Assessment of airflow limitation, airway inflammation, and symptoms during virus-induced wheezing episodes in 4-to 6-year-old children

作者：Konstantinou George N^*; Xepapadaki Paraskevi; Manousakis Emmanuel; Makrinioti Heidi; Kouloufakou Gratsia Kalliopi; Saxoni Papageorgiou Photini; Papadopoulos Nikolaos G

来源：Journal of Allergy and Clinical Immunology, 2013, 131(1): 87-U135.

DOI：10.1016/j.jaci.2012.10.033

• Airflow limitation
• airway inflammation
• spirometry
• reversibility
• exhaled nitric oxide
• forced expiratory volume at 0.5 seconds
• longitudinal study

Background: It is disputed whether recurrent episodes of wheeze in preschool-aged children comprise a distinct asthma phenotype. %26lt;br%26gt;Objective: We sought to prospectively assess airflow limitation and airway inflammation in children 4 to 6 years old with episodic virus-induced wheeze. %26lt;br%26gt;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 %26gt;= 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. %26lt;br%26gt;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 %26lt; .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. %26lt;br%26gt;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. (J Allergy Clin Immunol 2013;131:87-93.)

• 出版日期2013-1