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Clinical & Experimental Allergy

Childhood wheezing phenotypes and FeNO in atopic children at age 8

Authors

  • R. J. P. van der Valk,

    1. Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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    • both authors contributed equally.

  • D. Caudri,

    1. Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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    • both authors contributed equally.

  • O. Savenije,

    1. Department of Epidemiology, UMCG, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
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  • G. H. Koppelman,

    1. Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, UMCG, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
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  • H. A. Smit,

    1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
    2. Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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  • A. H. Wijga,

    1. Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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  • D. S. Postma,

    1. Department of Pulmonary Medicine, UMCG, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
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  • M. Kerkhof,

    1. Department of Epidemiology, UMCG, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
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  • B. Brunekreef,

    1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
    2. Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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  • J. C. de Jongste

    Corresponding author
    • Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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Correspondence:

Johan C. de Jongste, Professor of Pediatric Respiratory Medicine, Erasmus MC-Sophia, Department of Pediatrics, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.

E-mail: j.c.dejongste@erasmusmc.nl

Summary

Background

Fractional exhaled Nitric Oxide (FeNO) is a surrogate biomarker of the degree of eosinophilic airway inflammation. Using longitudinal latent class analysis, five wheezing phenotypes have been identified, characterized by different ages of onset and prognosis.

Objectives

To assess FeNO measured at 4 and 8 years in children with different phenotypes of wheeze and atopy.

Methods

Children participated in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study, a prospective birth cohort in the Netherlands. Respiratory health was assessed yearly by questionnaires until the age of 8 years; these data were used to identify five wheezing phenotypes. Associations between FeNO and wheezing phenotypes were investigated using weighted linear regression.

Results

Data on wheezing phenotypes and FeNO at 4 and 8 years were available in 588 and 973 children respectively. Compared with the phenotype of never and transient wheeze, FeNO at 4 years was higher in intermediate onset and persistent wheeze. FeNO at 8 years of age differed significantly between all phenotypes, with highest FeNO values for persistent, intermediate onset, and late onset wheeze. Rise in FeNO from 4 to 8 years in intermediate and late onset wheezers was significantly higher compared to FeNO rise in never and transient wheezers. Stratified analyses showed that the increase in FeNO in persistent, intermediate, and late onset wheeze was only present in children with allergic sensitization at 8 years.

Conclusions and Clinical Relevance

The FeNO measured at 8 years was associated with specific wheezing phenotypes, only among atopic children.

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