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Association between exhaled inflammatory markers and asthma control in children
D Van Vliet1, A Smolinska, Q Jöbsis
1Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Co-first authors.
Insights
This study found no link between general exhaled inflammatory markers and asthma control in children. However, specific volatile organic compounds (VOCs) effectively distinguished between well-controlled and poorly controlled asthma.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Biomarkers
Background:
- Asthma control in children remains a challenge, with limited understanding of exhaled inflammatory markers.
- Current methods for assessing asthma control may not fully capture disease status.
- Investigating novel exhaled biomarkers is crucial for improving pediatric asthma management.
Purpose of the Study:
- To determine the association between exhaled inflammatory markers (FeNO, VOCs, cytokines/chemokines) and asthma control in children.
- To evaluate the ability of these markers to differentiate between persistently controlled and uncontrolled asthma.
- To explore the utility of exhaled breath analysis in pediatric asthma phenotyping.
Main Methods:
- A one-year observational study involving 96 asthmatic children.
- Regular assessment of asthma control, fractional nitric oxide (FeNO), lung function (FEV1, FVC), exhaled VOCs, and EBC cytokines/chemokines.
- Random Forest analysis and ROC-curve analysis for classification model evaluation.
Main Results:
- No significant association was found between FeNO, EBC markers, or general VOCs and overall asthma control.
- A panel of 15 exhaled VOCs demonstrated high accuracy (AUC 86%) in discriminating between persistently controlled and uncontrolled asthma.
- Inclusion of FeNO and EBC markers did not significantly improve the classification accuracy of VOCs (AUC 87%).
Conclusions:
- Exhaled inflammatory markers like FeNO and EBC cytokines/chemokines are not reliable indicators of asthma control in children.
- Specific exhaled VOC profiles show promise as objective biomarkers for distinguishing asthma control states in pediatric populations.
- VOC analysis may offer a non-invasive tool for identifying children with persistent uncontrolled asthma, aiding in personalized treatment strategies.
Abstract:
The relationship between exhaled inflammatory markers and asthma control in children is unclear. To explore the association between inflammatory markers in exhaled breath (fractional nitric oxide (FeNO), volatile organic compounds (VOCs), cytokines/chemokines) and asthma control. To assess whether exhaled inflammatory markers are able to discriminate between children with persistently controlled/uncontrolled asthma. 96 asthmatic children were followed-up in a one-year observational study. Every 2 months, the following parameters were assessed: asthma control, FeNO, lung function (forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), exhaled VOCs, and cytokines/chemokines in exhaled breath condensate (EBC). Random Forest was used to analyse the relationship between exhaled inflammatory markers and asthma control. For each model, patients were randomly selected for a training set and validation set. To assess the accuracy of the classification models, receiver operating characteristic-curves (ROC-curves) were generated. No significant association was found between the exhaled inflammatory markers (FeNO, markers in EBC, VOCs) and asthma control (area under the ROC-curve 49%). However, 15 exhaled VOCs could discriminate between subgroups of children with persistently controlled and uncontrolled asthma during all clinical visits (area under the ROC-curve 86%). Adding FeNO and markers in EBC to this model, did not lead to a more accurate classification (area under the ROC-curve 87%). There was no association between exhaled inflammatory markers and asthma control in children. However, children with persistently controlled or uncontrolled asthma during the 12 month study period could be discriminated by a set of VOCs.
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