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Exploring the types of airway inflammation in hospitalized children with asthma
Peng Han1,2, Ju Yin2, Huimin Zou2
1Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, China.
Insights
Classifying childhood asthma by airway inflammation using blood eosinophils (EOS) and specific IgE (sIgE) helps personalize treatment. This study found consistent inflammation patterns across different classification standards, aiding accurate asthma management in children.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Allergy
Background:
- Asthma is a complex respiratory condition requiring personalized treatment approaches.
- Understanding distinct airway inflammation patterns in children is crucial for effective asthma management.
- Hospitalized pediatric asthma exacerbations necessitate research into underlying inflammatory mechanisms.
Purpose of the Study:
- To investigate and classify different types of airway inflammation in hospitalized children with asthma.
- To evaluate the distribution and characteristics of these inflammation types using varying classification standards.
- To determine the clinical utility of classifying airway inflammation based on peripheral blood eosinophil and specific IgE levels.
Main Methods:
- A retrospective study involving 351 hospitalized children and adolescents with asthma exacerbations.
- Classification into four airway inflammation types (Only-atopy, Only-EOS, T2-high, T2-low) using blood eosinophil (EOS) cut-offs (150, 300, 470/µL) and specific IgE (sIgE).
- Comparison of the proportion and clinical characteristics across different inflammation types and classification standards.
Main Results:
- The distribution of Only-atopy and Only-EOS groups remained consistent across different age periods and classification standards.
- Type 2 (T2)-low airway inflammation was associated with longer onset-to-admission time, prolonged hospitalization, and a higher proportion of siblings.
- The study identified distinct clinical features associated with T2-low inflammation, suggesting different pathophysiological pathways.
Conclusions:
- Classification of airway inflammation in children using peripheral blood EOS and sIgE levels is a valuable and consistent tool.
- The identified inflammation types exhibit consistent temporal patterns, supporting their clinical relevance.
- This classification approach aids in the accurate and personalized treatment of childhood asthma.
Background:
Asthma is a heterogeneous disease. Precise and personalized treatment is urgently needed to reduce the disease's burden. Thus, exploring the different types of airway inflammation in hospitalized children with asthma is beneficial for accurately managing childhood asthma.
Methods:
This retrospective study was conducted on children and adolescents with asthma who were hospitalized for asthma exacerbations. The classification cut-off values of blood eosinophil (EOS) were 150 (Standard 1), 300 (Standard 2), and 470/µL (Standard 3), respectively. Combined with specific IgE (sIgE, 0.7 kU/L), these individuals were divided into four airway inflammation types. We compared the proportion and characteristics of different airway inflammation. The P value < 0.05 indicated statistical significance.
Results:
A total of 351 children were enrolled in our study. Based on standard 1, 39.3% of the subjects were classified as Only-atopy group, 11.7% displayed Only-EOS group, 29.6% exhibited Type 2 (T2)-high group, and 19.4% exhibited T2-low group. Under standard 2, 51.3% of the subjects were classified as the Only-atopy group, 5.4% displayed the Only-EOS group, 17.7% exhibited the T2-high group, and 25.6% exhibited the T2-low group. In standard 3, 57.8% of the subjects were classified as the Only-atopy group, 2.9% displayed the Only-EOS group, 11.1% exhibited the T2-high group, and 28.2% exhibited the T2-low group. Furthermore, our findings indicate that patients with T2 low airway inflammation have a longer time from onset to admission, a longer hospitalization time, a lower proportion of atopic dermatitis, and a higher proportion of siblings.
Conclusion:
Regardless of the classification standard employed, the distribution of Only-atopy and Only-EOS was similar in different age periods. Moreover, the types of airway inflammation exhibited a consistent temporal pattern. The classification of airway inflammation in children based on peripheral blood and sIgE levels is a valuable tool for accurately treating asthma.
Trial Registration:
The study was registered at https://clinicaltrials.gov/ with the number: NCT05800379 on 05/04/2023.
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