Asthma-predictive-index, bronchial-challenge, sputum eosinophils in acutely wheezing preschoolers

Background: Most preschoolers with viral wheezing exacerbations are not atopic.

Aim: To test in a prospective controlled trial whether wheezing preschoolers presenting to the ED are different from the above in three different domains defining asthma: the atopic characteristics based on stringent asthma predictive index (S-API), the characteristics of bronchial hyperresponsiveness (BHR), and airway inflammation.

Methods: The S-API was prospectively collected in 41 preschoolers (age 31.9 ± 17.4 months, range; 1-6 years) presenting to the ED with acute wheezing and compared to healthy preschoolers (n109) from our community (community control group). Thirty out of the 41 recruited preschoolers performed two sets of bronchial challenge tests (BCT)-(methacholine and adenosine) within 3weeks and following 3 months of the acute event and compared to 30 consecutive ambulatory preschoolers, who performed BCT for diagnostic workup in our laboratory (ambulatory control group). On presentation, induced sputum (IS) was obtained from 22 of the 41 children.

Outcomes: Primary: S-API, secondary: BCTs characteristics and percent eosinophils in IS. Results: Significantly more wheezing preschoolers were S-API positive compared with the community control group: 20/41 (48.7%) versus 15/109 (13.7%, P<0.001). All methacholine-BCTs-30/30 (100%) were positive compared with 13/14 (92.8%) in the ambulatory control group (P0.32). However, 23/27 (85.2%) were adenosine-BCT positive versus 3/17 (17.5%) in the ambulatory control group (P<0.001). Diagnostic IS success rate was 18/22 (81.8%). Unexpectedly, 9/18 (50.0%) showed eosinophilia in the IS.

Conclusions: Wheezing preschoolers presenting to the ED is a unique population with significantly higher rate of positive S-API and adenosine-BCT compared with controls and frequently (50%) express eosinophilic airway inflammation.