Skin Barrier Function and Infant Tidal Flow-Volume Loops—A Population-Based Observational Study

Abstract

Background: The relationship between skin barrier- and lung function in infancy is largely unexplored. We aimed to explore if reduced skin barrier function by high transepidermal water loss (TEWL), or manifestations of eczema or Filaggrin (FLG) mutations, were associated with lower lung function in three-month-old infants. Methods: From the population-based PreventADALL cohort, 899 infants with lung function measurements and information on either TEWL, eczema at three months of age and/or FLG mutations were included. Lower lung function by tidal flow-volume loops was defined as the ratio of time to peak tidal expiratory flow to expiratory time (tPTEF/tE) <0.25 and a tPTEF <0.17 s (<25th percentile). A high TEWL >8.83 g/m2/h (>75th percentile) denoted reduced skin barrier function, and DNA was genotyped for FLG mutations (R501X, 2282del4 and R2447X). Results: Neither a high TEWL, nor eczema or FLG mutations, were associated with lower tPTEF/tE. While a high TEWL was associated with a lower tPTEF; adjusted OR (95% CI) 1.61 (1.08, 2.42), the presence of eczema or FLG mutations were not. Conclusions: Overall, a high TEWL, eczema or FLG mutations were not associated with lower lung function in healthy three-month-old infants. However, an inverse association between high TEWL and tPTEF was observed, indicating a possible link between the skin barrier- and lung function in early infancy.

Infant lung function and early skin barrier impairment in the development of asthma at age 3 years

“…Our finding that impaired skin barrier function in infancy was associated with asthma at age 3 years is to the best of our knowledge novel. We previously reported an inverse association between impaired skin function and lower lung function by t PTEF among 899 infants at age 3 months 18 . A German study found similar TEWL values using a patch test among 95 subjects with respiratory atopy, AD and controls 49 .…”

“…We previously reported an inverse association between impaired skin function and lower lung function by t PTEF among 899 infants at age 3 months. 18 A German study found similar TEWL values using a patch test among 95 subjects with respiratory atopy, AD and controls. 49 Collectively, our finding thus supports that barrier dysfunction may play a role in asthma development.…”

“…11,17 Lung function in early infancy can be measured with tidal flowvolume (TFV) loops, with a lower ratio of time to reach peak tidal expiratory flow (t PTEF ) to expiratory time (t E ) observed in infants with airway obstruction. 18 Lower t PTEF /t E in infancy increases the risk of developing childhood asthma, 19 and lower lung function was tracked from birth to adolescence in asthmatic children with allergic comorbidities. 20 In addition, infants and children with airway obstruction generally reach t PTEF earlier during expiration.…”

“…20 In addition, infants and children with airway obstruction generally reach t PTEF earlier during expiration. [21][22][23][24] Recently, we reported a possible link between higher TEWL and lower lung function by t PTEF , 18 suggesting that an impaired skin barrier function may play a role in asthma development.…”

Lung Function in Childhood: Designing the Future Trajectories

“…A lack of disease control substantially impacts the quality of life of the patients and their caregivers [ 4 ]. Lung function tests are also useful in identifying mechanisms that predispose a patient to develop asthma, among allergies and skin barrier dysfunction [ 5 ].…”