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Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Blood eosinophils in managing preschool wheeze: Lessons learnt from a proof-of-concept trial
Sejal Saglani1,2, Yvonne Bingham1,2, Ian Balfour-Lynn2
1National Heart & Lung Institute, Imperial College London, London, UK.
Insights
Personalizing preschool wheeze treatment with blood eosinophils or antibiotics did not reduce healthcare visits. Inhaled corticosteroid (ICS) use guided by eosinophils showed no benefit, and adherence was poor.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Trial Research
Background:
- Preschool wheeze management traditionally relies on symptom patterns.
- Current treatment strategies lack personalization based on objective biomarkers.
- Identifying effective personalized therapies is crucial for improving outcomes.
Purpose of the Study:
- To evaluate if personalized therapy for preschool wheeze, guided by blood eosinophils or airway bacterial infection, reduces unscheduled healthcare visits (UHCVs).
- To compare the efficacy of inhaled corticosteroids (ICS) or targeted antibiotics against standard care.
- To investigate the relationship between clinical phenotypes and biomarkers.
Main Methods:
- A randomized trial involving children aged 1-5 years with recurrent wheeze.
- Intervention group received ICS for high blood eosinophils (≥3%) or antibiotics for bacterial infection.
- Control group received standard care; primary outcome was UHCV at 4 months.
Main Results:
- No significant difference in UHCVs between the intervention and control groups (16/30 vs 15/30).
- Blood eosinophil levels, atopy, and infection status were not associated with wheeze phenotypes (EVW/MTW).
- Median ICS adherence was 67% in patients using adherence monitors.
Conclusions:
- Personalizing preschool wheeze treatment based on blood eosinophils or bacterial infection did not reduce UHCVs.
- Clinical phenotype did not correlate with allergen sensitization or blood eosinophil counts.
- Poor adherence to ICS may have limited the effectiveness of personalized therapy.
Background:
Management of preschool wheeze is based predominantly on symptom patterns.
Objective:
To determine whether personalizing therapy using blood eosinophils or airway bacterial infection results in fewer attacks compared with standard care.
Methods:
A proof-of-concept, randomized trial to investigate whether the prescription of inhaled corticosteroids (ICS) guided by blood eosinophils, or targeted antibiotics for airway bacterial infection, results in fewer unscheduled healthcare visits (UHCVs) compared with standard care. Children aged 1-5 years with ≥2 wheeze attacks in the previous year were categorized as episodic viral wheeze (EVW) or multiple trigger wheeze (MTW). The intervention group was prescribed ICS if blood eosinophils ≥3%, or targeted antibiotics if there is positive culture on induced sputum/cough swab. The control group received standard care. The primary outcome was UHCV at 4 months.
Results:
60 children, with a median age of 36.5 (range 14-61) months, were randomized. Median blood eosinophils were 5.2 (range 0-21)%, 27 of 60 (45%) children were atopic, and 8 of 60 (13%) had airway bacterial infection. There was no relationship between EVW, MTW and either blood eosinophils, atopic status or infection. 67% in each group were prescribed ICS. 15 of 30 control subjects and 16 of 30 patients in the intervention group had UHCV over 4 months (p = .8). The time to first UHCV was similar. 50% returned adherence monitors; in those, median ICS adherence was 67%. There were no differences in any parameter between those who did and did not have an UHCV.
Conclusion:
Clinical phenotype was unrelated to allergen sensitization or blood eosinophils. ICS treatment determined by blood eosinophils did not impact UHCV, but ICS adherence was poor.
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