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Predicting asthma morbidity in children using proposed markers of Th2-type inflammation
Jon R Konradsen1,2,3, Elizabeth Skantz1,2, Björn Nordlund1,2,3
1Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Insights
Assessing Th2 inflammation with exhaled nitric oxide (FeNO) and blood eosinophils (B-Eos) effectively identifies children with high pediatric asthma morbidity. Adjusting FeNO for height enhances its clinical utility.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Biomarker Research
Background:
- Persistent asthma in children often involves Th2-mediated inflammation.
- Key biomarkers include blood eosinophils (B-Eos), exhaled nitric oxide (FeNO), total serum IgE (S-IgE), and serum periostin.
- Evaluating these biomarkers aids in understanding asthma morbidity.
Purpose of the Study:
- To investigate the association between pediatric asthma morbidity and elevated levels of Th2 inflammation biomarkers.
- To determine the predictive value of these biomarkers in identifying children with significant asthma symptoms.
Main Methods:
- A nationwide Swedish study included 96 school-age children with persistent asthma.
- Methods included asthma control tests, quality of life questionnaires, pulmonary function tests, bronchial hyperresponsiveness assessment, height-adjusted FeNO, blood sampling (S-IgE, B-Eos, periostin), and HRCT of the lungs.
Main Results:
- Children with high FeNO and B-Eos were younger, had more severe and allergic asthma, reduced control and quality of life, more exacerbations, lower FEV1/FVC, and increased bronchial hyperresponsiveness and airway thickening.
- Serum periostin levels did not correlate with clinical characteristics or other biomarkers.
Conclusions:
- Combined assessment of FeNO and B-Eos is highly predictive for identifying children with the highest asthma morbidity.
- Adjusting FeNO measurements for height improves its clinical applicability in pediatric asthma management.
Background:
Assessment of inflammation is becoming a common practice in the clinical work-up of children with persistent asthma. Biomarkers of Th2-mediated inflammation include blood eosinophils (B-Eos), exhaled nitric oxide (FeNO), total serum IgE (S-IgE), and serum periostin. The aim of this study was to investigate the associations between asthma morbidity and increased levels of these biomarkers in pediatric asthma.
Methods:
School-age children (n = 96) with various manifestations of persistent asthma were included in this nationwide Swedish study. The protocol included the asthma control test, Juniper's quality of life questionnaire (QoL), assessment of pulmonary function, bronchial hyperresponsiveness, height-adjusted FeNO, blood sampling for S-IgE, B-Eos, and periostin, and high-resolution computed tomography (HRCT) of the lungs.
Results:
Children with both high levels of height-adjusted FeNO and B-Eos were younger (p = 0.001), had more often severe asthma (p = 0.015), were more allergic (p < 0.001), had a reduced asthma control (p = 0.035), reduced QoL (p = 0.035), more exacerbations (p = 0.004), reduced FEV1/FVC (p = 0.001), and increased bronchial hyperresponsiveness (p < 0.001) as well as greater bronchial wall thickening on HRCT (p = 0.022) compared to those with low levels of both biomarkers. Grouping children according to high and low serum periostin levels did not relate to differences in clinical characteristics and biomarkers.
Conclusions:
Assessment of both local and systemic Th2-mediated inflammation by the analysis of easily attainable biomarkers such as exhaled NO and blood eosinophils has a high predictive value for the identification of children with the highest asthma morbidity. Adjusting FeNO values according to the individual child's height increases the clinical usefulness of this biomarker.
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