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Published on: August 7, 2017
Prediction of asthma exacerbations in children: results of a one-year prospective study
C M H H T Robroeks1, D van Vliet, Q Jöbsis
1Department of Paediatric Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands. c.bootsma.robroeks@mumc.nl
Insights
Asthma exacerbations in children can be predicted by measuring interleukin-5 (IL-5) levels in exhaled breath and assessing asthma control scores. These non-invasive markers can help manage childhood asthma effectively.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Biomarkers and Diagnostics
Background:
- Underdiagnosis and poor asthma control are common challenges in pediatric asthma management.
- Predicting and preventing asthma exacerbations is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate non-invasive inflammatory markers in exhaled breath for predicting childhood asthma exacerbations.
- To analyze the temporal changes of these markers before, during, and after exacerbations.
Main Methods:
- A prospective, one-year longitudinal study involving 40 children (aged 6-16) with asthma.
- Regular assessments included pulmonary symptoms, medication use, lung function (FEV1), asthma control score, exhaled nitric oxide, and inflammatory markers in breath condensate (including IL-5).
Main Results:
- Sixteen children experienced exacerbations; condensate acidity, IL-5, and asthma control score predicted exacerbations (P < 0.05).
- Multivariate analysis identified asthma control score and IL-5 levels as the strongest predictors (P = 0.007 and P = 0.035).
- Children with optimal IL-5 and control scores had a two-fold reduced risk of exacerbations.
Conclusions:
- Exhaled breath condensate IL-5 levels and asthma control scores are significant predictors of asthma exacerbations in children.
- These findings suggest potential for using these markers to guide asthma treatment titration in future research.
Background:
Underdiagnosis and low levels of asthma control are frequent occurring problems in patients with asthma.
Objective:
The study aim was to evaluate the ability of non-invasive inflammatory markers in exhaled breath to predict exacerbations of childhood asthma, and to assess the time course of changes in these exhaled markers before, during and after exacerbations.
Methods:
The design was a prospective one-year longitudinal study. Regular two-month visits at the outpatient clinic were performed. Forty children with asthma (aged 6-16 years) participated. The primary outcome measure was the occurrence of an exacerbation. Assessment was made of the presence and severity of pulmonary symptoms, use of medication, and measurements of forced expiratory volume in 1 s using home monitor. The following independent parameters were assessed during outpatient visits: (1) exhaled nitric oxide, (2) inflammatory markers in exhaled breath condensate: acidity, nitrite, hydrogen peroxide, interleukin-1α, -5, -13, interferon-γ, (3) lung function, (4) asthma control score.
Results:
Thirty-eight of 40 children completed the study. Sixteen children developed exacerbations, of which ten were moderate and six severe. Univariate Cox regression analysis revealed that condensate acidity, interleukin-5 and asthma control score were significant predictors of an asthma exacerbation (P < 0.05). In the multivariate Cox regression analysis, exacerbations were best predicted by the asthma control score and by the level of interleukin-5 in exhaled breath condensate (Wald scores of 7.19 and 4.44, P = 0.007 and P = 0.035 respectively). The predicted survival curve of this multivariate model showed a two times reduced risk on exacerbations in the category of children with the 10% most optimal values of IL-5 and asthma control score.
Conclusions And Clinical Relevance:
Both exhaled breath condensate interleukin-5 level and asthma control score were significant predictors of asthma exacerbations. These findings open up the possibility of assessing the potential of such parameters to titrate asthma treatment in future studies.
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