Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Asthma predictive index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea

  • Lee, Dong Hyeon (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kwon, Ji-Won (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Kim, Hyung Young (Department of Pediatrics, Pusan National University Yangsan Hospital) ;
  • Seo, Ju-Hee (Department of Pediatrics, Korea Cancer Center Hospital) ;
  • Kim, Hyo-Bin (Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Lee, So-Yeon (Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jang, Gwang-Cheon (Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital) ;
  • Song, Dae-Jin (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kim, Woo Kyung (Department of Pediatrics, Inje University Seoul Paik Hospital) ;
  • Jung, Young-Ho (Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Soo-Jong (Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shim, Jung Yeon (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2019.06.13
  • 심사 : 2019.11.03
  • 발행 : 2020.03.15
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초록

Background: It is challenging to diagnose asthma in preschool children. The asthma predictive index (API) has been used to predict asthma and decide whether to initiate treatment in preschool children. Purpose: This study aimed to investigate the association between questionnaire-based current asthma with API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children. Methods: We performed a population-based cross-sectional study in 916 preschool children aged 4-6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the previous 12 months using a modified International Study of Asthma and Allergies in Childhood questionnaire. Clinical and laboratory parameters were compared between groups according to the presence of current asthma. Results: The prevalence of current asthma was 3.9% in the study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent API scores than children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no intergroup differences in spirometry results, methacholine provocation test results, FeNO level, or atopic sensitization rate were observed. Conclusion: The questionnaire-based diagnosis of current asthma is associated with API, but not with spirometry, AHR, FeNO, or atopic sensitization in preschool children.

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참고문헌

  1. Castro-Rodriguez JA. The Asthma Predictive Index: a very useful tool for predicting asthma in young children. J Allergy Clin Immunol 2010;126:212-6. https://doi.org/10.1016/j.jaci.2010.06.032
  2. Guilbert TW, Morgan WJ, Zeiger RS, Bacharier LB, Boehmer SJ, Krawiec M, et al. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol 2004;114:1282-7. https://doi.org/10.1016/j.jaci.2004.09.020
  3. Caudri D, Wijga A, A Schipper CM, Hoekstra M, Postma DS, Koppelman GH, et al. Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age. J Allergy Clin Immunol 2009;124:903-10. https://doi.org/10.1016/j.jaci.2009.06.045
  4. Caudri D, Wijga AH, Hoekstra MO, Kerkhof M, Koppelman GH, Brunekreef B, et al. Prediction of asthma in symptomatic preschool children using exhaled nitric oxide, Rint and specific IgE. Thorax 2010;65:801-7. https://doi.org/10.1136/thx.2009.126912
  5. Huffaker MF, Phipatanakul W. Utility of the Asthma Predictive Index in predicting childhood asthma and identifying disease-modifying interventions. Ann Allergy Asthma Immunol 2014;112:188-90. https://doi.org/10.1016/j.anai.2013.12.001
  6. Oh MA, Shim JY, Jung YH, Seo JH, Young Kim H, Kwon JW, et al. Fraction of exhaled nitric oxide and wheezing phenotypes in preschool children. Pediatr Pulmonol 2013;48:563-70. https://doi.org/10.1002/ppul.22705
  7. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC):rationale and methods. Eur Respir J 1995;8:483-91. https://doi.org/10.1183/09031936.95.08030483
  8. Soh JE, Kim KM, Kwon JW, Kim HY, Seo JH, Kim HB, et al. Recurrent wheeze and its relationship with lung function and airway inflammation in preschool children: a cross-sectional study in South Korea. BMJ Open 2017;7:e018010. https://doi.org/10.1136/bmjopen-2017-018010
  9. Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000;162:1403-6. https://doi.org/10.1164/ajrccm.162.4.9912111
  10. Leonardi NA, Spycher BD, Strippoli MP, Frey U, Silverman M, Kuehni CE. Validation of the Asthma Predictive Index and comparison with simpler clinical prediction rules. J Allergy Clin Immunol 2011;127:1466-72. https://doi.org/10.1016/j.jaci.2011.03.001
  11. Lee JW, Shim JY, Kwon JW, Kim HY, Seo JH, Kim BJ, et al. Exhaled nitric oxide as a better diagnostic indicator for evaluating wheeze and airway hyperresponsiveness in preschool children. J Asthma 2015;52:1054-9. https://doi.org/10.3109/02770903.2015.1046078
  12. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2018. Available from: https://ginasthma.org.
  13. Shim JY, Kim HB, Lee SY, Yu J, Kim WK, Kang D, et al. Effects of early measles on later rhinitis and bronchial hyperresponsiveness. Ann Allergy Asthma Immunol 2010;105:43-9. https://doi.org/10.1016/j.anai.2010.04.016
  14. Kurukulaaratchy RJ, Matthews S, Holgate ST, Arshad SH. Predicting persistent disease among children who wheeze during early life. Eur Respir J 2003;22:767-71. https://doi.org/10.1183/09031936.03.00005903
  15. Pescatore AM, Dogaru CM, Duembgen L, Silverman M, Gaillard EA, Spycher BD, et al. A simple asthma prediction tool for preschool children with wheeze or cough. J Allergy Clin Immunol 2014;133:111-8. https://doi.org/10.1016/j.jaci.2013.06.002
  16. Hafkamp-de Groen E, Lingsma HF, Caudri D, Levie D, Wijga A, Koppelman GH, et al. Predicting asthma in preschool children with asthma-like symptoms: validating and updating the PIAMA risk score. J Allergy Clin Immunol 2013;132:1303-10. https://doi.org/10.1016/j.jaci.2013.07.007
  17. Chang TS, Lemanske RF Jr, Guilbert TW, Gern JE, Coen MH, Evans MD, et al. Evaluation of the modified asthma predictive index in high-risk preschool children. J Allergy Clin Immunol Pract 2013;1:152-6. https://doi.org/10.1016/j.jaip.2012.10.008
  18. Devulapalli CS, Carlsen KC, Haland G, Munthe-Kaas MC, Pettersen M, Mowinckel P, et al. Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age. Thorax 2008;63:8-13. https://doi.org/10.1136/thx.2006.060616
  19. Lodrup Carlsen KC, Soderstrom L, Mowinckel P, Haland G, Pettersen M, Munthe Kaas MC, et al. Asthma prediction in school children; the value of combined IgE-antibodies and obstructive airways disease severity score. Allergy 2010;65:1134-40.
  20. Castro-Rodriguez JA, Cifuentes L, Martinez FD. Predicting asthma using clinical indexes. Front Pediatr 2019;7:320. https://doi.org/10.3389/fped.2019.00320
  21. Wi CI, Park MA, Juhn YJ. Development and initial testing of Asthma Predictive Index for a retrospective study: an exploratory study. J Asthma 2015;52:183-90. https://doi.org/10.3109/02770903.2014.952438
  22. Hill DA, Spergel JM. The atopic march: critical evidence and clinical relevance. Ann Allergy Asthma Immunol 2018;120:131-7. https://doi.org/10.1016/j.anai.2017.10.037
  23. Belgrave DC, Granell R, Simpson A, Guiver J, Bishop C, Buchan I, et al. Developmental profiles of eczema, wheeze, and rhinitis: two populationbased birth cohort studies. PLoS Med 2014;11:e1001748. https://doi.org/10.1371/journal.pmed.1001748
  24. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368:733-43. https://doi.org/10.1016/S0140-6736(06)69283-0
  25. Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD. Tucson Children's Respiratory Study: 1980 to present. J Allergy Clin Immunol 2003;111:661-75. https://doi.org/10.1067/mai.2003.162
  26. Gelfand EW. Is asthma in childhood different from asthma in adults? Why do we need special approaches to asthma in children? Allergy Asthma Proc 2008;29:99-102. https://doi.org/10.2500/aap.2008.29.3090
  27. Warke TJ, Fitch PS, Brown V, Taylor R, Lyons JD, Ennis M, et al. Exhaled nitric oxide correlates with airway eosinophils in childhood asthma. Thorax 2002;57:383-7. https://doi.org/10.1136/thorax.57.5.383
  28. Berry MA, Shaw DE, Green RH, Brightling CE, Wardlaw AJ, Pavord ID. The use of exhaled nitric oxide concentration to identify eosinophilic airway inflammation: an observational study in adults with asthma. Clin Exp Allergy 2005;35:1175-9. https://doi.org/10.1111/j.1365-2222.2005.02314.x
  29. Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008;32:1096-110. https://doi.org/10.1183/09031936.00002108
  30. Cockcroft DW. Direct challenge tests: Airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest 2010;138:18S-24S. https://doi.org/10.1378/chest.10-0088
  31. Anderson SD, Brannan JD. Bronchial provocation testing: the future. Curr Opin Allergy Clin Immunol 2011;11:46-52. https://doi.org/10.1097/ACI.0b013e3283423183
  32. Ater D, Bar BE, Fireman N, Fireman E, Shai H, Tasher D, et al. Asthmapredictive-index, bronchial-challenge, sputum eosinophils in acutely wheezing preschoolers. Pediatr Pulmonol 2014;49:952-9. https://doi.org/10.1002/ppul.22926
  33. Mallol J, Garcia-Marcos L, Aguirre V, Martinez-Torres A, Perez-Fernandez V, Gallardo A, et al. The International Study of Wheezing in Infants: questionnaire validation. Int Arch Allergy Immunol 2007;144:44-50. https://doi.org/10.1159/000102613
  34. Chong Neto HJ, Rosario N, Dela Bianca AC, Sole D, Mallol J. Validation of a questionnaire for epidemiologic studies of wheezing in infants. Pediatr Allergy Immunol 2007;18:86-7. https://doi.org/10.1111/j.1399-3038.2006.00488.x
  35. Castro-Rodriguez JA, Atton I, Villarroel G, Serrano CA. Serum periostin is not related to asthma predictive index. Allergol Immunopathol (Madr) 2018;46:235-40. https://doi.org/10.1016/j.aller.2017.05.012

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