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Persistent ventilation inhomogeneity after an acute exacerbation in preschool children with recurrent wheezing

Kowalik, Krzysztof; Dai, Ruixue; Safavi, Shahideh; Reyna, Myrtha E.; Lou, Wendy; Lepine, Claire; McDonald, Erica; Schaap, Mirjam J.; Brydges, May G.; Dubeau, Aimee; Boutis, Kathy; Narang, Indra; Eiwegger, Thomas; Moraes, Theo J.; Ratjen, Felix; Subbarao, Padmaja

Persistent ventilation inhomogeneity after an acute exacerbation in preschool children with recurrent wheezing Thumbnail


Authors

Krzysztof Kowalik

Ruixue Dai

Shahideh Safavi

Myrtha E. Reyna

Wendy Lou

Claire Lepine

Erica McDonald

Mirjam J. Schaap

May G. Brydges

Aimee Dubeau

Kathy Boutis

Indra Narang

Thomas Eiwegger

Theo J. Moraes

Felix Ratjen

Padmaja Subbarao



Abstract

© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd. Background: Preschool children with recurrent wheezing suffer high morbidity. It is unclear whether objective measures of asthma control, such as pulmonary function tests (PFTs), provide additional information to the clinical assessment. Methods: We recruited children between 3 and 6years old, with a history of recurrent wheezing in the preceding year and treated for acute wheezing exacerbation in the emergency department (ED) into an observational cohort study. Children attended two outpatient visits: the first study visit within five days of discharge from the ED and the second study visit 12weeks after the ED visit. We performed standardized symptom score (test for respiratory and asthma control in kids (TRACK)), multiple breath washout (MBW), spirometry, and clinical assessment at both visits. Results: Seventy-four children, mean (standard deviation (SD)) age of 4.32years (0.84), attended both visits. Paired FEV0.75 and lung clearance index (LCI) measurements at both time points were obtained in 37 and 34 subjects, respectively. Feasibility for all tests improved at visit 2 and was not age-dependent. At the second study visit, a third had controlled asthma based on the TRACK score, and the mean lung clearance index (LCI) improved from 9.86 to 8.31 (P=.003); however, 46% had an LCI in the abnormal range. FEV0.75 z-score improved from −1.66 to −1.17 (P=.05) but remained in the abnormal range in 24%. LCI was abnormal in more than half of the children with “well-controlled” asthma based on the TRACK score. There was no correlation between PFT measures and TRACK scores at either visit. Conclusions: Lung clearance index demonstrates a persistent deficit post-exacerbation in a large proportion of preschoolers with recurrent wheezing, highlighting that symptom scores alone may not suffice for monitoring these children.

Citation

Kowalik, K., Dai, R., Safavi, S., Reyna, M. E., Lou, W., Lepine, C., …Subbarao, P. (2020). Persistent ventilation inhomogeneity after an acute exacerbation in preschool children with recurrent wheezing. Pediatric Allergy and Immunology, https://doi.org/10.1111/pai.13245

Journal Article Type Article
Acceptance Date Mar 4, 2020
Online Publication Date Mar 11, 2020
Publication Date Mar 11, 2020
Deposit Date Jun 30, 2020
Publicly Available Date Mar 12, 2021
Journal Pediatric Allergy and Immunology
Print ISSN 0905-6157
Electronic ISSN 1399-3038
Publisher Wiley
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1111/pai.13245
Keywords asthma, lung clearance index, multiple breath washout, preschool children, pulmonary function test, symptom assessment, test for respiratory and asthma control in kids, wheeze
Public URL https://nottingham-repository.worktribe.com/output/4711076
Publisher URL https://onlinelibrary.wiley.com/doi/10.1111/pai.13245
Additional Information This is the peer reviewed version of the following article: Kowalik K, Dai R, Safavi S, et al. Persistent ventilation inhomogeneity after an acute exacerbation in preschool children with recurrent wheezing. Pediatr Allergy Immunol. 2020;00:1–8, which has been published in final form at https://doi.org/10.1111/pai.13245. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

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