, Switzerland
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25
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Mallol J. ASMA DEL LACTANTE: ACTUALIZACIÓN. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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26
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Landgraf-Rauf K, Anselm B, Schaub B. The puzzle of immune phenotypes of childhood asthma. Mol Cell Pediatr 2016; 3:27. [PMID: 27468754 PMCID: PMC4965363 DOI: 10.1186/s40348-016-0057-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/19/2016] [Indexed: 02/07/2023] Open
Abstract
Asthma represents the most common chronic childhood disease worldwide. Whereas preschool children present with wheezing triggered by different factors (multitrigger and viral wheeze), clinical asthma manifestation in school children has previously been classified as allergic and non-allergic asthma. For both, the underlying immunological mechanisms are not yet understood in depth in children. Treatment is still prescribed regardless of underlying mechanisms, and children are not always treated successfully. This review summarizes recent key findings on the complex mechanisms of the development and manifestation of childhood asthma. Whereas traditional classification of childhood asthma is primarily based on clinical symptoms like wheezing and atopy, novel approaches to specify asthma phenotypes are under way and face challenges such as including the stability of phenotypes over time and transition into adulthood. Epidemiological studies enclose more information on the patient’s disease history and environmental influences. Latest studies define endotypes based on molecular and cellular mechanisms, for example defining risk and protective single nucleotide polymorphisms (SNPs) and new immune phenotypes, showing promising results. Also, regulatory T cells and recently discovered T helper cell subtypes such as Th9 and Th17 cells were shown to be important for the development of asthma. Innate lymphoid cells (ILC) could play a critical role in asthma patients as they produce different cytokines associated with asthma. Epigenetic findings showed different acetylation and methylation patterns for children with allergic and non-allergic asthma. On a posttranscriptional level, miRNAs are regulating factors identified to differ between asthma patients and healthy controls and also indicate differences within asthma phenotypes. Metabolomics is another exciting chapter important for endotyping asthmatic children. Despite the development of new biomarkers and the discovery of new immunological molecules, the complex puzzle of childhood asthma is still far from being completed. Addressing the current challenges of distinct clinical asthma and wheeze phenotypes, including their stability and underlying endotypes, involves addressing the interplay of innate and adaptive immune regulatory mechanisms in large, interdisciplinary cohorts.
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Affiliation(s)
- Katja Landgraf-Rauf
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU, Lindwurmstraße 4, 80337, Munich, Germany.,Member of German Lung Centre (DZL), CPC, Munich, Germany
| | - Bettina Anselm
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU, Lindwurmstraße 4, 80337, Munich, Germany
| | - Bianca Schaub
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU, Lindwurmstraße 4, 80337, Munich, Germany. .,Member of German Lung Centre (DZL), CPC, Munich, Germany.
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27
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Kaiser SV, Huynh T, Bacharier LB, Rosenthal JL, Bakel LA, Parkin PC, Cabana MD. Preventing Exacerbations in Preschoolers With Recurrent Wheeze: A Meta-analysis. Pediatrics 2016; 137:peds.2015-4496. [PMID: 27230765 DOI: 10.1542/peds.2015-4496] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Half of children experience wheezing by age 6 years, and optimal strategies for preventing severe exacerbations are not well defined. OBJECTIVE Synthesize the evidence of the effects of daily inhaled corticosteroids (ICS), intermittent ICS, and montelukast in preventing severe exacerbations among preschool children with recurrent wheeze. DATA SOURCES Medline (1946, 2/25/15), Embase (1947, 2/25/15), CENTRAL. STUDY SELECTION Studies were included based on design (randomized controlled trials), population (children ≤6 years with asthma or recurrent wheeze), intervention and comparison (daily ICS vs placebo, intermittent ICS vs placebo, daily ICS vs intermittent ICS, ICS vs montelukast), and outcome (exacerbations necessitating systemic steroids). DATA EXTRACTION Completed by 2 independent reviewers. RESULTS Twenty-two studies (N = 4550) were included. Fifteen studies (N = 3278) compared daily ICS with placebo and showed reduced exacerbations with daily medium-dose ICS (risk ratio [RR] 0.70; 95% confidence interval [CI], 0.61-0.79; NNT = 9). Subgroup analysis of children with persistent asthma showed reduced exacerbations with daily ICS compared with placebo (8 studies, N = 2505; RR 0.56; 95% CI, 0.46-0.70; NNT = 11) and daily ICS compared with montelukast (1 study, N = 202; RR 0.59; 95% CI, 0.38-0.92). Subgroup analysis of children with intermittent asthma or viral-triggered wheezing showed reduced exacerbations with preemptive high-dose intermittent ICS compared with placebo (5 studies, N = 422; RR 0.65; 95% CI, 0.51-0.81; NNT = 6). LIMITATIONS More studies are needed that directly compare these strategies. CONCLUSIONS There is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.
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Affiliation(s)
| | - Tram Huynh
- School of Public Health, University of California, Berkeley, California
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | | | - Leigh Anne Bakel
- Department of Pediatrics, University of Colorado, Denver, Colorado; and
| | - Patricia C Parkin
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Cabana
- Department of Pediatrics, Phillip Lee Institute for Health Policy Studies, and Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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