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Original article
Lung function, airway remodelling and inflammation in symptomatic infants: outcome at 3 years
  1. Kristiina Malmström1,
  2. Anna S Pelkonen1,
  3. L Pekka Malmberg1,
  4. Seppo Sarna2,
  5. Harry Lindahl3,
  6. Merja Kajosaari3,
  7. Markku Turpeinen1,
  8. Sejal Saglani4,
  9. Andy Bush4,
  10. Tari Haahtela1,
  11. Peter K Jeffery5,
  12. Mika J Mäkelä1
  1. 1Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland
  2. 2Department of Public Health, University of Helsinki, Finland
  3. 3Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
  4. 4Department of Respiratory Paediatrics, Imperial College London, UK
  5. 5Lung Pathology, Department of Gene Therapy, Imperial College London, UK
  1. Correspondence to Kristiina Malmström, Department of Allergy, Helsinki University Central Hospital; P O Box 160, FI-00029 Helsinki, Finland; kristiina.malmstrom{at}fimnet.fi

Abstract

Background Relationships between early deficits of lung function, infant airway pathology and outcome in symptomatic infants are unclear. A study was undertaken to determine the associations between early lung function, airway histology and inflammation in symptomatic infants with the continuance of respiratory symptoms, lung function and subsequent use of inhaled asthma medication at the age of 3 years.

Methods 53 children who underwent lung function measurements and bronchoscopy following referral to a specialist children's hospital for recurrent lower respiratory symptoms at a mean age of 1 year were followed up at 3 years of age. Assessments were made of respiratory symptoms during the previous year, lung function by oscillometry and atopy by skin prick testing. Individual data on the purchase of asthma medications were obtained from the Social Insurance Institution for the 12 months preceding the follow-up visit.

Results 50 children (94%) were re-evaluated, of whom 40 had ongoing airway symptoms. 11/39 (28%) who underwent successful oscillometry had reduced lung function, 31/50 (62%) used inhaled corticosteroids (ICS) regularly and 12/50 (24%) used ICS intermittently. Abnormal lung function at infancy was associated with ongoing airway symptoms (p<0.001) and with the purchase of ICS (p=0.009) and β agonists (p=0.002). Reticular basement membrane thickness in infancy and the numbers of mucosal mast cells, but not eosinophils, correlated significantly with the amount of ICS purchased at 3 years (p=0.003 and p=0.018, respectively).

Conclusions Reduced lung function, thickening of the reticular basement membrane and increased density of mucosal mast cells in infancy are associated with respiratory morbidity and treatment needs at age 3 years in this highly selected group of children.

  • Asthma mechanisms
  • lung physiology
  • paediatric asthma

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Footnotes

  • Funding This study has received funding from the Nummela Sanatorium Foundation, Liv och Hälsa Foundation, Pediatric Research Foundation, Helsinki University Central Hospital Research Fund, Sigrid Juselius Foundation and AstraZeneca Finland.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Helsinki University Central Hospital.

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

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