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Prediction of asthma exacerbations in children: Results of a one-year prospective study

机译：儿童哮喘急性发作的预测：一项为期一年的前瞻性研究结果

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Background: Underdiagnosis and low levels of asthma control are frequent occurring problems in patients with asthma. Objective: The study aim was to evaluate the ability of non-invasive inflammatory markers in exhaled breath to predict exacerbations of childhood asthma, and to assess the time course of changes in these exhaled markers before, during and after exacerbations. Methods: The design was a prospective one-year longitudinal study. Regular two-month visits at the outpatient clinic were performed. Forty children with asthma (aged 6-16 years) participated. The primary outcome measure was the occurrence of an exacerbation. Assessment was made of the presence and severity of pulmonary symptoms, use of medication, and measurements of forced expiratory volume in 1 s using home monitor. The following independent parameters were assessed during outpatient visits: (1) exhaled nitric oxide, (2) inflammatory markers in exhaled breath condensate: acidity, nitrite, hydrogen peroxide, interleukin-1α, -5, -13, interferon-γ, (3) lung function, (4) asthma control score. Results: Thirty-eight of 40 children completed the study. Sixteen children developed exacerbations, of which ten were moderate and six severe. Univariate Cox regression analysis revealed that condensate acidity, interleukin-5 and asthma control score were significant predictors of an asthma exacerbation (P < 0.05). In the multivariate Cox regression analysis, exacerbations were best predicted by the asthma control score and by the level of interleukin-5 in exhaled breath condensate (Wald scores of 7.19 and 4.44, P = 0.007 and P = 0.035 respectively). The predicted survival curve of this multivariate model showed a two times reduced risk on exacerbations in the category of children with the 10% most optimal values of IL-5 and asthma control score. Conclusions and Clinical Relevance: Both exhaled breath condensate interleukin-5 level and asthma control score were significant predictors of asthma exacerbations. These findings open up the possibility of assessing the potential of such parameters to titrate asthma treatment in future studies.
机译：背景：哮喘患者经常发生诊断不足和哮喘控制水平低下的问题。目的：研究目的是评估呼出气中非侵入性炎症标志物预测儿童哮喘恶化的能力，并评估这些呼气标志物在恶化之前，之中和之后的时间变化。方法：该设计为前瞻性的一年纵向研究。在门诊定期进行了两个月的访问。 40名哮喘儿童（6-16岁）参加了比赛。主要结局指标是病情加重。使用家庭监护仪评估1秒钟内肺部症状的存在和严重程度，药物的使用以及强制呼气量的测量。门诊就诊时评估了以下独立参数：（1）呼出一氧化氮，（2）呼出气冷凝物中的炎性标志物：酸度，亚硝酸盐，过氧化氢，白介素-1α，-5，-13，干扰素-γ（3 ）肺功能，（4）哮喘控制评分。结果：40名儿童中有38名完成了研究。 16名儿童病情加重，其中10位为中度，6位为重度。单因素Cox回归分析显示，凝结酸度，白细胞介素5和哮喘控制评分是哮喘急性发作的重要预测指标（P <0.05）。在多变量Cox回归分析中，哮喘控制评分和呼出气冷凝物中白细胞介素5的水平可以最好地预测病情加重（Wald评分分别为7.19和4.44，P = 0.007和P = 0.035）。该多变量模型的预测生存曲线显示，在IL-5最佳值和哮喘控制评分为10％的最佳儿童中，加重的风险降低了两倍。结论和临床意义：呼出气冷凝物白细胞介素5水平和哮喘控制评分均是哮喘急性发作的重要预测指标。这些发现为在将来的研究中评估此类参数以提高哮喘治疗的可能性提供了可能性。

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