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

• Published in: Clinical and experimental allergy 2012-05, Vol.42 (5), p.792-798
• Main Authors: Robroeks, C. M. H. H. T., van Vliet, D., Jöbsis, Q., Braekers, R., Rijkers, G. T., Wodzig, W. K. W. H., Bast, A., Zimmermann, L. J. I., Dompeling, E.
• Format: Article
• Language: English
• Subjects: Acidity; Asthma; Asthma - diagnosis; Asthma - mortality; asthma control score; Biological and medical sciences; Child; Children; Chronic obstructive pulmonary disease, asthma; Condensates; Cytokines - metabolism; Disease Progression; Exhalation; exhaled breath condensate; Female; Forced Expiratory Volume; Fundamental and applied biological sciences. Psychology; Fundamental immunology; gamma -Interferon; Humans; Hydrogen peroxide; Inflammation; Interleukin 5; Lung; Male; Medical sciences; monitoring; Nitric oxide; Nitric Oxide - analysis; Nitrite; paediatric asthma; Pneumology; Prognosis; Prospective Studies; Regression analysis; Survival
• ISSN: 0954-7894; 1365-2222
• DOI: 10.1111/j.1365-2222.2012.03992.x

Summary 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