Occupational Asthma Reference

Shah SP, Grunwell J, Shih J, Stephenson S, Fitzpatrick AM, Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents, J Allergy Clin Immunol Pract, 2019;78:2624-2633,10.1016/j.jaip.2019.04.043

Keywords: asthma, Th2, definition

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Abstract

Background.
Non-invasive markers of Type-2 inflammation are needed to identify children and adolescents who might benefit from personalized biologic therapy.

Objective.
We hypothesized that blood eosinophil counts would predict one or more acute visits for asthma and that prediction could be improved with the addition of a second, non-invasive Type-2 inflammatory biomarker.

Methods.
Children and adolescents 5 to 21 years (N=589) with an asthma exacerbation necessitating systemic corticosteroid treatment in the previous year completed a characterization visit and telephone calls at 6 and 12 months. The primary outcome was an acute visit for asthma with receipt of systemic corticosteroids. Acute visits were verified by medical record review. Exploratory outcomes included time to first acute visit and hospitalization.

Results.
Acute visits occurred in 106 (35.5%) children and 72 (24.8%) adolescents. Elevated blood eosinophils were associated with increased odds and shorter time to first acute visit, but optimal cut-points differed by age (=150 vs. =300 cells/microliter for children vs. adolescents, respectively). Addition of a second marker of Type-2 inflammation did not improve prediction in children, but increased the odds and hazard of an acute visit up to 16.2% and 11.9%, respectively, in adolescents. Similar trends were noted for hospitalizations.

Conclusion.
Blood eosinophils and other non-invasive markers of Type-2 inflammation may be useful in the clinical assessment of children and adolescents with asthma. However, features of Type-2 inflammation vary by age. Whether children and adolescents also respond differently to management of Type-2 inflammation is unclear and warrants further evaluation.

Plain text: Background. Non-invasive markers of Type-2 inflammation are needed to identify children and adolescents who might benefit from personalized biologic therapy. Objective. We hypothesized that blood eosinophil counts would predict one or more acute visits for asthma and that prediction could be improved with the addition of a second, non-invasive Type-2 inflammatory biomarker. Methods. Children and adolescents 5 to 21 years (N=589) with an asthma exacerbation necessitating systemic corticosteroid treatment in the previous year completed a characterization visit and telephone calls at 6 and 12 months. The primary outcome was an acute visit for asthma with receipt of systemic corticosteroids. Acute visits were verified by medical record review. Exploratory outcomes included time to first acute visit and hospitalization. Results. Acute visits occurred in 106 (35.5%) children and 72 (24.8%) adolescents. Elevated blood eosinophils were associated with increased odds and shorter time to first acute visit, but optimal cut-points differed by age (>=150 vs. >=300 cells/microliter for children vs. adolescents, respectively). Addition of a second marker of Type-2 inflammation did not improve prediction in children, but increased the odds and hazard of an acute visit up to 16.2% and 11.9%, respectively, in adolescents. Similar trends were noted for hospitalizations. Conclusion. Blood eosinophils and other non-invasive markers of Type-2 inflammation may be useful in the clinical assessment of children and adolescents with asthma. However, features of Type-2 inflammation vary by age. Whether children and adolescents also respond differently to management of Type-2 inflammation is unclear and warrants further evaluation.

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