Abstract

Predicting exacerbation in young children with intermittent asthma

Author(s): Stefan Zielen*, Martin Christmann, Sophie von Erffa, Martin Rosewich, Markus Rose & Johannes Schulze

Background: To predict asthma exacerbations (AE) in young children with intermittent asthma is often difficult. Objective: To find predictive parameters for AE in young children with intermittent asthma by examining different biomarkers and anamnestic factors. Methods: 142 children with intermittent asthma aged 4-7 years were included in the study. AE was defined as increased need of Salbutamol (≥ 2 puffs per week or ≥ 5 puffs in two weeks) due to cough symptoms. We analyzed lung function, bronchial hyperreactivity by methacholine testing, exhaled NO (eNO), total IgE, specific IgE and former medical history of 142 children as possible predictive parameters for a further episode during a one year observation period. Of 142 children 63 (44.4%) had an AE during the study. An analysis of the basic parameters indicated that FEV1 (%), FEV1/VC (%) and PD20FEV1 were significantly decreased in children with consecutive AE (p <0.05). Analysis concluded cut off levels of 103% (FEV1), 89.7% (FEV1/VC) and 0.129 mg (PD20FEV1) as risk factors. In addition younger age indicated a trend towards AE (p=0.053). All other parameters (number of previous episodes, parental smoking, eNO and allergic sensitization) did not have an effect on the AE rate. The presence of two or three risk factors was associated with a significantly higher risk of AE. Conclusion: Levels of FEV1, FEV1/VC and PD20FEV1 below cut off levels are highly predictive for a consecutive AE. Easyto- evaluate the presence of two or three parameters justifies a risk factor based treatment strategy.