Diagnosis Of Asthma In Children Research Articles

Personalized prediction of early childhood asthma persistence: A machine learning approach.

Early childhood asthma diagnosis is common; however, many children diagnosed before age 5 experience symptom resolution and it remains difficult to identify individuals whose symptoms will persist. Our objective was to develop machine learning models to identify which individuals diagnosed with asthma before age 5 continue to experience asthma-related visits. We curated a retrospective dataset for 9,934 children derived from electronic health record (EHR) data. We trained five machine learning models to differentiate individuals without subsequent asthma-related visits (transient diagnosis) from those with asthma-related visits between ages 5 and 10 (persistent diagnosis) given clinical information up to age 5 years. Based on average NPV-Specificity area (ANSA), all models performed significantly better than random chance, with XGBoost obtaining the best performance (0.43 mean ANSA). Feature importance analysis indicated age of last asthma diagnosis under 5 years, total number of asthma related visits, self-identified black race, allergic rhinitis, and eczema as important features. Although our models appear to perform well, a lack of prior models utilizing a large number of features to predict individual persistence makes direct comparison infeasible. However, feature importance analysis indicates our models are consistent with prior research indicating diagnosis age and prior health service utilization as important predictors of persistent asthma. We therefore find that machine learning models can predict which individuals will experience persistent asthma with good performance and may be useful to guide clinician and parental decisions regarding asthma counselling in early childhood.

СУЧАСНА ДІАГНОСТИКА БРОНХІАЛЬНОЇ АСТМИ У ДІТЕЙ

O. O. Rechkina Abstract Underdiagnosis and late diagnosis of asthma in children remain the topical problem of current world and local pediatrics, especially in primary medical care. Considering recent literature data, the author has presented the latest recommendations on timely diagnosis of asthma in children. The causes of underdiagnosis of the disease, terminology difficulties, risk of asthma progression development have been reviewed. Based on 2021 European Respiratory Society recommendations the key criteria of asthma diagnosis in children of different age have been listed. Key words: asthma in children, risk criteria, diagnosis

Effects of the salbutamol bronchodilator response on measurements of fractional exhaled nitric oxide in children with asthma: a prospective, observational study.

Salbutamol bronchodilator response (BDR) test and fractional exhaled nitric oxide (FeNO) have been recommended for the diagnosis of asthma in children, but FeNO levels is affected by many factors. Nonetheless, data of the effect on the FeNO values throughout the bronchodilator test and the differences in FeNO values between BDR positive (BDR+) and negative (BDR-) children with asthma are still limited. We aimed to evaluate the effect of the BDR test on FeNO and the differences in FeNO levels between BDR+ and BDR- children with asthma. This was a prospective, observational study performed over a 5-month period (December 2018 to April 2019) and involved 57 children with asthma. The FeNO levels at pre-spirometry, post-spirometry, and post-salbutamol BDR testing were estimated. Finally, the children were divided into two groups i.e., BDR+ and BDR-, and differences in the FeNO levels were compared between the two groups. The spirometry results were normal in 2 patients (3.5%). There were 53 (93%) patients with obstructive lung disease, including 40 (70.2%), 11 (19.3%), and 2 (3.5%) patients with mild, moderate, and severe obstruction, respectively. The remaining two patients had mixed lesions (3.5%), none of which were restrictive. The baseline median FeNO levels were significantly higher in the BDR+ group than in the BDR- group [33.00 (23.78, 46.73) vs. 23.00 (9.80, 37.80), (P=0.048)]. Following spirometry, there was a statistically significant decrease in median FeNO levels from baseline to post-spirometry (P=0.002). However, there was no significant difference between the median FeNO levels at baseline and following the BDR test (P=0.976). The impact of spirometry on FeNO was not statistically different in BDR+ versus BDR- children (Z=-0.186, P=0.853); however, the impact of bronchodilators on FeNO exhibited a statistically significant difference between the two groups (Z=3.160, P=0.002). This study revealed dynamic changes in the FeNO levels during the BDR test. The use of a bronchodilator results in a statistically significant difference in FeNO levels between BDR+ and BDR- children with asthma. Moreover, spirometry leads to a marked decrease in the FeNO levels. Our results will allow clinicians to better interpret FeNO, BDR and pulmonary function outcomes and better develop clinical protocols.

History of phototherapy in neonatal jaundice and the likelihood of childhood asthma

Introduction: The increased risk for childhood asthma in children suffering from hyperbilirubinemia, and those who underwent phototherapy has attracted enormous interest. Objectives: In this study, we attempted to explain the relationship between childhood asthma and phototherapy. Patients and Methods: This case-control study was performed on children aged between 2 and 14 years old with a definitive diagnosis of childhood asthma. A sex and age-matched group of children without any pieces of evidence, of asthma or other respiratory problems were also selected as the control group. The hospital’s recorded files were the primary sources for the information about demographics, history of asthma in neonates or his/her parents, history and time of phototherapy as well as the data on neonatal hyperbilirubinemia. Results: In total, 69 children who have asthma and 71 non-asthmatic children as the controls were included in this study. Moreover, these two groups were matched for baseline variables. Comparing the history of phototherapy between the asthmatic and non-asthmatic groups showed a higher rate of phototherapy in the former group (37.7% versus 11.3%; P < 0.001). Accordingly, the risk of asthma could be increased according to the history of phototherapy, up to four times (OR = 4.76, 95%CI: 1.97–11.51, P < 0.001). Conclusion: The risk of childhood asthma can increase if a child had the previous phototherapy. This causal effect is independent of the degree or the age of occurring hyperbilirubinemia, which is the main indication for phototherapy.

Protocol for the derivation and validation of a clinical prediction model to support the diagnosis of asthma in children and young people in primary care

Background: Accurately diagnosing asthma can be challenging. Uncertainty about the best combination of clinical features and investigations for asthma diagnosis is reflected in conflicting recommendations from international guidelines. One solution could be a clinical prediction model to support health professionals estimate the probability of an asthma diagnosis. However, systematic review evidence identifies that existing models for asthma diagnosis are at high risk of bias and unsuitable for clinical use. Being mindful of previous limitations, this protocol describes plans to derive and validate a prediction model for use by healthcare professionals to aid diagnostic decision making during assessment of a child or young person with symptoms suggestive of asthma in primary care. Methods: A prediction model will be derived using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and linked primary care electronic health records (EHR). Data will be included from study participants up to 25 years of age where permissions exist to use their linked EHR. Participants will be identified as having asthma if they received at least three prescriptions for an inhaled corticosteroid within a one-year period and have an asthma code in their EHR. To deal with missing data we will consider conducting a complete case analysis. However, if the exclusion of cases with missing data substantially reduces the total sample size, multiple imputation will be used. A multivariable logistic regression model will be fitted with backward stepwise selection of candidate predictors. Apparent model performance will be assessed before internal validation using bootstrapping techniques. The model will be adjusted for optimism before external validation in a dataset created from the Optimum Patient Care Research Database. Discussion: This protocol describes a robust strategy for the derivation and validation of a prediction model to support the diagnosis of asthma in children and young people in primary care.

Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort.

Diagnosing asthma in children remains a challenge because respiratory symptoms are not specific and vary over time. In a real-life observational study, we assessed the diagnostic accuracy of respiratory symptoms, objective tests and two paediatric diagnostic algorithms (proposed by the Global Initiative for Asthma (GINA) and the National Institute for Health and Care Excellence (NICE)) in the diagnosis of asthma in school-aged children. We studied children aged 5-17 years who were referred consecutively to pulmonary outpatient clinics for evaluation of suspected asthma. Symptoms were assessed by parental questionnaire. The investigations included specific IgE measurement or skin prick tests, measurement of exhaled nitric oxide fraction (F eNO), spirometry, body plethysmography and bronchodilator reversibility (BDR). Asthma was diagnosed by paediatric pulmonologists based on all available data. We assessed diagnostic accuracy of symptoms, tests and diagnostic algorithms by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC). Among 514 participants, 357 (70%) were diagnosed with asthma. The combined sensitivity and specificity was highest for any wheeze (sensitivity=75%, specificity=65%), dyspnoea (sensitivity=56%, specificity=76%) and wheeze triggered by colds (sensitivity=58%, specificity=78%) or by exercise (sensitivity=55%, specificity=74%). Of the diagnostic tests, the AUC was highest for specific total airway resistance (sRtot; AUC=0.73) and lowest for the residual volume (RV)/total lung capacity (TLC) ratio (AUC=0.56). The NICE algorithm had sensitivity=69% and specificity=67%, whereas the GINA algorithm had sensitivity=42% and specificity=90%. This study confirms the limited usefulness of single tests and existing algorithms for the diagnosis of asthma. It highlights the need for new and more appropriate evidence-based guidance.

Factors associated with wheezing among Lebanese children: Results of a cross-sectional study

BackgroundIn Lebanon, asthma is underdiagnosed due to low access to healthcare, particularly in rural areas, although asthma diagnosis in children is based mainly on clinical symptoms. Thus, wheezing might be more suggestive of undiagnosed respiratory diseases including asthma in Lebanese children. This study aimed to determine the factors associated with wheezing in Lebanese children without asthma diagnosis. MethodsThis cross-sectional study was conducted between December 2015 and April 2016, enrolling a total of 1203 schoolchildren. ResultsOut of 1500 prepared questionnaires, 1380 questionnaires were distributed in schools, and 1203 (87.17%) were collected back from the parents of children aged between 4–17 years old. The sample included 42 (3.5%) [95% CI 0.025–0.045] children with reported chronic wheezing. A multivariable analysis was performed taking the presence versus absence of wheezing in children as the dependent variable. The results showed that spraying pesticides at home (aOR=1.91), presence of humidity at home (aOR=2.21) and child reflux (aOR=2.60) were significantly associated with the presence of wheezing in children. ConclusionThe findings of the study suggest that certain environmental factors, such as pesticides, humidity at home and reflux disease, might be associated with wheezing episodes in children. Those factors can be prevented through raising awareness by health care professionals.

Heavy metal concentration in classroom dust samples and its relationship with childhood asthma: a study from Islamic Republic of Iran.

Classrooms are an important environment for young children as this is where they spend a large part of their time. This study was designed to quantify the levels of heavy metals in classroom dusts in Shiraz, a city southwestern Iran. The potential association between heavy metal levels and childhood asthma was also investigated. We selected 32 schools for collecting classroom dust samples during September-November 2016. The concentration of 10 heavy metals was measured in these dust samples by optical emission spectrometry. The diagnosis of childhood asthma was made using both the medical chart of each student and examination by an allergist. The data were analysed using SPSS, version 21.0. The concentration of heavy metals in classroom dust samples ranged from 7559 to 53 723.0 mg/kg (mean: 16 945.5 mg/kg) for Fe, 169.0 to 952.0 mg/kg (mean 288.9 mg/kg) for Mn, and 9.0 to 971.0 mg/kg (mean 258.8 mg/kg) for Pb. We found no correlation between heavy metals in classroom dust and childhood asthma. In comparison with studies reported elsewhere, the maximum levels of lead in our study were greater. A potential explanation for the lack of correlation with childhood asthma is the large mass of the particles, preventing them from reaching the lower airways. Nevertheless, special attention should be paid to reducing high levels of heavy metals in classroom dust in this area.

Protocol for the derivation and validation of a clinical prediction model to support the diagnosis of asthma in children and young people in primary care.

Background: Accurately diagnosing asthma can be challenging. Uncertainty about the best combination of clinical features and investigations for asthma diagnosis is reflected in conflicting recommendations from international guidelines. One solution could be a clinical prediction model to support health professionals estimate the probability of an asthma diagnosis. However, systematic review evidence identifies that existing models for asthma diagnosis are at high risk of bias and unsuitable for clinical use. Being mindful of previous limitations, this protocol describes plans to derive and validate a prediction model for use by healthcare professionals to aid diagnostic decision making during assessment of a child or young person with symptoms suggestive of asthma in primary care. Methods: A prediction model will be derived using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and linked primary care electronic health records (EHR). Data will be included from study participants up to 25 years of age where permissions exist to use their linked EHR. Participants will be identified as having asthma if they received at least three prescriptions for an inhaled corticosteroid within a one-year period and have an asthma code in their EHR. To deal with missing data we will consider conducting a complete case analysis. However, if the exclusion of cases with missing data substantially reduces the total sample size, multiple imputation will be used. A multivariable logistic regression model will be fitted with backward stepwise selection of candidate predictors. Apparent model performance will be assessed before internal validation using bootstrapping techniques. The model will be adjusted for optimism before external validation in a dataset created from the Optimum Patient Care Research Database. Discussion: This protocol describes a robust strategy for the derivation and validation of a prediction model to support the diagnosis of asthma in children and young people in primary care.

Value of bronchial reversibility to salbutamol, exhaled nitric oxide and responsiveness to methacholine to corroborate the diagnosis of asthma in children

Introduction and ObjectivesFunctional and inflammatory measures have been recommended to corroborate asthma diagnosis in schoolchildren, but the evidence in this regard is conflicting. We aimed to determine, in real-life clinical situation, the value of spirometry, spirometric bronchial reversibility to salbutamol (BDR), bronchial responsiveness to methacholine (MCT) and fractional exhaled nitric oxide (FENO), to corroborate the diagnosis of asthma in children on regular inhaled corticosteroids (ICS) referred from primary care. MethodsOne hundred and seventy-seven schoolchildren with mild-moderate persistent asthma, on treatment with regular ICS, participated in the study. Abnormal tests were defined as FENO ≥ 27 ppb, BDR (FEV1 ≥ 12%) and methacholine PC20 ≤ 4 mg/mL. ResultsThe proportions of positive BDR, FENO and MCT, were 16.4%, 33.3%, and 87.0%, respectively. MCT was associated with FENO (p < 0.03) and BDR (p = 0.001); FENO was associated with BDR (p = 0.045), family history of asthma (p = 0.003) and use of asthma medication in the first two years of life (p = 0.004). BDR was significantly related with passive tobacco exposure (p = 0.003). ConclusionsSpirometry, BDR and BDR had a poor performance for corroborating diagnosis in our asthmatic children on ICS treatment; on the contrary, MCT was positive in most of them, which agrees with previous reports. Although asthma tests are useful to corroborate asthma when positive, clinical diagnosis remains the best current approach for asthma diagnosis, at least while better objective and feasible measurements at the daily practice are available. At present, these tests may have a better role for assessing the management and progression of the condition.

Usefulness of sRtot and Rint in bronchodilator testing in the diagnosis of asthma in children.

IntroductionThe usefulness of total specific resistance (sRtot) and interrupter resistance (Rint) as a bronchodilator reversibility test (BT) alternative to forced expiratory volume in 1 s (FEV1) in asthma diagnosis in children has not been established.AimTo compare different applied definitions of airflow obstruction in children measuring response to the bronchodilator by spirometry, plethysmography and the interrupter technique in asthmatic children.Material and methodsIt was a prospective, real-life, non-interventional study. Children, aged 6–18 with newly diagnosed asthma, able to perform lung function tests were included into the study. Subjects underwent a history taking, physical examination, reversibility test in spirometry, plethysmography, and the interrupter technique. A standard cut-off of 12% from the initial value for reversibility in FEV1 was employed. Improvement in the pre-bronchodilator sRtot and Rint ≥ 25% and ≥ 35% was assessed after administration of salbutamol (400 µg) as well as allergen sensitization were measured.ResultsWe included 135 children diagnosed with asthma into the analysis. All investigated parameters changed statistically significantly due to the bronchodilator administration in the examined patients. The FEV1 was not as useful in diagnostics of asthma as the sRtot and Rint, taking into consideration the fait accompli that all the study participants had aptly been diagnosed as having asthma (p < 0.001). The differences between the sRtot and Rint were not statistically significant (p = 0.215).ConclusionsOur results suggest that sRtot and Rint may be useful parameters in BT in clinical practice in the asthma diagnostic process in children.

New Risk Factors for Transient Tachypnea of the Newborn and Childhood Asthma: A Study of Clinical Data and a Survey of Parents.

Objectives: It is established that transient tachypnea of the newborn (TTN) is associated with an increased risk of early childhood asthma. However, the question remains whether both asthma and TTN have common risk factors as well as the same underlying etiology. This study aims to determine possible risk factors for TTN as well as early childhood asthma.Methods: This study was carried out in two phases. While the first phase included medical records of 1318 newborns, the second phase consisted of a phone survey.Results: Elective cesarean section (ECS), maternal asthma, gestational age (GA), babies with large and small birth weight, number of pregnancies, and number of children were found to be significantly associated with TTN. ECS, maternal asthma, length of the hospital stay due to TTN, and O2 treatment were statistically significant for asthma. TTN was found to be associated with a subsequent diagnosis of childhood asthma after adjusting for ECS and maternal asthma.Conclusions: Both ECS and maternal asthma are the common risk factors for the development of both TTN and childhood asthma as previously reported. In order to uncover this association, when ECS is taken out, it is seen that the association between TTN and asthma is stronger. Furthermore, O2 treatment and duration of hospital stay due to TTN were also found to be associated with childhood asthma. Association of maternal allergic rhinitis and eczema with TTN was investigated and there was no relationship between maternal allergic rhinitis or maternal eczema and the subsequent diagnosis of TTN.

Evaluation of Clinically and Physiologically Atypical Asthma: If It Doesn’t Wheeze It May Still Be Asthma

Investigators in this study (1) evaluated the relationship between the lack of clinical wheeze and lack of wheeze during positive bronchial challenge testing (BCT) in children suspected of having asthma and (2) evaluated the diagnostic value of provocation concentration respiratory rate (PCRR), oxygen saturation (PCO2-SAT), and wheezing (PCwheeze) and whether the value of these measures was influenced by age.Participants (n = 724) were recruited from children ages 3 months to 18 years without a diagnosis of asthma or conditions causing bronchial hyperresponsiveness or obstruction who were referred for possible asthma from 2009 to 2016.BCT was performed with methacholine (sensitive) to distinguish presence or absence of asthma or adenosine (specific) to distinguish asthma from other conditions. A positive BCT result was determined by the provocation concentration that resulted in a 20% decrease in forced expiratory volume in 1 second in children able to perform spirometry (group B) or a 50% increase in respiratory rate, a 5% decrease in oxygen saturation, or appearance of wheezing in those unable to perform spirometry (group A).BCT results were positive for 507 out of 724 children; 89 (17.6%) in group A (median age: 3 [interquartile range: 2.5–3.7] years) were unable to perform spirometry, and 418 (82.4%) in group B (median age: 10.7 [interquartile range: 6.8–15.6] years) were able to perform spirometry. Children without physician-documented wheeze in the whole population (groups A plus B) were more likely (65.5%) to have a positive BCT result without wheeze compared with those with physician-documented wheeze (41.0%, P < .001). In group A, adding PCRR and PCO2-SAT increased BCT sensitivity by 23.6%.Many children in both groups did not wheeze despite reaching BCT endpoints. Most children without physician-documented wheeze did not wheeze on BCT. In young children, adding PCRR and PCO2-SAT substantially increased BCT sensitivity.By documenting the possibility of absent wheezing during bronchial hyperresponsiveness diagnosed by positive BCT results, researchers in this study demonstrated that the presence of wheezing is not essential for a diagnosis of asthma. Inclusion of tachypnea and decreased oxygen saturation improved the sensitivity of asthma diagnosis in children too young to perform spirometry. Corresponding changes in specificity were not described, and the relative benefits of a sensitive or specific asthma definition in young children should be considered, depending on the circumstances. In children able to perform spirometry, a 20% decrease in forced expiratory volume in 1 second remained the more-sensitive measure. The combination of different BCT methods was a possible study limitation, despite similarities of the outcomes.

UTILITY OF TBA IN ASSESSING REVERSIBILITY TO BRONCHODILATOR IN CHILDREN

SESSION TITLE: Pediatrics SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: To evaluate the utility of TBA in assessing reversibility to bronchodilator in children METHODS: This is a cross-sectional study. A total of 72 subjects were classified as to doubtful and probable asthma based on the questionnaire adopted from 2017 GINA guidelines. The TPEF/TE and VPEF/TE were measured using Jaeger Masterscreen Baby Body Pediatric System and all subjects where exposed to bronchodilator salbutamol to deteremined reversibility and response. RESULTS: The doubtful and probable range of TPTEF/TE pre-bronchodilator were 25.91 + 8.61 and 25.07 + 7.54 while VPEF/TE values pre-bronchodilator revealed 28.88 + 6.75 and 28 + 6.34 respectively. Bronchodilator response in children with TPTEF/TE in doubtful asthma revealed 18 (50%) and 16 (44.44%) non-responders. VPEF/TE had 19 (54.29%) responders and 15 (40.54%) non-responders. There were 18 (50%) responders and 20 (55.56%) non-responders with TPTEF/TE in probable asthma group. The cut-off value of TPTEF in this study is > 12.4 with 100% sensitivity and specificity while VPEF salbutamol response cut-off value of > 12 with 100% sensitivity and 94.59% specificity. CONCLUSIONS: This study showed that TBA (TPTEF/TE and VPEF/TE) pre-bronchodilator values of 25.91 + 8.61 and 28.88 + 6.75 can be used as a reference value for patients with doubtful and probable asthma. However, the utility of TBA as a tool to determine the reversibility to bronchodilator is statistically not significant. Cut-off value of TPTEF/TE and VPEF/TE for reversibility to bronchodilator showed > 12.4 and > 12 respectively. Both showed 100% sensitivity and 94.9% specificity for VPEF/TE. CLINICAL IMPLICATIONS: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation . It may be difficult to make a confident diagnosis of asthma in children 5 years and younger, because episodic respiratory symptoms such as wheezing and cough are also common in children without asthma, particularly in those 0-2 years old. These patients may subject to Tidal Breathing Analysis (TBA) in order to identify patients with expiratory obstruction and reversibility to salbutamol nebulization. Numerous study has been published to emphasize the usefulness of tidal breathing analysis to diagnosed probable asthma/obstructive airway disease. However, there has been limited studies regarding the range of significant values of TBA parameters in assessing airway obstruction and reversibility after bronchodilator challenge. This study proved that TBA can be used to delineate patients with doubtful and probable asthma and will give the sensitivity and specificity cut-off values for reversibility to bronchodilator. DISCLOSURES: No relevant relationships by Brenda Lou Lovely Abanilla, source=Web Response

Asthma and anaphylaxis.

Both asthma and anaphylaxis are recognized noncommunicable hypersensitivity conditions, which should be correctly diagnosed and treated/controlled in order to decrease avoidable deaths. Nevertheless, their association is not completely clear. We here propose to review the current and new evidence-based data of asthma and anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals in treating symptoms and preventing death. Hypersensitivity life-threatening conditions, such as anaphylaxis and asthma can coexist, mimic or worse each other. Asthma itself is not a strong predictor of more severe anaphylaxis. However, poor asthma control associated with more severe anaphylaxis reactions in all ages. In children, asthma is associated with the severity and recurrences of anaphylactic reactions. Although recent data point for the association between asthma and anaphylaxis, we still do not have harmonized evidence to confirm if we are dealing with two independent comorbidities one worsening each other. However, as far as this review is covering two relevant public health problems in the field of allergy, it is mandatory put in place decisions supporting recommendations to better manage the affected patients and reduce the risk.General strategies should include regular notification of this association, optimization of the classification and coding for anaphylaxis and asthma (new ICD 11 allergy codes) in order to harmonize epidemiological stratified data, early diagnosis of asthma in childhood, regular investigation of asthma in cases of anaphylaxis and optimization of the asthma control and lung function for all patients with indication to provocation tests, desensitization or allergen immunotherapy regardless to the trigger. Implementation of these strategies will involve national and international support for ongoing efforts in relationship with networks of centres of excellence to provide personalized management for the most at-risk patients and prevent death.

Development of an automated ImmunoCAP research assay for eosinophil derived neurotoxin and its use in asthma diagnosis in children

BackgroundEosinophil Derived Neurotoxin (EDN) is an eosinophil granule protein that is released during eosinophil activation. EDN has proven to be a promising marker for eosinophilic inflammation both in asthma and in wheezing symptoms in children. ObjectivesHere we present a novel ImmunoCAPTM automated immunofluorescence research assay for measurement of EDN and its potential use in diagnosis of asthmatic children. MethodsWe report the analytical performance of the assay in serum, heparin- and EDTA-plasma in terms of precision, linearity, sensitivity, interfering substances and specimen handling. We also compared the EDN research assay with established methods for asthma diagnosis: fraction of exhaled nitric oxide (FeNO) and blood eosinophil fraction (EOS%) to demonstrate the diagnostic value of EDN in childhood asthma. ResultsThe total precision (measured using percentage CV) was ≤5.8% for both serum and plasma. The dilution analysis yielded linear results across the dynamic range of the assay for both serum and plasma. No notable interferences of endogenous substances were observed.The median concentration of EDN was significantly higher in the asthma group compared to the healthy controls and the EDN correlates well with EOS%. Conclusionswe have shown that EDN can be measured reliably and robustly with the ImmunoCAP platform in both serum and plasma samples. EDN can be used to distinguish asthmatic from healthy children and correlates well with EOS% and could be a valuable complement to both EOS% and FeNO.

Diagnosis of asthma in children: the contribution of a detailed history and test results.

There are few data on the usefulness of different tests to diagnose asthma in children. We assessed the contribution of a detailed history and a variety of diagnostic tests for diagnosing asthma in children. We studied children aged 6-16 years referred consecutively for evaluation of suspected asthma to two pulmonary outpatient clinics. Symptoms were assessed by parental questionnaire. The clinical evaluation included skin-prick tests, measurement of exhaled nitric oxide fraction (F eNO), spirometry, bronchodilator reversibility and bronchial provocation tests (BPT) by exercise, methacholine and mannitol. Asthma was diagnosed by the physicians at the end of the visit. We assessed diagnostic accuracy of symptoms and tests by calculating sensitivity, specificity, positive and negative predictive values and area under the curve (AUC). Of the 111 participants, 80 (72%) were diagnosed with asthma. The combined sensitivity and specificity was highest for reported frequent wheeze (more than three attacks per year) (sensitivity 0.44, specificity 0.90), awakening due to wheeze (0.41, 0.90) and wheeze triggered by pollen (0.46, 0.83) or by pets (0.29, 0.99). Of the diagnostic tests, the AUC was highest for F eNO measurement (0.80) and BPT by methacholine (0.81) or exercise (0.74), and lowest for forced expiratory volume in 1 s (FEV1) (0.62) and FEV1/forced vital capacity ratio (0.66), assessed by spirometry. This study suggests that specific questions about triggers and severity of wheeze, measurement of F eNO and BPT by methacholine or exercise contribute more to the diagnosis of asthma in school-aged children than spirometry, bronchodilator reversibility and skin-prick tests.

A clinical study to determine the threshold of bronchodilator response for diagnosing asthma in Chinese children

BackgroundThere is few objective, clinically feasible and inexpensive test for diagnosing childhood asthma. We want to find an ideal way to solve it.MethodsThe control group was 301 non-asthmatic children, and the asthma group was 286 asthmatic children. The asthmatic children were divided into three groups according to the severity of their disease. Pre- and post-bronchodilator spirometer tests were performed, and the main spirometer parameters were compared. The bronchodilator response (BDR) [BDR is used to determine the reversibility of airway obstruction by measuring the changes of forced expiratory volume in the first second (FEV1) before and after inhalation of bronchodilators] was then determined, and the optimal threshold of BDR for diagnosing childhood asthma was found.Results301 non-asthmatic children and 286 asthmatic children participated in the study, the demographics were similar. FEV1 for pre-bronchodilator of asthmatic children was significantly lower than that of non-asthmatic children (P ≤ 0.01). BDR of non-asthmatic children was 3.30 ± 3.85%. BDR of asthmatic children was 9.45 ± 9.15%. There was no significant difference in BDR for patients with different severities of asthma within the group. BDR had no statistical correlation with gender, age, height, weight in neither non-asthmatic children nor asthmatic children. On the receiver-operating characteristic curve, a BDR threshold of ≥ 7.5% offered an optimal balance in asthma diagnosis with a sensitivity rate of 50.7% and specificity rate of 87.7%. Meanwhile, with a BDR threshold of ≥ 12%, the sensitivity rate was 28.7% and the specificity rate was 96.3%.ConclusionA BDR threshold of ≥ 7.5% has more value in childhood asthma diagnosis as compared to ≥ 12%.

Dose, Timing, and Type of Infant Antibiotic Use and the Risk of Childhood Asthma.

Aspects of infant antibiotic exposure and its association with asthma development have been variably explored. We aimed to evaluate comprehensively and simultaneously the impact of dose, timing, and type of infant antibiotic use on the risk of childhood asthma. Singleton, term-birth, non-low-birth-weight, and otherwise healthy children enrolled in the Tennessee Medicaid Program were included. Infant antibiotic use and childhood asthma diagnosis were ascertained from prescription fills and healthcare encounter claims. We examined the association using multivariable logistic regression models. Among 152 622 children, 79% had at least 1 antibiotic prescription fill during infancy. Infant antibiotic use was associated with increased odds of childhood asthma in a dose-dependent manner, with a 20% increase in odds (adjusted odds ratio [aOR], 1.20 [95% confidence interval {CI}, 1.19-1.20]) for each additional antibiotic prescription filled. This significant dose-dependent relationship persisted after additionally controlling for timing and type of the antibiotics. Infants who had broad-spectrum-only antibiotic fills had increased odds of developing asthma compared with infants who had narrow-spectrum-only fills (aOR, 1.10 [95% CI, 1.05-1.19]). There was no significant association between timing, formulation, anaerobic coverage, and class of antibiotics and childhood asthma. We found a consistent dose-dependent association between antibiotic prescription fills during infancy and subsequent development of childhood asthma. Our study adds important insights into specific aspects of infant antibiotic exposure. Clinical decision making regarding antibiotic stewardship and prevention of adverse effects should be critically assessed prior to use during infancy.

Diagnosis of Bronchial Asthma in Children 3–6 Years Old by Using Serum Periostin and Surrogate Markers of Eosinophilic Inflammation (Blood Eosinophils and Total IgE): a Cross-Sectional Study

Background. It is difficult to diagnose bronchial asthma (BA) in children under the age of 6 due to the limited ability to study respiratory function. Therefore, it is relevant to search for such diagnostic markers of BA that do not require the active participation of a child.Objective. Our aim was to assess the diagnostic value of serum periostin levels in comparison with surrogate markers of eosinophilic inflammation (total IgE and blood eosinophils) for the diagnosis of BA in preschool children.Methods. A cross-sectional study included children 3–6 years of age with BA and healthy peers. The levels of serum periostin (ELISA), total IgE (chemiluminescent method), blood eosinophils (counted on a hematological analyzer) were determined. To study the diagnostic value of peripheral blood parameters ROC-analysis was used.Results. Children with BA (n = 56) compared with the healthy group (n = 29) showed higher levels of serum periostin (median and quartile) — 5.7 (3.4, 8.0) and 2.7 (1, 7; 3.6) ng/ml (p &lt; 0.001), total IgE — 180 (122; 622) and 55 (45; 87) IU/ml (p &lt; 0.001), blood eosinophils — 6.1% (3.8; 8.0) and 3.6% (2.7; 4.1) (p &lt; 0.001). The area under the ROC curve (AUC) for serum periostin was 0.81 (95% CI 0.73–0.89), for total IgE — 0.86 (95% CI 0.77–0.92), for blood eosinophils — 0.77 (95% CI 0.67–0.86). Independent predictors of serum periostin were total IgE and the number of exacerbations of BA over the past 12 months &gt; 2 (R2 = 0.527).Conclusion. The level of serum periostin in preschool children with BA is higher than in their healthy peers. The diagnostic value of serum periostin in BA is in the range from moderate to good and is comparable to that for the levels of blood eosinophils and total IgE.