Asthma-predictive-index, bronchial-challenge, sputum eosinophils in acutely wheezing preschoolers

Authors


  • Financial disclosure: The authors have indicated they have no financial relationships relevant to this article to disclose.
  • Conflict of interest: The authors declare that they have no conflicts of interests to disclose.
  • Contributors' statement: Dr. Dorit Ater: conceived the study, designed the protocol, planned the statistical analysis, supervised and acquired the study data, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submitted.
  • Dr. Bat-El Bar: acquired the study data, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submitted.
  • Dr. Nir Fireman: acquired the study data, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submitted.
  • Dr. Elizabeth Fireman: was responsible for the induced sputum cytology evaluation, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submitted.
  • Dr. Hanita Shai: acquired the study data, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submitted.
  • Dr. Ilan Dalal: supervised and acquired the study data, contributed to the interpretation of the study results, critically reviewed the manuscript, and approved the final manuscript as submitted.
  • Dr. Diana Tasher: was responsible for virology studies, contributed to the interpretation of the study results, critically reviewed the manuscript, and approved the final manuscript as submitted.
  • Dr. Avigdor Mandelberg: conceived the study, designed the protocol, planned the statistical analysis, supervised and acquired the study data collection, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submit.
  • Dr. Ater and Dr. Mandelberg had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Summary

Background

Most preschoolers with viral wheezing exacerbations are not atopic.

Aim

To test in a prospective controlled trial whether wheezing preschoolers presenting to the ED are different from the above in three different domains defining asthma: the atopic characteristics based on stringent asthma predictive index (S-API), the characteristics of bronchial hyper-responsiveness (BHR), and airway inflammation.

Methods

The S-API was prospectively collected in 41 preschoolers (age 31.9 ± 17.4 months, range; 1–6 years) presenting to the ED with acute wheezing and compared to healthy preschoolers (n = 109) from our community (community control group). Thirty out of the 41 recruited preschoolers performed two sets of bronchial challenge tests (BCT)-(methacholine and adenosine) within 3 weeks and following 3 months of the acute event and compared to 30 consecutive ambulatory preschoolers, who performed BCT for diagnostic workup in our laboratory (ambulatory control group). On presentation, induced sputum (IS) was obtained from 22 of the 41 children.

Outcomes

Primary: S-API, secondary: BCTs characteristics and percent eosinophils in IS.

Results

Significantly more wheezing preschoolers were S-API positive compared with the community control group: 20/41 (48.7%) versus 15/109 (13.7%, P < 0.001). All methacholine-BCTs—30/30 (100%) were positive compared with 13/14 (92.8%) in the ambulatory control group (P = 0.32). However, 23/27 (85.2%) were adenosine-BCT positive versus 3/17 (17.5%) in the ambulatory control group (P < 0.001). Diagnostic IS success rate was 18/22 (81.8%). Unexpectedly, 9/18 (50.0%) showed eosinophilia in the IS.

Conclusions

Wheezing preschoolers presenting to the ED is a unique population with significantly higher rate of positive S-API and adenosine-BCT compared with controls and frequently (50%) express eosinophilic airway inflammation. Pediatr Pulmonol. 2014; 49:952–959. © 2013 Wiley Periodicals, Inc.

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