Symptom-pattern phenotype and pulmonary function in preschool wheezers

Sonnappa, Samatha; Bastardo, Cristina; Wade, Angela; Saglani, Sejal; McKenzie, S A; Bush, Andrew; Aurora, Paul

doi:10.1016/j.jaci.2010.04.018

Cited by 120 publications

(120 citation statements)

References 42 publications

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“…72 healthy controls (37 males; median age 5.5 yrs, IQR 5.1-6.2 yrs) were also recruited [7]. All 28 wheezers were able to perform MBW and sRaw measurements, and FeNO measurement was successful in 22 children.…”

Section: Resultsmentioning

confidence: 99%

“…All subjects underwent clinical and lung function assessments, as previously described [7]. Briefly, the assessments included: FeNO measured at an expiratory flow of 50 mL?s -1 using the single-breath online method according to the American Thoracic Society/European Respiratory Society guidelines [9], with computerised equipment and a chemiluminescence analyser (CLD 88; EcoMedics, Durnten, Switzerland); multiple-breath washout (MBW) indices (lung clearance index (LCI), a measure of overall ventilation inhomogeneity, and conducting zone contribution to ventilation inhomogeneity (Scond) and acinar zone contribution to ventilation inhomogeneity (Sacin)), measured by using sulfur hexafluoride as the inert marker gas; and plethysmographic specific airway resistance (sRaw).…”

Section: Methodsmentioning

confidence: 99%

“…We recently reported that preschool children with multiple-trigger wheeze have abnormal lung function whilst those with episodic (viral) wheeze do not, irrespective of atopic and current wheeze status [7]. In a subgroup of these children with severe recurrent wheeze, SAGLANI et al [8] previously performed endobronchial biopsies at a median age of 29 months.…”

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confidence: 99%

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Relationship between past airway pathology and current lung function in preschool wheezers

Sonnappa¹,

Bastardo²,

Saglani³

et al. 2011

Eur Respir J

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The functional outcome in preschool severe wheezers with eosinophilic airway inflammation and increased reticular basement membrane (RBM) thickness is unknown. We investigated the relationship between airway pathology at age 2 yrs and lung function at age 4-6 yrs in previous severe wheezers.Severe wheezers previously investigated by endobronchial biopsy and healthy children aged 4-6 yrs were recruited. Lung clearance index (LCI), conducting zone ventilation inhomogeneity (Scond), acinar ventilation inhomogeneity by multiple-breath washout, plethysmographic-specific airway resistance and exhaled nitric oxide fraction (FeNO) were measured. Lung function was compared between wheezers and healthy controls, and in wheezers correlated with past RBM thickness and mucosal eosinophilia (EG2+ cells).72 healthy controls and 28 previous severe wheezers were tested. Wheezers had significantly higher median LCI (6.8 versus 6.6; p50.001) and Scond (0.046 versus 0.016; p,0.0005) than healthy controls. Past RBM thickness (r50.474, p50.047) and EG2+ cells (r50.552, p50.041) showed significant correlations with current FeNO, but no correlations were seen between past RBM thickness and current lung function.RBM thickness and EG2+ cells at age 2 yrs show a significant positive association with FeNO at age 5 yrs. Although lung function was abnormal at age 5 yrs in severe wheezers, this did not correlate with past RBM thickness.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Relationship between past airway pathology and current lung function in preschool wheezers

Sonnappa¹,

Bastardo²,

Saglani³

et al. 2011

Eur Respir J

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“…Despite significant differences in clinical presentation, lung function and genetics between children with EVW and MTW phenotypes, there is a large overlap between the groups [16][17][18][19]. While some children retain a consistent pattern of EVW or MTW over longer periods, symptom patterns change over time in many [15].…”

Section: Distinguishing Between Evw and Mtwmentioning

confidence: 99%

Classification and pharmacological treatment of preschool wheezing: changes since 2008

et al. 2014

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Since the publication of the European Respiratory Society Task Force report in 2008, significant new evidence has become available on the classification and management of preschool wheezing disorders. In this report, an international consensus group reviews this new evidence and proposes some modifications to the recommendations made in 2008. Specifically, the consensus group acknowledges that wheeze patterns in young children vary over time and with treatment, rendering the distinction between episodic viral wheeze and multiple-trigger wheeze unclear in many patients. Inhaled corticosteroids remain first-line treatment for multiple-trigger wheeze, but may also be considered in patients with episodic viral wheeze with frequent or severe episodes, or when the clinician suspects that interval symptoms are being under reported. Any controller therapy should be viewed as a treatment trial, with scheduled close follow-up to monitor treatment effect. The group recommends discontinuing treatment if there is no benefit and taking favourable natural history into account when making decisions about long-term therapy. Oral corticosteroids are not indicated in mild-to-moderate acute wheeze episodes and should be reserved for severe exacerbations in hospitalised patients. Future research should focus on better clinical and genetic markers, as well as biomarkers, of disease severity.

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“…In children with preschool wheeze, levels of FeNO were higher in those with current symptoms or atopy compared with controls [117,118]. Although anti-inflammatory therapy has been shown to reduce FeNO in wheezy preschool children, there are no published data on its utility in monitoring control, adjusting therapy or in predicting exacerbations [63,64,[119][120][121].…”

Section: Exhaled Nitric Oxide Fractionmentioning

confidence: 99%

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

et al. 2015

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This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children.Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases. @ERSpublications Review on the role of lung function, measurement of BHR and airway inflammation in monitoring of children with asthma

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Symptom-pattern phenotype and pulmonary function in preschool wheezers

Cited by 120 publications

References 42 publications

Relationship between past airway pathology and current lung function in preschool wheezers

Relationship between past airway pathology and current lung function in preschool wheezers

Classification and pharmacological treatment of preschool wheezing: changes since 2008

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

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