Symptom-pattern phenotype and pulmonary function in preschool wheezers - 07/08/11
, Cristina M. Bastardo, MD a, Angela Wade, PhD c, Sejal Saglani, MRCPCH, MD d, Sheila A. McKenzie, FRCPCH, MD e, Andrew Bush, FRCP, FRCPCH, MD d, Paul Aurora, MRCPCH, PhD a, b
Reprint requests: Samatha Sonnappa, MD, FRCPCH, PhD, Portex Unit: Respiratory Medicine and Physiology, UCL Institute of Child Health and Great Ormond Street Hospital for Children, 30 Guilford St, London WC1N 1EH, United Kingdom.Abstract |
Background |
Pulmonary function in preschool wheezing phenotypes based on wheeze onset and duration and atopic status has been extensively described but has not been studied in symptom-pattern phenotypes of episodic (viral) and multiple-trigger wheeze.
Objective |
We investigated whether multiple-trigger wheezers were more likely to have abnormal pulmonary function and increased fraction of exhaled nitric oxide (FeNO) than episodic (viral) wheezers and whether multiple-breath wash-out was more sensitive at detecting abnormal pulmonary function than specific airways resistance (sRaw) in preschool wheezers.
Methods |
FeNO, multiple-breath wash-out indices (lung clearance index [LCI] and conductive airways ventilation inhomogeneity [Scond]) and sRaw were measured in healthy children and those with recurrent wheeze aged 4 to 6 years. Subgroup analysis was performed according to current symptom-pattern (multiple-trigger vs episodic [viral]), atopic status (atopic vs nonatopic), and wheeze status (currently symptomatic vs asymptomatic).
Results |
Seventy-two control subjects and 62 wheezers were tested. Multiple-trigger wheezers were associated with an average increase of 11% (95% CI, 7% to 18%; P < .001) in LCI, 211% (95% CI, 70% to 470%; P < .001) in Scond, and 15% (95% CI, 3% to 28%; P = .01) in sRaw compared with episodic (viral) wheezers. Pulmonary function in episodic (viral) wheezers did not differ significantly from control subjects. The presence of current atopy or wheeze was associated with higher FeNO (P = .05) but did not influence pulmonary function significantly. On average, LCI was abnormal in 39% (95% CI, 32% to 45%), Scond was abnormal in 68% (95% CI, 61% to 74%), and sRaw was abnormal in 26% (95% CI, 16% to 35%) of multiple-trigger wheezers.
Conclusions |
Multiple-trigger wheeze is associated with pulmonary function abnormalities independent of atopic and current wheeze status. Scond is the most sensitive indicator of abnormal pulmonary function in preschool wheezers.
Le texte complet de cet article est disponible en PDF.Key words : Children, episodic (viral) wheeze, multiple-trigger wheeze, phenotype, preschool wheeze, pulmonary function, symptom-pattern
Abbreviations used : BDR, FeNO, FRC, ICS, LCI, MBW, PFT, Sacin, Scond, SPT, sRaw
Plan
| Supported by Asthma UK, the European Respiratory Society, and Smiths Medical. |
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| Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest. |
Vol 126 - N° 3
P. 519 - septembre 2010 Retour au numéro
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