TY - JOUR
T1 - Assessment of airflow limitation, airway inflammation, and symptoms during virus-induced wheezing episodes in 4- to 6-year-old children
AU - Konstantinou, George N.
AU - Xepapadaki, Paraskevi
AU - Manousakis, Emmanuel
AU - Makrinioti, Heidi
AU - Kouloufakou-Gratsia, Kalliopi
AU - Saxoni-Papageorgiou, Photini
AU - Papadopoulos, Nikolaos G.
PY - 2013/1
Y1 - 2013/1
N2 - Background: It is disputed whether recurrent episodes of wheeze in preschool-aged children comprise a distinct asthma phenotype. Objective: We sought to prospectively assess airflow limitation and airway inflammation in children 4 to 6 years old with episodic virus-induced wheeze. Methods: Ninety-three children 4 to 6 years old with a history of mild, virus-induced episodes of wheeze who were able to perform acceptable fraction of exhaled nitric oxide (Feno) maneuvers and spirometry (with forced expiratory time ≥0.5 seconds) were followed prospectively. Lung function and Feno values were measured every 6 weeks (baseline) within the first 48 hours of an acute wheezing episode (day 0) and 10 and 30 days later. Symptom scores and peak flow measurement were recorded daily. Results: Forty-three children experienced a wheezing episode. At day 0, Feno values were significantly increased, whereas forced expiratory volume at 0.5 seconds (FEV0.5) significantly decreased compared with baseline (16 ppb [interquartile range {IQR}, 13-20 ppb] vs 9 ppb IQR, 7-11 ppb] and 0.84 L [IQR, 0.75-0.99 L] vs 0.99 L [IQR, 0.9-1.07 L], respectively; both P <.001). Airflow limitation at day 0 was reversible after bronchodilation. FEV0.5 and Feno values were significantly associated with each other and with lower and upper respiratory tract symptoms when assessed longitudinally but not cross-sectionally at all time points independently of atopy. Feno and FEV0.5 values returned to baseline levels within 10 days. Conclusions: Mild episodes of wheeze in preschoolers are characterized by enhanced airway inflammation, reversible airflow limitation, and asthma-related symptoms. Feno values increase significantly during the first 48 hours and return to personal baseline within 10 days from the initiation of the episode. Longitudinal follow-up suggests that symptoms, inflammation, and lung function correlate well in this phenotype of asthma. © 2012 American Academy of Allergy, Asthma & Immunology.
AB - Background: It is disputed whether recurrent episodes of wheeze in preschool-aged children comprise a distinct asthma phenotype. Objective: We sought to prospectively assess airflow limitation and airway inflammation in children 4 to 6 years old with episodic virus-induced wheeze. Methods: Ninety-three children 4 to 6 years old with a history of mild, virus-induced episodes of wheeze who were able to perform acceptable fraction of exhaled nitric oxide (Feno) maneuvers and spirometry (with forced expiratory time ≥0.5 seconds) were followed prospectively. Lung function and Feno values were measured every 6 weeks (baseline) within the first 48 hours of an acute wheezing episode (day 0) and 10 and 30 days later. Symptom scores and peak flow measurement were recorded daily. Results: Forty-three children experienced a wheezing episode. At day 0, Feno values were significantly increased, whereas forced expiratory volume at 0.5 seconds (FEV0.5) significantly decreased compared with baseline (16 ppb [interquartile range {IQR}, 13-20 ppb] vs 9 ppb IQR, 7-11 ppb] and 0.84 L [IQR, 0.75-0.99 L] vs 0.99 L [IQR, 0.9-1.07 L], respectively; both P <.001). Airflow limitation at day 0 was reversible after bronchodilation. FEV0.5 and Feno values were significantly associated with each other and with lower and upper respiratory tract symptoms when assessed longitudinally but not cross-sectionally at all time points independently of atopy. Feno and FEV0.5 values returned to baseline levels within 10 days. Conclusions: Mild episodes of wheeze in preschoolers are characterized by enhanced airway inflammation, reversible airflow limitation, and asthma-related symptoms. Feno values increase significantly during the first 48 hours and return to personal baseline within 10 days from the initiation of the episode. Longitudinal follow-up suggests that symptoms, inflammation, and lung function correlate well in this phenotype of asthma. © 2012 American Academy of Allergy, Asthma & Immunology.
KW - Airflow limitation
KW - airway inflammation
KW - exhaled nitric oxide
KW - forced expiratory volume at 0.5 seconds
KW - longitudinal study
KW - reversibility
KW - spirometry
U2 - 10.1016/j.jaci.2012.10.033
DO - 10.1016/j.jaci.2012.10.033
M3 - Article
SN - 0091-6749
VL - 131
SP - 87-e5
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 1
ER -