ADD TOPIC TO EMAIL ALERTS
Receive an email when new articles are published on
Provide your email address to receive an email when new articles are posted on . ” data-action=”subscribe”> Subscribe
We were unable to process your request. Please try again later. If you continue to experience this issue, please contact [email protected].
Back to Healio
Children with uncontrolled asthma who visited the emergency department had a higher frequency of viral infections and more acute symptoms than children with controlled asthma, according to a study published in Annals of allergy, asthma and immunology.
These acute symptoms occur especially among allergy patients, Darrell L. Dinwiddie, PhD, assistant professor in the department of pediatrics and scholar in the Center for Clinical Translational Sciences at the University of New Mexico Health Sciences Center, and colleagues wrote.
Data was derived from Dinwiddie DL, et al. Ann Allergy Asthma Immunol. 2022;doi:10.1016/j.anai.2022.06.017.
The prospective cross-sectional study involved 120 children ages 4 to 18 years presenting with acute asthma exacerbations in the Emergency Department of Arkansas Children’s Hospital between fall 2014 and fall 2017.
The researchers collected information from questionnaires detailing past and present medical history, Asthma Control Test (ACT) and Pediatric Respiratory Symptom Scores (PRS), of which the researchers defined scores of 1 to 5 as mild and from 6 to 15 as moderate/severe. Providers also performed nasopharyngeal swabs, collected blood samples, and tested for inflammatory mediators.
Based on ACT scores, there were 33 patients with controlled asthma and 87 patients with uncontrolled asthma. Patients with controlled asthma had a mean PRS score of 4.839 (standard deviation [SD]3.184), and those with uncontrolled asthma had a comparable mean PRS score of 6.205 (SD, 3.432).
Caregiver reports indicated that 73% of patients had a history of allergy, including 67% of those with controlled asthma and 78% of those with uncontrolled asthma.
Upon analysis, 72% of the cohort had virus at the time of presentation to the ED. The most common viruses included rhinovirus (RV; 48%), respiratory syncytial virus (RSV; 18%), and influenza (15%).
Specifically, 77% of people with uncontrolled asthma and 58% of people with controlled asthma had virus-related asthma exacerbations (VRAEs) at presentation.
Patients with asthma not controlled with VRAE had more acute symptoms by PRS score (mean, 6.26; SD, 3.19) than those with controlled asthma and VRAE (4.41; SD, 3.39) and those without no virus (mean, 3.43; SD, 3.8). ), suggesting that viral infection significantly improves acute symptoms in this population, according to the researchers.
In addition, patients with uncontrolled allergy, VRAE, and reported allergy had PRS scores that were a mean of 3,363 points higher than those with well-controlled asthma, allergy, and viruses.P = .041).
Among patients with uncontrolled asthma and RAEs, those with total IgE greater than 371 IU/dL had moderately higher acute symptoms with a mean PRS score of 7.75 (SD, 3.32) compared with those with total IgE greater than 371 IU/dl. low, with a mean PRS score of 4.12 (SD, 5.07).
Patients with uncontrolled asthma, RAEA, and a positive specific IgE test had an increase in mean acute asthma symptoms (7.23; SD, 3.14) compared with those with uncontrolled asthma, RAEA, and no test. positive IgE (3.24; SD, 1.86).
In addition, patients with uncontrolled asthma had higher mean nasal periostin levels (13.98 pg/mL; SD, 18.39) during an exacerbation compared with those with controlled asthma (4.39 pg/mL; SD, 4.09; P = .028). Patients with more severe PRS scores also had higher levels of periostin, the researchers wrote, adding that levels of the protein may be a good indicator of asthma control before exacerbations.
Overall, the researchers concluded, there is an association between uncontrolled asthma and a higher frequency of viral infections when presenting to the ED, with more acute symptoms among those with RAEs and allergies.
Perspective
go back up
Angela Duff Hogan, MD, FAAAAI, FACAAI, FAAP
Viral infections are the most common cause of acute wheezing/exacerbations of asthma in children. It would be useful to be able to predict which child will have more difficulty managing viral infection at the time of an acute exacerbation. This study evaluated multiple risk factors associated with increased respiratory symptoms during an acute viral infection.
The authors attempted to answer whether the virus-induced asthma attack was more severe if the patient had uncontrolled asthma versus controlled asthma in the previous month by measuring the ACT score in the emergency department. They found that children with poorly controlled asthma at the time of viral infection/exacerbation had more acute symptoms.
This study demonstrated that this difference in symptom severity did not correlate with viral load. Although viruses increase allergic inflammation of the airways, those children with uncontrolled asthma and viral infections had a more significant increase in inflammation as evidenced by periostin levels obtained by nasal absorption with filter paper. The authors stated that nasal periostin levels could be a marker of poor asthma control during viral exacerbation and suggest who might be at risk for a more severe exacerbation.
Furthermore, this study reaffirms that there is a synergistic additive effect on inflammation induced by the presence of atopy and respiratory viral infections, especially rhinovirus.
In an ideal setting, it would be helpful to know which child with an acute exacerbation of asthma needs to be observed longer, admitted and followed up tomorrow, as well as which child needs more medications, steroids or long-term follow-up. This study reaffirms that those children with rhinovirus infections, poorly controlled asthma before their attack, and a history of atopy are at increased risk of more severe exacerbations as measured by acute symptoms.
A device that measures nasal periostin such as the FENO instruments should be considered to help determine the severity of the asthma exacerbation from a pro-inflammatory perspective.
Finally, it is curious that the study was completed in 2017 and is only now being published. I don’t think they had enough patients to draw many conclusions before.
Angela Duff Hogan, MD, FAAAAI, FACAAI, FAAP
Vice Chair, ACAAI Asthma Committee
Children’s Allergy, Asthma and Immunology, Children’s Specialty Group, Children’s Hospital of the Daughters of the King
Professor of Pediatrics, Eastern Virginia School of Medicine
Disclosures: Hogan reports being a member of the GSK Speakers Bureau and a member of the ALK Pediatric Advisory Committee.
Perspective
go back up
Giorgio Ciprandi, MD
The link between allergies, infections and asthma exacerbations is well known and still deserves adequate attention in clinical practice. This study confirms previous research on this topic. The results are not surprising, but they are relevant as they confirm the important link between allergies, infections and asthma exacerbations.
In particular, the novelty of this study is that it underlines the importance of uncontrolled asthma. Unfortunately, the authors used ACT scores to measure asthma control. This questionnaire assesses the perception of asthma control, without considering objective variables.
Still, it is important to emphasize the concept that asthma must be controlled. Many asthmatics are still not well controlled. This finding should give pause to the fact that a lot of effort is still needed to achieve the goal of asthma treatment, namely control, because uncontrolled asthma is like a cat biting its own tail. The results of this study underscore this goal.
Although this study measured some biomarkers and details of virus infection that are not suitable in clinical practice, blood eosinophil count is a reliable marker of allergic inflammation. Therefore, it can be routinely evaluated in clinical practice. In addition, functional data must be considered.
Viral infections trigger a cascade of inflammatory events, including the release of cytokines. It is well known that RV increases IL-8 at the nasal level. IL-8 explains the mucopurulent rhinorrhea.
Interestingly, it has been shown very recently that in children with asthma exacerbations (AEs), the number of previous AEs is the most important risk factor for new AEs. Therefore, prevention of AE is mandatory. There may be different ways to prevent AEs, including allergen immunotherapy and manipulation of the immune response using natural substances such as probiotics, vitamin D, and herbal medicines.
Giorgio Ciprandi, MD
Allergist, Allergy Clinic, Casa di Cura Villa Serena, Genoa, Italy
Disclosures: Ciprandi does not report relevant financial disclosures.
ADD TOPIC TO EMAIL ALERTS
Receive an email when new articles are published on
Provide your email address to receive an email when new articles are posted on . ” data-action=”subscribe”> Subscribe
We were unable to process your request. Please try again later. If you continue to experience this issue, please contact [email protected].
Back to Healio
Source: www.healio.com