Recurrent Severe Preschool Wheeze: From Prespecified Diagnostic Labels to Underlying Endotypes
| العنوان: | Recurrent Severe Preschool Wheeze: From Prespecified Diagnostic Labels to Underlying Endotypes |
|---|---|
| المؤلفون: | Sara Fontanella, Lisa G. Gregory, Luisa Polo Silveira, Aldara Martin Alonso, Clare M. Lloyd, Polly F. M. Robinson, Daphne Kaya-de Vries, Adnan Custovic, James Cook, Andrew Bush, Sachin Ananth, Sejal Saglani, Louise Fleming |
| المساهمون: | British Lung Foundation, National Institute for Health Research |
| المصدر: | American Journal of Respiratory and Critical Care Medicine. 204:523-535 |
| بيانات النشر: | American Thoracic Society, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Male, Pulmonary and Respiratory Medicine, YOUNG-CHILDREN, Pediatrics, medicine.medical_specialty, pediatric wheeze, PERSISTENT ASTHMA, Genotype, LAVAGE, Respiratory System, INFANTS, PHENOTYPES, Critical Care and Intensive Care Medicine, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Critical Care Medicine, INFLAMMATION, Risk Factors, General & Internal Medicine, Humans, Medicine, 030212 general & internal medicine, INDUCED SPUTUM, 11 Medical and Health Sciences, Respiratory Sounds, Science & Technology, business.industry, Airway inflammation, Genetic Variation, Infant, ASSOCIATION, infection, Asthma, CONFIRMATION, Phenotype, 030228 respiratory system, endotypes, Child, Preschool, Preschool wheeze, Female, Symptom Assessment, business, Life Sciences & Biomedicine, cluster analysis |
| الوصف: | Rationale: Preschool wheezing is heterogeneous, but the underlying mechanisms are poorly understood. Objectives: To investigate lower airway inflammation and infection in preschool children with different clinical diagnoses undergoing elective bronchoscopy/bronchoalveolar lavage-BAL. Methods: We recruited 136 children aged 1-5 years (105 recurrent severe wheeze-RSW; 31 non-wheeze respiratory disorders-NWRD). RSW were assigned as episodic viral-EVW or multiple trigger wheeze-MTW. We compared lower airway inflammation/infection in different clinical diagnoses and undertook data-driven analyses to determine clusters of pathophysiological features, and investigated their relationships with pre-specified diagnostic labels. Measurements and Main Results: Blood eosinophils and allergic sensitization were significantly higher in RSW than NWRD. Blood neutrophils, BAL eosinophils and neutrophils, and positive bacterial culture and virus detection rates were similar between groups. However, pathogen distribution differed significantly, with higher detection of rhinovirus in RSW and Moraxella in sensitized RSW. EVW and MTW did not differ in blood/BAL inflammation, or bacterial/virus detection. Partition Around Medoids algorithm revealed 4 clusters of pathophysiological features: (1) Atopic (17.9%); (2) Non-atopic, low infection rate, high inhaled corticosteroids-ICS (31.3%); (3) Non-atopic, high infection rate (23.1%); and (4) Non-atopic, low infection rate, no ICS (27.6%). Cluster allocation differed significantly between RSW and NWRD (RSW evenly distributed across clusters, 60% of NWRD assigned to cluster 4, p |
| تدمد: | 1535-4970 1073-449X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c4fc07204b5efcaa75d9382e19977949Test https://doi.org/10.1164/rccm.202009-3696ocTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....c4fc07204b5efcaa75d9382e19977949 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15354970 1073449X |
|---|