The enigma of preschool wheezing: Can exacerbations be predicted?
Published online: September 26, 2018
Recurrent wheezing is a common and troubling symptom in preschool children associated with urgent medical visits and frequent missed days from preschool and/or work. To date, the specific factors that contribute to recurrent wheezing in preschool children are unclear. The clinical management of preschool children with recurrent wheezing can therefore be quite challenging given the marked variability in clinical presentation and associated features, as well as limited available evidence to guide therapy.
In a research article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Fitzpatrick and colleagues in the National Heart, Lung and Blood Institute’s (NHLBI) AsthmaNet applied latent class analysis (LCA) to a large dataset of 1,708 well-characterized and medication adherent preschool children age 12-71 months with recurrent wheezing enrolled in NHLBI-sponsored Phase III clinical trials. The primary objective of the analysis was to identify groups of preschool children with shared clinical features and to assess the clinical utility of those groups in predicting future exacerbation and the response to inhaled corticosteroid treatment initiation.
LCA identified four groups of preschool children with recurrent wheezing. These groups were not distinguished by current symptoms but differed primarily with regard to exposures and Type-2 inflammatory features (including blood eosinophils and allergen sensitization patterns). Annualized exacerbation rates were lowest in class 1 (“minimal sensitization”) and class 3 (“sensitization with tobacco smoke exposure”) and were nearly 50% greater in class 2 (“sensitization with indoor pet exposure”) and class 4 (“multiple sensitization and eczema”). In a setting of high adherence, daily inhaled corticosteroid treatment improved exacerbation rates in classes 2 and 4 with more predominant Type-2 inflammatory features but not the other groups.
The investigators conclude that sensitization is a useful predictor of future exacerbation in preschool children. However, exacerbations were still relatively common in each of the identified groups despite treatment, suggesting that some exacerbations may result from other triggers independent of Type-2 inflammation that are not suppressed by low-dose inhaled corticosteroid treatment.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
18-00630, Phenotypes of recurrent wheezing in preschool children: identification by latent class analysis and utility in prediction of future exacerbation
Anne M. Fitzpatrick, PhD, Leonard B. Bacharier, MD, Theresa W. Guilbert, MD, Daniel J. Jackson, MD, Stanley J. Szefler, MD, Avraham Beigelman, MD, Michael D. Cabana, MD, Ronina Covar, MD, Fernando Holguin, MD, Robert F. Lemanske Jr., MD, Fernando D. Martinez, MD, Wayne Morgan, MD, Wanda Phipatanakul, MD, MS, Jacqueline A. Pongracic, MD, Robert S. Zeiger, MD, PhD, David T. Mauger, PhD On behalf of the NIH/NHLBI AsthmaNet