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Infant lung function and early skin barrier impairment in the development of asthma at age 3 years
Martin Färdig1,2, Angela Hoyer1,2, Catarina Almqvist2,3
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Infants with lower lung function or impaired skin barrier function face a higher risk of developing asthma by age three. Eczema and filaggrin (FLG) mutations were linked to asthma only in children with existing atopic dermatitis or allergic sensitization.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Dermatology
Background:
- Asthma development in early childhood is multifactorial.
- Factors like lung function, skin barrier integrity, eczema, and genetic predispositions (filaggrin mutations) are implicated but not fully understood.
- Investigating these early-life markers may reveal critical insights into asthma pathogenesis.
Purpose of the Study:
- To examine the association between early-life indicators (lung function, skin barrier function, eczema, FLG mutations) and the development of asthma by age three.
- To explore potential sex-specific differences in these associations.
Main Methods:
- Utilized data from the PreventADALL randomized controlled intervention study.
- Evaluated 1337 children for asthma at age 3 years, assessing lung function (time to peak tidal expiratory flow/expiratory time), transepidermal water loss (TEWL), eczema, and FLG mutations at 3 months.
- Logistic regression models were employed to analyze associations, reporting adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Main Results:
- Lower lung function (tPTEF/tE <0.25) and impaired skin barrier (TEWL >9.50 g/m²/h) were significantly associated with increased asthma risk (aOR 5.4 and 1.6, respectively).
- Eczema and FLG mutations were associated with asthma only in children with atopic dermatitis or allergic sensitization.
- Sex-stratified analysis revealed increased asthma risk in boys with lower lung function (aOR 7.7) and in girls with FLG mutations (aOR 3.5).
Conclusions:
- Lower lung function and impaired skin barrier function in infancy are potential risk factors for developing asthma by age three.
- These findings highlight the importance of early-life respiratory and skin health assessments in predicting childhood asthma.
- Sex-specific associations suggest different developmental pathways for asthma in boys and girls.
Background:
Largely unexplored, we investigated if lower lung function, impaired skin barrier function by transepidermal water loss (TEWL), eczema, and filaggrin (FLG) mutations in infancy were associated with asthma in early childhood.
Methods:
From the factorially designed randomized controlled intervention study PreventADALL, we evaluated 1337/2394 children from all randomization groups with information on asthma at age 3 years, and at age 3 months either lung function, TEWL, eczema, and/or FLG mutations. Lower lung function was defined as the time to peak tidal expiratory flow to expiratory time (tPTEF /tE ) <0.25, and skin barrier impairment as a high TEWL >9.50 g/m2 /h. Eczema was clinically observed, and DNA genotyped for FLG mutations. Asthma was defined as asthma-like symptoms (≥3 episodes of bronchial obstruction) between age 2-3 years as well as a history of doctor-diagnosed asthma and/or asthma medication use. Associations were analyzed in logistic regression models, presented with adjusted ORs (aOR) and 95% confidence intervals (CI).
Results:
Lower lung function and skin barrier impairment were associated with asthma in general; aOR (95% CI) 5.4 (2.1, 13.7) and 1.6 (1.1, 2.5), while eczema and FLG mutations were associated with asthma in children with atopic dermatitis or allergic sensitization only. Stratifying for sex, the risk of asthma was only increased in boys with lower lung function; aOR (95% CI) 7.7 (2.5, 23.6), and in girls with FLG mutations; aOR (95% CI) 3.5 (1.5, 8.2).
Conclusion:
Lower lung function and impaired skin barrier function in infancy may increase the risk of asthma at age 3 years.
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