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Background: Preschool wheezing is common and many children experience exacerbations and are well in between. Raised blood eosinophils in older children are associated with exacerbation-prone wheeze, but there are currently no biomarkers to predict near-future exacerbations in preschoolers. There is evidence suggesting that eosinophils are acutely a...
Context in source publication
Context 1
... stable disease absolute blood eosinophil num- bers were significantly associated with both, parent-reported near-future exacerbations and unscheduled healthcare visits ( F4 c Fig. 4). Children with blood eosinophils ‡0.3 · 10 9 /L dur- ing stable disease were significantly more likely to experi- ence a near-future exacerbation compared to those with counts <0.3 · 10 9 /L. Twelve of the 17 children (71%) with blood eosinophils ‡0.3 · 10 9 /L had a subsequent exacerba- tion, whereas no child with counts <0.3 · 10 9 ...
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Citations
... [9][10][11][12][13][14][15][16][17] Most studies have investigated blood eosinophils when asthma is in stable state but not during an exacerbation of asthma. 18 Blood eosinophil count varies between exacerbation and stable-state, [19][20][21] and the usefulness of measuring a spot blood eosinophil count during an exacerbation in relation to short-term outcome of the exacerbation as well as the long-term outcome of asthma is not known. ...
Background:
An elevated blood eosinophil count when asthma is stable predicts exacerbations and therapeutic response to corticosteroids or biologics targeting eosinophils. Few studies have examined the prognostic value of blood eosinophils measured at exacerbation.
Aim:
To elucidate the relationship between a spot blood eosinophil count-measured at the onset of a life-threatening asthma exacerbation-with indices of exacerbation severity and risk of subsequent exacerbations.
Methods:
Real-world, retrospective review of all life-threatening asthma cases admitted at 4 public hospitals in Singapore between 2011-2015. We assessed the trends and correlations between blood eosinophil count on admission with arterial blood gas values, duration of mechanical ventilation, and risk of death, hypoxic ischemic encephalopathy or respiratory arrest. Risk of future exacerbations among survivors was modelled using Cox regression and survival curves.
Results:
There were 376 index life-threatening exacerbations with median blood eosinophil count (5-95th percentiles) of 0.270×109 /L (0-1.410×109 /L). Arterial pH decreased and PCO2 increased with increasing eosinophil count. Duration of mechanical ventilation and risk of death, hypoxic ischaemic encephalopathy or respiratory arrest did not vary with eosinophils. Among 329 survivors who were followed-up over a median of 52 months, blood eosinophils≥1.200×109 /L was associated with an increased hazard of emergency visits and/or admissions for asthma (hazard ratio 1.8, 95% confidence interval 1.1-2.9, p=0.02).
Conclusion:
In this study of life-threatening asthma, we found that a spot blood eosinophil count correlates with severity of respiratory failure and predicts risk of subsequent exacerbations. This article is protected by copyright. All rights reserved.
Asthma is a heterogeneous disease, characterised by different phenotypes and endotypes. Precision medicine in asthma refers to the implementation of a targeted therapy for each individual child, based on the identification of treatable traits, including environmental, immunological and genetic factors. Severe asthma in children is associated with increased hospitalisation rates, a lower quality of life, increased healthcare costs and an increased mortality. In the era of new molecular biologics treatments, it is essential to improve deep phenotyping of children with severe asthma in order to deliver the most effective treatment to each individual child. In this review, we discuss the personalised approach to the assessment and management of severe asthma. We explore the indications and use of the currently licensed biologics, as well as the potential of other emerging treatments.
Objective:
Increased eosinophil level in bronchoalveolar lavage fluid (BALF) characterizes asthma in school-age children and adults and has been suggested as a marker for disease severity and response to treatment. We aimed to investigate the occurrence and yield of BALF eosinophil cell count in preschool children with recurrent wheezing and its possible relation to future diagnosis of asthma.
Methods:
BALF was retrospectively studied in young wheezy children and its relation to asthma at age 6 years was evaluated. BALF from children aged 1-48 months (mean = 20.4) was analyzed in preschool wheezy children. Children with anatomical airway obstruction and other lower airway/lung diseases who underwent BALF served as controls. Assessment of asthma was accomplished at 6 years.
Results:
Eighty-two children were included. The mean age during bronchoscopy and BAL was 20.4 ± 14.4 months (range: 1-48 months). Twenty-six patients had recurrent preschool wheezing, 13 anatomical airway obstruction and 43 had other lower airways/lung diseases. Groups were comparable for age during bronchoscopy and gender. No difference was found between groups for any of the BALF cell types. Eosinophils were very low in all three groups [mean (interquartile range): 0 (0-0.4), 0 (0-0.8), and 0.4 (0-1), respectively, p = 0.25]. No difference in eosinophil levels during bronchoscopy was found between asthmatic children to non-asthmatic as defined at age 6 years.
Conclusions:
Wheezing in preschool children is not associated with increased BALF eosinophils; hence, at this age, the diagnostic yield of BALF for cell count analysis for diagnosing asthma is limited and is not routinely indicated.
