Severe bronchial asthma of childhood: phenotype or phenotypes?
DOI:
https://doi.org/10.15574/PP.2024.98.86Keywords:
severe bronchial asthma, children, bronchial hypersensitivityAbstract
The study of the phenotypes of severe bronchial asthma in children is extremely relevant. The frequent deterioration of the quality of children’s life, increased dissatisfaction with therapy due to the increased risk of adverse effects, the occurrence of side effects of treatment and the development of life-threatening exacerbations of asthma are urgent problems of pediatric allergology.
Aim - to study the diagnostic value of some clinical and spirographic indicators of severe bronchial asthma in order to optimize the verification of the variant of the disease in school-aged children.
Materials and methods. Сlinical and paraclinical examination was carried out of 359 children with bronchial asthma. 2 clinical groups were formed: the first (I) group was formed by 138 school-aged children with severe persistent bronchial asthma (average age - 11.7±0.3 years, the share of boys - 69.3%), and the second (II) group included 221 patients for moderately severe asthma (average age - 11.6±0.2 years; the share of boys - 72.9%). According to the main clinical characteristics, the groups were comparable.
Results. We found that the risk factors for severe asthma persistence associated with low birth weight (odds ratio - 2.2, relative risk - 1.4), early onset of the disease (odds ratio - 1.7, relative risk - 1.3), the triggering effect of acute respiratory infections on asthma exacerbations (odds ratio - 2.4, relative risk - 1.5). It has been established that patients with severe bronchial asthma have a higher non-specific hypersensitivity of the bronchi to direct and indirect broncho-provocative stimuli: indicators of a provocative concentration of histamine <1.0 mg/ml in the PC20H sample increase the chances of severe persistence of the disease by 5.4 times. The study of the diagnostic value in the verification of the phenotype of severe asthma for the provocation concentration of histamine <1.0 mg/ml in the PC20H sample is characterized by a sensitivity of 79.6% and a specificity of 57.9%, and for bronchospasm index >16.0% in a sample with physical exertion - sensitivity 32.8% and specificity of 81.1%.
Conclusions. Phenotype of severe asthma are determined by a combination of clinical, anamnestic and paraclinical signs of the disease, accompanied by pronounced hypersensitivity of the bronchi to indirect and direct irritants. At the same time, the existence of a single phenotype of severe asthma remains a matter of debate, or it is still advisable to mention several phenotypes of severe disease.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
References
Al-Jahdali H, Wali S, Albanna AS et al. (2022). Prevalence of eosinophilic, atopic, and overlap phenotypes among patients with severe asthma in Saudi Arabia: a cross-sectional study. BMC Pulm Med. 2: 67-72. https://doi.org/10.1186/s12890-022-01856-9; PMid:35177038 PMCid:PMC8855582
Bacharier LB, Strunk RC, Mauger D, White D, Lemanske Jr RF, Sorkness CA. (2004). Classifying asthma severity in children: mismatch between symptoms, medication use, and lung function. American journal of respiratory and critical care medicine. 170(4): 426-432. https://doi.org/10.1164/rccm.200308-1178OC; PMid:15172893
Barsky EE, Giancola LM, Baxi SN, Gaffin JM. (2018). A practical approach to severe asthma in children. Annals of the American Thoracic Society. 15(4): 399-408. https://doi.org/10.1513/AnnalsATS.201708-637FR; PMid:29220200 PMCid:PMC5879140
Bousquet J, Mantzouranis E, Cruz AA, Aït-Khaled N, Baena-Cagnani CE, Bleecker ER et al. (2010). Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. J Allergy Clin Immunol. 126(5): 926-38. https://doi.org/10.1016/j.jaci.2010.07.019; PMid:20926125
Camiolo MJ, Kale SL, Oriss TB, Gauthier M, Ray A. (2021). Immune responses and exacerbations in severe asthma. Curr Opin Immunol. 72: 34-42. https://doi.org/10.1016/j.coi.2021.03.004; PMid:33773471 PMCid:PMC8460694
Chung KF, Dixey P, Abubakar-Waziri H, Bhavsar P, Patel PH, Guo S, Ji Y. (2022). Characteristics, phenotypes, mechanisms and management of severe asthma. Chin Med J (Engl). 135(10): 1141-1155. https://doi.org/10.1097/CM9.0000000000001990; PMid:35633594 PMCid:PMC9337252
Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ et al. (2014). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal. 43(14): 343-373. https://doi.org/10.1183/09031936.00202013; PMid:24337046
Crisford H, Sapey E, Rogers GB, Taylor S, Nagakumar P, Lokwani R, Simpson JL. (2021). Neutrophils in asthma: the good, the bad and the bacteria. Thorax. 76(8): 835-844. https://doi.org/10.1136/thoraxjnl-2020-215986; PMid:33632765 PMCid:PMC8311087
Fitzpatrick AM, Teague WG, Meyers DA, Peters SP, Li X, Li H et al. (2011). Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program. J Allergy Clin Immunol. 127(2): 382-389.e1-13. https://doi.org/10.1016/j.jaci.2010.11.015; PMid:21195471 PMCid:PMC3060668
Fitzpatrick AM. (2016). Severe Asthma in Children: Lessons Learned and Future Directions. J Allergy Clin Immunol Pract. 4(1): 11-19; quiz 20-1. https://doi.org/10.1016/j.jaip.2015.10.008; PMid:26772923 PMCid:PMC4715862
FitzGerald JM, Bleecker ER, Nair P, Korn S, Ohta K, Lommatzsch M et al. (2016). Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 388(10056): 2128-2141. https://doi.org/10.1016/S0140-6736(16)31322-8; PMid:27609406
Garas M, Sazhyn S, Lekhkun G, Goncharuk R, Gorenko N. (2018). Indices of nonspecific bronchial reactivity in severe asthma phenotype determination in schoolchildren. Wiad Lek. 71(8): 1537-1540.
GINA. (2012). Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA). Date last updated: December 2012. URL: http://www.ginasthma.org.
Gold DR, Adamkiewicz G, Arshad SH, Celedón JC, Chapman MD, Chew GL et al. (2017). The indoor environment and childhood asthma-implications for home environmental intervention in asthma prevention and management. J Allergy Clin Immunol. 140(4): 933-949. https://doi.org/10.1016/j.jaci.2017.04.024; PMid:28502823 PMCid:PMC5632590
Guilbert TW, Bacharier LB, Fitzpatrick AM. (2014). Severe asthma in children. J Allergy Clin Immunol Pract. 2: 489-500. https://doi.org/10.1016/j.jaip.2014.06.022; PMid:25213041 PMCid:PMC4589165
Haktanir Abul M, Phipatanakul W. (2019). Severe asthma in children: Evaluation and management. Allergol Int. 68(2): 150-157. https://doi.org/10.1016/j.alit.2018.11.007; PMid:30648539
Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. (2015). Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Environ Health Perspect. 123(1): 6-20. https://doi.org/10.1289/ehp.1307922; PMid:25303775 PMCid:PMC4286274
Kanchongkittiphon W, Gaffin JM, Kopel L, Petty CR, Bollinger ME, Miller RL, Phipatanakul W. (2016). Association of FEF 25%-75% and bronchodilator reversibility with asthma control and asthma morbidity in inner-city children with asthma. Annals of Allergy, Asthma & Immunology. 117(1): 97-99. https://doi.org/10.1016/j.anai.2016.04.029; PMid:27236218 PMCid:PMC4930883
Kyvsgaard JN, Chawes BL, Horner DL, Hesselberg LM, Melgaard ME, Jensen SK et al. (2023). Risk Factors and Age-Related Patterns of Asthma-Like Symptoms in Early Childhood. J Allergy Clin Immunol Pract. 11(6): 1773-1784.e10. https://doi.org/10.1016/j.jaip.2023.02.031; PMid:36889671
Lee E, Lee SH, Kwon JW, Kim YH, Yoon J, Cho HJ et al. (2017, Feb 23). Persistent asthma phenotype related with late-onset, high atopy, and low socioeconomic status in school-aged Korean children. BMC Pulm Med. 17(1): 45. https://doi.org/10.1186/s12890-017-0387-5; PMid:28231776 PMCid:PMC5324247
Liu AH, Babineau DC, Krouse RZ, Zoratti EM, Pongracic JA, O'Connor GT et al. (2016). Pathways through which asthma risk factors contribute to asthma severity in inner-city children. J Allergy Clin Immunol. 138(4): 1042-1050. https://doi.org/10.1016/j.jaci.2016.06.060; PMid:27720018 PMCid:PMC5381517
Ni M, Li B, Zhang Q, Zhao J, Li W, Qi S et al. (2023). Relationship Between Birth Weight and Asthma Diagnosis: A Cross-Sectional Survey Study Based on the National Survey of Children's Health in the U.S. BMJ Open. 13(12): e076884. https://doi.org/10.1136/bmjopen-2023-076884; PMid:38040432 PMCid:PMC10693893
Marseglia GL, Licari A, Tosca MA, Ciprandi G. (2020). Biologics to Treat Severe Asthma in Children and Adolescents: A Practical Update. Pediatr Allergy Immunol Pulmonol. 33(4): 168-176. https://doi.org/10.1089/ped.2020.1212; PMid:35921565 PMCid:PMC9353987
McDonald VM, Gibson PG. (2012). Exacerbations of severe asthma. Clin Exp Allergy. 42(5): 670-677. https://doi.org/10.1111/j.1365-2222.2012.03981.x; PMid:22515389
Padró-Casas C, Basagaña M, Rivera-Ortún ML, García-Olivé I, Pollan-Guisasola C, Teniente-Serra A et al. (2023). Characterization and Factors Associated with Poor Asthma Control in Adults with Severe Eosinophilic Asthma. J Pers Med. 13(7): 1173. https://doi.org/10.3390/jpm13071173; PMid:37511786 PMCid:PMC10381894
Reddy MB, Liu AH, Robinson JL, Klinnert MD. (2019). Recurrent wheeze phenotypes in poor urban preschool-age children. J Allergy Clin Immunol Pract. 7(2): 736-739.e5. https://doi.org/10.1016/j.jaip.2018.06.026; PMid:30053592
Shein SL, Speicher RH, Filho JO, Gaston B, Rotta AT. (2016). Contemporary treatment of children with critical and near-fatal asthma. Rev Bras Ter Intensiva. 28(2): 167-178. https://doi.org/10.5935/0103-507X.20160020
Schoettler N, Strek ME. (2020). Recent Advances in Severe Asthma: From Phenotypes to Personalized Medicine. Chest. 157(3): 516-528. https://doi.org/10.1016/j.chest.2019.10.009; PMid:31678077 PMCid:PMC7609962
Teach SJ, Gill MA, Togias A, Sorkness CA, Arbes SJr, Calatroni A et al. (2015). Preseasonal treatment with either omalizumab or an inhaled corticosteroid boost to prevent fall asthma exacerbations. J Allergy Clin Immunol. 136(6): 1476-1485. https://doi.org/10.1016/j.jaci.2015.09.008; PMid:26518090 PMCid:PMC4679705
Teague WG, Phillips BR, Fahy JV, Wenzel SE, Fitzpatrick AM, Moore WC et al. (2018, Mar-Apr). Baseline Features of the Severe Asthma Research Program (SARP III) Cohort: Differences with Age. J Allergy Clin Immunol Pract. 6(2): 545-554.e4. https://doi.org/10.1016/j.jaip.2017.05.032; PMid:28866107 PMCid:PMC5832534
Zhou X, Zhang P, Tan H, Dong B, Jing Z, Wu H et al. (2023). Progress in diagnosis and treatment of difficult-to-treat asthma in children. Ther Adv Respir Dis. 17: 17534666231213637. https://doi.org/10.1177/17534666231213637; PMid:38069568 PMCid:PMC10710755
Zoratti EM, Krouse RZ, Babineau DC, Pongracic JA, O'Connor GT, Wood RA. (2016). Asthma phenotypes in inner-city children. J Allergy Clin Immunol. 138(4): 1016-1029. https://doi.org/10.1016/j.jaci.2016.06.061; PMid:27720016 PMCid:PMC5104222
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Ukrainian Journal of Perinatology and Pediatrics
![Creative Commons License](http://i.creativecommons.org/l/by-nc/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.