| Autor: |
Padró-Casas C; Allergy Section, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Carretera de Canyet s/n, 08916 Badalona, Spain., Basagaña M; Allergy Section, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Carretera de Canyet s/n, 08916 Badalona, Spain., Martínez-Colls MDM; Pediatric Department, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain., García-Olivé I; Pneumology Department, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain., Pollan Guisasola C; Otorhinolaryngology Department, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain., Teniente-Serra A; Immunology Department, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain., Martínez-Cáceres E; Immunology Department, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain., Navarro JT; Department of Hematology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Institut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain., Martínez-Rivera C; Pneumology Department, Severe Asthma Unit, Hospital Universitari Germans Trias i Pujol, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08916 Badalona, Spain. |
| Abstrakt: |
Background/Objectives : The objective of this study was to provide real-world data on prognostic factors in children with severe eosinophilic asthma and to assess biomarkers of outcome. Methods : Fifty-nine children (aged 6-17 years) were included in a prospective cohort attended in a Severe Asthma Unit of a tertiary care teaching hospital in Badalona (Barcelona, Spain) and visited at baseline and at 1-year follow-up. Study variables included asthma control using the Asthma Control Test (ACT), forced expiratory volume in one second (FEV 1 ), exacerbation episodes, fractional exhaled nitric oxide (FeNO), and inflammatory biomarkers (blood tests, sputum cells, immunoallergic tests, and levels of cytokines and effector cells in blood and sputum). Results : There were 36 boys and 23 girls, with a mean (SD) age of 11.9 (2.8) years. Uncontrolled severe asthma was diagnosed in 83.1% of cases, with poor symptom control (ACT score < 20) in 52.5%, obstructive pattern (FEV 1 < 80% predicted) in 35.6%, and more than one exacerbation in the previous year in 30.5%. The mean duration of asthma was 9.2 (3.6) years. Positive prick tests were recorded in 55 patients, with polysensitization in 6. The mean percentage of sputum eosinophils was 2.5% (3.1%), and the mean eosinophil blood count 543.4 (427.7) cells/µL. Ten patients (32%) showed sputum eosinophilia (>3% eosinophils). Sputum eosinophils did not correlate with blood eosinophils, FeNO, and serum periostin. At 12 months, 13 (22%) children had uncontrolled asthma and 46 (78%) had controlled asthma. Variables significantly associated with uncontrolled asthma were duration of asthma (OR = 1.23, 95% CI 1.01-1.49, p = 0.04) and an ACT score < 20 (OR = 0.80, 95% CI 0.69-0.93, p = 0.004). Lower serum levels of IL-9 appeared to be related with uncontrolled asthma, but statistical significance was not reached. Conclusions : Pediatric severe eosinophilic asthma showed a predominant allergic phenotype with symptomatic disease as a main contributor of uncontrolled asthma at 1 year. Predictive biomarkers of outcome were not identified. Further studies are needed to confirm the present findings especially considering additional variables for a better phenotypic characterization of severe eosinophilic asthma in children and to study in-depth the role of inflammatory biomarkers. |
