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Asthma‐predictive‐index, bronchial‐challenge, sputum eosinophils in acutely wheezing preschoolers
Author(s) -
Ater Dorit,
Bar BatEl,
Fireman Nir,
Fireman Elizabeth,
Shai Hanita,
Tasher Diana,
Dalal Ilan,
Mandelberg Avigdor
Publication year - 2014
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22926
Subject(s) - medicine , asthma , ambulatory , sputum , pediatrics , methacholine , prospective cohort study , emergency department , respiratory disease , tuberculosis , lung , pathology , psychiatry
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.