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Point-of-Care Blood Eosinophils to Predict Preschool Wheeze Attacks
Kushalinii Hillson1,2, Sara Fontanella1, Hernani Almeida1
1National Heart & Lung Institute, Imperial College London, London, UK.
Insights
Point-of-care blood eosinophil counts (BEC) are feasible in preschool wheeze patients. Elevated BEC combined with a low symptom score may predict future wheeze attacks, aiding clinical management.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Diagnostics
Background:
- Previous analyses indicated blood eosinophil counts (BEC) predict preschool wheeze attacks.
- Prospective clinical utility of BEC for predicting wheeze attacks in young children remained uninvestigated.
Purpose of the Study:
- To assess the feasibility of point-of-care (POC) eosinophil measurements in preschool wheezers.
- To correlate BEC with clinical symptoms and lung function.
- To evaluate the predictive utility of BEC for subsequent wheeze attacks.
Main Methods:
- Preschool children (1-5 years) with recurrent wheeze underwent finger-prick blood sampling for POC eosinophils.
- Lung function was assessed using forced oscillation technique (FOT) and spirometry.
- Symptom severity was recorded using the TRACK questionnaire.
- A decision tree model analyzed the prediction of wheeze attacks within 3 months.
Main Results:
- POC eosinophil measurements were feasible in a clinical setting.
- Higher BEC were observed in atopic children and in those experiencing wheeze attacks.
- BEC moderately correlated with FOT bronchodilator reversibility.
- A decision tree model identified BEC ≥ 4% and TRACK score < 75 as predictors of future wheeze attacks.
Conclusions:
- Point-of-care blood eosinophil testing is a viable option in outpatient pediatric clinics.
- Elevated BEC, particularly when accompanied by low reported symptom scores, shows potential for predicting future wheeze attacks in preschool children.
- These findings suggest a role for POC BEC in refining the management of preschool wheeze.
Background:
Post hoc analysis of clinical trials shows blood eosinophil counts (BEC) predict future preschool wheeze attacks; however, prospective usefulness in a clinical setting is unreported. We assessed the feasibility of point-of-care (POC) eosinophil measurements in preschool wheezers and related BEC to symptoms, lung function, and utility in predicting attacks.
Methods:
Children aged 1-5 years with recurrent wheeze underwent finger-prick sampling during the outpatient clinic for POC eosinophils, forced oscillation technique (FOT) and/or spirometry, and symptom score (TRACK questionnaire). The utility of BEC and/or the other tests in predicting wheeze attacks in the subsequent 3 months was analysed by comparing those with and without an attack and using a predictive decision tree (DT) model.
Results:
Seventy-three children (median age 4.27 years) were recruited; BEC were higher in atopic children (median 0.5 × 109/L vs. 0.3 × 109/L non-atopic, p < 0.01). BEC moderately correlated with FOT reactance bronchodilator reversibility z-score changes (r = 0.495, p = 0.005), but no other lung function measures or TRACK score. 68/73 (93%) children were followed up at 3 months. 29/68 (43%) children had > 1 wheeze attack requiring unscheduled healthcare attendance. Absolute and %eosinophils at the baseline visit were higher in those who had an attack (median 0.5 × 109/L vs. 0.3 × 109/L, p = 0.03 and median 6% vs. 4%, p < 0.01). The DT model showed children with BEC ≥ 4% and TRACK score < 75 were more likely to have a future attack (probability 0.63).
Conclusion:
POC blood eosinophils were feasible in a clinical setting. Our preliminary data suggest elevated BEC with a low symptom score predicts a wheeze attack within 3 months.
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