Evolution of Airway Inflammation in Preschoolers with Asthma—Results of a Two-Year Longitudinal Study

Abstract

Fractional exhaled nitric oxide (FeNO) is a non-invasive marker for eosinophilic airway inflammation and has been used for monitoring asthma. Here, we assess the characteristics of FeNO from preschool to school age, in parallel with asthma activity. A total of 167 asthmatic children and 66 healthy, age-matched controls were included in the 2-year prospective PreDicta study evaluating wheeze/asthma persistence in preschool-aged children. Information on asthma/rhinitis activity, infections and atopy was recorded at baseline. Follow-up visits were performed at 6-month intervals, as well as upon exacerbation/cold and 4–6 weeks later in the asthmatic group. We obtained 539 FeNO measurements from asthmatics and 42 from controls. At baseline, FeNO values did not differ between the two groups (median: 3.0 ppb vs. 2.0 ppb, respectively). FeNO values at 6, 12, 18 and 24 months (4.0, CI: 0.0–8.6; 6.0, CI: 2.8–12.0; 8.0, CI: 4.0–14.0; 8.5, CI: 4.4–14.5 ppb, respectively) increased with age (correlation p ≤ 0.001) and atopy (p = 0.03). FeNO was non-significantly increased from baseline to the symptomatic visit, while it decreased after convalescence (p = 0.007). Markers of disease activity, such as wheezing episodes and days with asthma were associated with increased FeNO values during the study (p < 0.05 for all). Age, atopy and disease activity were found to be important FeNO determinants in preschool children. Longitudinal and individualized FeNO assessment may be valuable in monitoring asthmatic children with recurrent wheezing or mild asthma.

Physical activity in asthma control and its immune modulatory effect in asthmatic preschoolers

“…The “Post‐infectious immune reprogramming and its association with persistence and chronicity of respiratory allergic diseases” (PreDicta) study was designed to prospectively evaluate asthma persistence in preschoolers in association with microbial exposures and immunological responses 26 . PreDicta has demonstrated differential immune responses to viruses in asthma, 27,28 as well as evolution of airway inflammation at that age 29 …”

Changes in fractional exhaled nitric oxide, exhaled carbon monoxide and pulmonary function during the acute attack, treatment and remission phases of pediatric asthma

“…Children aged 3-5 years with asthma may exhibit noneosinophilic inflammation. Additionally, Xepapadak and other demonstrated that FeNO level can be elevated with time and age (13). The difference in results between the two age groups could also be attributed to different FeNO detection methods and difficulty controlling the degree of cooperation by younger children.…”

Application of high dimensional flow cytometry and unsupervised analysis to define the immune cell landscape of early childhood respiratory and blood compartments

“…A detailed understanding of the tissue-specific immune landscape in health and disease is required to improve the clinical management of many childhood diseases. Aberrant inflammation is a hallmark of several childhood lung diseases, including bronchopulmonary dysplasia (Balany and Bhandari, 2015), preschool wheeze (Xepapadaki et al, 2020), asthma (Chedevergne et al, 2000), cystic fibrosis (Tirouvanziam et al, 2000), primary ciliary dyskinesia (Cockx et al, 2017), and COVID-19 (Neeland et al, 2021). Despite this, little is known regarding the immune cell profiles and mechanisms governing inflammatory processes in the early life respiratory system.…”