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

Dorit Ater1, Bat-El Bar, Nir Fireman

  • 1Pediatric Pulmonary Unit, Wolfson Medical Centre, Holon, Israel; The Sackler School of Medicine, Tel Aviv University, Holon, Israel.

Pediatric Pulmonology
|October 30, 2013
PubMed

Insights

Wheezing preschoolers visiting the emergency department show higher rates of atopy and airway inflammation. These children represent a distinct group with unique asthma-defining characteristics.

Area of Science:

  • Pediatric Respiratory Medicine
  • Allergy and Immunology
  • Clinical Trial Research

Background:

  • Most preschoolers experiencing viral wheezing exacerbations do not exhibit atopy.
  • Asthma diagnosis in preschoolers is challenging due to overlapping symptoms with viral infections.

Purpose of the Study:

  • To investigate if preschoolers with acute wheezing presenting to the emergency department (ED) differ from non-atopic children.
  • To compare atopic characteristics (using stringent asthma predictive index - S-API), bronchial hyper-responsiveness (BHR), and airway inflammation in wheezing preschoolers versus controls.

Main Methods:

  • Prospective controlled trial involving 41 preschoolers with acute wheezing presenting to the ED.
  • Comparison with 109 healthy community controls and 30 ambulatory controls undergoing bronchial challenge tests (BCT).
  • Assessment of S-API, BCT (methacholine and adenosine), and induced sputum (IS) for eosinophils.

Main Results:

  • Significantly higher S-API positivity in wheezing preschoolers (48.7%) compared to community controls (13.7%).
  • Positive adenosine BCT in 85.2% of wheezing preschoolers versus 17.5% in ambulatory controls.
  • Eosinophilic airway inflammation detected in 50% of wheezing preschoolers via induced sputum.

Conclusions:

  • Preschoolers with acute wheezing in the ED represent a unique population distinct from typical viral wheezing cases.
  • This population exhibits a significantly higher prevalence of positive S-API and adenosine BCT.
  • Frequent presence of eosinophilic airway inflammation (50%) highlights a distinct inflammatory profile.
Abstract

Keywords:
BHR: induced sputumadenosineasthmaasthma predictive indexbronchial challenge testcontrolled clinical trialmethacholinepreschool childrenwheezing

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