Examining associations between biomarkers and future wheeze attacks in preschool children (TAILOR): an observational study
Author(s)
Perikleous, Andreas
Type
Thesis
Abstract
Preschool wheezing is a common condition which can result in repeated hospital admissions and impaired quality of life. In adults and older children, airway Type-2 inflammation is predictive of inhaled corticosteroid (ICS) response, and this may also apply to preschool children. This study hypothesised that blood eosinophil count (BEC) ≥300 cells/μL, fractional exhaled nitric oxide (FeNO) ≥10 ppb and allergic sensitisation, alone or combined, are associated with future wheeze attacks and their performance is feasible in primary care and acceptable to families. Preschool children aged 1-5 years were recruited from primary and secondary care and measured with finger-prick (BEC), skin-prick (allergic sensitisation) and FeNO offline testing. Children were followed for 12 months and the occurrence of wheeze attacks, days out of nursery and work for children and parents were monthly recorded. BEC ≥300 cells/μL was associated with higher wheeze attack risk over 12 months. Its predictive ability increased when combined with FeNO ≥10 ppb. Allergic sensitisation was not associated with future wheeze attacks. BEC was unstable [children did not remain in their same BEC threshold category (≥300 or <300 cells/μL)] in the three-to-four months following baseline. BEC ≥300 cells/μL alone and in combination with allergic sensitisation (yes/no) was associated with reduced wheeze attack risk in those who had compared to those who had not been prescribed ICS in the six months following baseline, but not thereafter. This may have been associated with BEC instability. Parents and healthcare professionals deemed these tests acceptable and feasible to guide treatment decisions if supported by evidence, parent-doctor empathetic interactions, healthcare funding, and nurses performing these tests. The study showed biomarkers could identify children at higher wheeze attack risk and lays the ground for a future study comparing biomarker- (measured during clinical stability) to symptom-based ICS treatment decisions in reducing wheeze attacks over 12 months.
Date Issued
2024-12-19
Date Awarded
01/06/2025
Advisor
Bush, Andrew
Fleming, Louise
Pavord, Ian
Griffiths, Christopher
Bowen, Sarah-Jane
Sponsor
Asthma UK
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)