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Asthma
Prediction of asthma in symptomatic preschool children using exhaled nitric oxide, Rint and specific IgE
  1. Daan Caudri1,
  2. Alet H Wijga2,
  3. Maarten O Hoekstra3,
  4. Marjan Kerkhof4,
  5. Gerard H Koppelman5,
  6. Bert Brunekreef6,7,
  7. Henriette A Smit2,7,
  8. Johan C de Jongste1
  1. 1Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
  2. 2The Netherlands Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  3. 3Centre for Paediatric Allergology, University Medical Centre St Radbout, Nijmegen, The Netherlands
  4. 4Department of Epidemiology, University Medical Centre Groningen, University of Groningen, The Netherlands
  5. 5Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, The Netherlands
  6. 6Institute for Risk Assessment Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
  7. 7Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Professor J C de Jongste, Erasmus MC/Sophia Children's Hospital, Department of Paediatric Respiratory Medicine, PO Box 2060, Rotterdam 3000 CB, The Netherlands; j.c.dejongste{at}erasmusmc.nl

Abstract

Rationale For clinicians it remains very difficult to predict whether preschool children with symptoms suggestive of asthma will develop asthma in later childhood.

Objective To investigate whether measurement of fraction of exhaled nitric oxide (FENO), interrupter resistance (Rint) or specific immunoglobulin E (IgE) in 4-year-old children with suggestive symptoms can predict asthma symptoms up to age 8 years.

Methods Children were recruited from the PIAMA birth cohort. All children with symptoms suggestive of asthma at age 3 or 4 years, who were invited for medical examination at age 4 (n=848), were eligible. Associations of FENO (n=308), Rint (n=482) and specific IgE (n=380) at 4 years with wheezing and asthma at the ages of 5–8 years were assessed using repeated measurement analyses. The added predictive value of these objective tests was then investigated by including parameters for clinical history in the model.

Results FENO and specific IgE measured at 4 years were associated with wheezing and asthma at 8 years. Both tests also remained significant predictors after mutual adjustment and adjustment for clinical history: OR on wheezing at 8 years for FENO (10log-scale, per IQR) 1.6 (95% CI 1.1 to 2.2) and for specific IgE 2.8 (95% CI 1.9 to 4.1). Rint was significantly associated with wheezing at age 6, but not at 7 and 8 years.

Conclusions In preschool children with symptoms suggestive of asthma, both FENO and specific IgE measured at age 4, but not Rint, improved the prediction of asthma symptoms until the age of 8 years, independent of clinical history.

  • Prognosis
  • breath test
  • airway resistance
  • radioallergosorbent test
  • paediatrics
  • allergic lung disease
  • clinical epidemiology
  • exhaled airway markers
  • paediatric asthma

https://doi.org/10.1136/thx.2009.126912

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    Footnotes

    • Funding The Netherlands Organisation for Health Research and Development; the Netherlands Organisation for Scientific Research; the Netherlands Asthma Fund; the Netherlands Ministry of Spatial Planning, Housing, and the Environment; and the Netherlands Ministry of Health, Welfare and Sport. The salary of DC was paid by a ‘Toptalent’ grant from the Netherlands Organisation for Scientific Research (NWO). None of the funding sources had a role in either the study design, data collection, analyses, interpretation of the data, writing of the report or decision to submit this paper for publication.

    • Competing interests None.

    • Ethics approval The study protocol was approved by the medical ethics committees of the participating university hospitals: ErasmusMC, University Medical Centre Rotterdam, University Medical Centre Groningen, University Medical Centre Utrecht.

    • Provenance and peer review Not commissioned; externally peer reviewed.