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Wheezing in school children is not always asthma
W Nystad1, T Stensrud, B Rijcken
1Laboratory of Sport Medicine, Norwegian University of Physical Education and Sport, Oslo. Wenche.Nystad@folkehels.no
Summary
Children with asthma show distinct differences in lung function, bronchial hyper-responsiveness (BHR), exercise-induced bronchoconstriction (EIB), and skin prick test (SPT) reactivity compared to those with wheeze or neither condition.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Asthma diagnosis in children can be challenging, often overlapping with symptoms like wheezing.
- Differentiating between childhood asthma, isolated wheeze, and healthy controls is crucial for accurate management and research.
- Understanding distinct physiological markers can improve diagnostic accuracy and treatment strategies.
Purpose of the Study:
- To investigate differences in lung function, bronchial hyper-responsiveness (BHR), exercise-induced bronchoconstriction (EIB), and skin prick test (SPT) reactivity among school children categorized as having asthma, wheeze only, or neither.
- To establish objective physiological parameters that distinguish these pediatric respiratory conditions.
Main Methods:
- A cohort of 2188 school children was initially surveyed for asthma and wheeze status.
- A random sample of 80 children from each of three groups (asthma, wheeze, no asthma/no wheeze) was selected for detailed testing (n=240).
- Tests included methacholine inhalation challenge for BHR (PD20 FEV1), assessment of EIB, and SPT reactivity.
Main Results:
- Children with asthma exhibited significantly higher prevalence of BHR (68%) compared to wheeze (31%) and no asthma/no wheeze (30%) groups.
- Exercise-induced bronchoconstriction (EIB) was more frequent in asthmatics (40%) than in the other two groups (12% and 7%).
- Positive SPT reactivity was twice as common in children with asthma (58%) versus the wheeze (27%) and no asthma/no wheeze (25%) groups. Children with wheeze were similar to those without asthma/wheeze for these parameters.
Conclusions:
- Children diagnosed with asthma demonstrate distinct physiological and immunological profiles compared to children experiencing wheeze without asthma or those without respiratory symptoms.
- Objective measures like BHR, EIB, and SPT reactivity are valuable in differentiating childhood asthma from simple wheeze.
- The findings support the clinical distinction between asthma and isolated wheeze based on objective physiological testing.