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A new index to identify risk of multi-trigger wheezing in infants with first episode of wheezing
Yuhe Zhang1, Chunju Zhou, Jinrong Liu
1Department of Pediatrics, Beijing Renhe Hospital , Beijing , China .
Insights
A new index combining wheezing severity, family history of atopy, and airway epithelial cell counts can predict multi-trigger wheezing in infants. This aids early asthma diagnosis and treatment in young children with recurrent wheezing.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Allergy and Immunology
Background:
- Early identification of multi-trigger wheezing in infants is crucial for timely asthma diagnosis and management.
- Predicting multi-trigger wheezing aids in differentiating it from transient wheezing episodes.
Purpose of the Study:
- To develop and validate a predictive index for multi-trigger wheezing in infants experiencing their first wheezing episode.
- To assess the combined predictive value of clinical factors and sputum biomarkers.
Main Methods:
- A cohort of 128 infants (2-20 months) with first wheezing episode was followed for two years.
- Data collected included personal/family history of atopy, wheezing severity (Preschool Respiratory Assessment Measure), and sputum exfoliated airway epithelial cell (EAEC) counts.
- Wheezing was classified as multi-trigger or non-multi-trigger wheezing.
Main Results:
- An index combining wheezing severity score, sputum EAEC count, and atopic history demonstrated high predictive performance.
- The combined index achieved 95.1% sensitivity and 74.2% specificity for predicting multi-trigger wheezing.
- Individual factors showed lower predictive value compared to the combined index.
Conclusions:
- Wheezing severity, atopic history, and EAEC count are significant predictors of future multi-trigger wheezing in infants.
- This predictive index can assist clinicians in identifying infants at higher risk for persistent asthma.
- Early identification facilitates prompt intervention and improved long-term respiratory health outcomes.
Objective:
Identification of young children who are likely to have multi-trigger wheezing is very important for early diagnosis and treatment of asthma. We investigate an index for predicting multi-trigger wheezing in infants with first episode of wheezing.
Methods:
One-hundred twenty-eight infants (2-20 months) with first episode of wheezing were followed for two years. Personal and family history of atopic diseases was recorded. Wheezing severity was evaluated using the Preschool Respiratory Assessment Measure. Sputum samples were collected from patients, stained with hematoxylin and eosin and studied by optical microscopy. The largest Creola body in sputum was located and the number of shed exfoliated airway epithelial cells (EAECs) counted. Recurrent wheezing was observed and classified as multi-trigger wheezing or non-multi-trigger wheezing. The predictive value of EAECs, family or personal history of atopic disease and the severity of wheezing for subsequent development of multi-trigger wheezing was analyzed.
Results:
Better predictive performance was achieved by considering the three measures together than by considering each separately. Receiver operator characteristic analysis showed that an index combining wheezing severity score of 9495 sputum EAECs and a family or personal history of atopic disease had a sensitivity of 95.1%, specificity of 74.2%, a positive predictive value of 58.6% and a negative predictive value of 93.6% for prediction of multi-trigger wheezing.
Conclusion:
For infants with first episode of wheezing, wheezing severity score, family or personal history of atopic disease and number of EAECs in sputum can predict future multi-trigger wheezing.
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