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The Effect of Vascular Endothelial Growth Factor on the Bronchial Hyper-Responsiveness in Children Asthma Patients
Characteristics of Pediatric Asthma Patients with Bronchodilator Irreversible Airflow Obstruction (AO) G. Chiang, R. C. Strunk, L. B. Bacharier; Pediatrics, Washington University/St. Louis Children’s Hospital, St. Louis, MO. RATIONALE: The FEV1/FVC ratio is a better discriminator of asthma severity than other lung function parameters, worsening with both duration and severity of disease. We examined factors that characterize pediatric patients with bronchodilator irreversible AO. METHODS: Randomly selected charts of patients seen for asthma care were reviewed in a case-control study. Cases were selected by AO, defined as FEV1/FVC ratio 75% both pre- and post-bronchodilator. Each case of AO was matched to a control without AO (FEV1/FVC 85% prebronchodilator) by age, gender and race. Variables examined included insurance status, asthma severity by GINA Guidelines, parental history of asthma, emergency visits or hospitalizations, percutaneous skin testing, smoke exposure, and comorbidities (GE reflux (GERD) and sinusitis). RESULTS: 106 children aged 13.6±2.7 years (range 7-19), with equal numbers of African-Americans and Caucasians, were included. Asthma was well-controlled in both groups at the time of the visit, with severity determined by controller medication use rather than recent symptoms in >90% in both groups. Differences in FEV1/FVC were due to differences in FEV1 %predicted and not due to differences in FVC %predicted [FEV1 73±17 and 103±12 (p<0.001), FVC 100±12 and 100±16 (p=0.8) for obstructed and controls, respectively]. Those obstructed had greater asthma severity (by GINA Guidelines, p=0.0001, and prior intubation, p=0.013). GERD was slightly more common in AO (20.8 vs 7.5%, p=0.09). The groups did not differ significantly in any other variable examined, including skin test positivity. CONCLUSIONS: The presence of AO in children with asthma is an indicator of more severe disease and does not appear related to degree of allergic sensitization.
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Epidemiological Study on Allergy and Asthma Phenotypes: Subclinical and Severe Asthma C. D’Ambrosio1, P. Pierimarchi2, M. Bresciani1, C. Parisi1, D. Spina1, A. Torre2, M. Turbati3, G. Rasi2, S. Bonini1,2; 1IRCCS San Raffaele, Roma, ITALY, 2INMM-CNR, Roma, ITALY, 3ASSILT, Roma, ITALY. RATIONALE: Characterization of allergy and asthma phenotypes is crucial for better targeted management of individual patients. Allergic rhinitis may be a risk factor for asthma and is often associated with bronchial hyper-responsiveness (sub-clinical asthma). Severe asthma is a controversial nosological entity accountable for most social costs due to asthma. METHODS: An ongoing polycentric awareness and prevention campaign addressed to all workers of the major Italian telecommunication company was designed to select allergic rhinitis subjects and subjects with severe asthma (FEV1<70% than predicted after one month of optimal treatment, according to GINA-Guidelines). All workers that volunteered entering the study were administered a modified ISAAC/ECHRS questionnaire, and underwent physical examination and skin prick tests with a standard panel of 8 aero-allergens. Patients with allergic rhinitis, no clinical history of asthma and normal spirometric values were challenged with metacholine according to ATS-Guidelines. RESULTS: We report here data from the first population sample of 1,000 subjects: 554 volunteered to enter the study. Out of the 88 subjects with pure allergic rhinitis, 16 (18%) showed bronchial hyper-reactivity (BHR). No statistical difference was found between the persistent and intermittent rhinitis groups. Only one subject had severe asthma, according to set criteria. CONCLUSIONS: The high prevalence of subclinical asthma - as defined in our study - supports the soundness of ARIA recommendations to evaluate allergic rhinitis patients for asthma and to test whether rhinitis patients with BHR are proner to develop overt asthma. Severe asthma appears to be a rare disease, calling for collaborative multicentric studies on large populations.
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Declines in Daily Digital Measures of FEV1 and Peak Flow Correspond with Albuterol Usage in Adults, but not in Children K. D. Carel1,2, N. Rabinovitch1,2, M. Strand3, M. Gleason1, J. R. Mault4, A. H. Liu1,2; 1Pediatrics, National Jewish Medical and Research Center, Denver, CO, 2Pediatrics, University of Colorado School of Medicine, Denver, CO, 3Biostatistics, National Jewish Medical and Research Center, Denver, CO, 4MicroLife USA, Dunedin, FL. RATIONALE: Although asthma management guidelines recommend disease control assessments to include albuterol usage and daily peak flow monitoring, evidence correlating these measures in children is limited and unclear. We used daily electronic monitoring of both albuterol usage and lung function [peak flows (PEF) and FEV1] to determine their correlation in children and adults with asthma, when measured objectively. METHODS: For 6 weeks, 30 children and 15 adults with asthma used electronic, self-recording monitors of albuterol use (DOSER), and FEV1 and PEF (Microlife Digital Peak Flow FEV1 Meter) daily. Correlations were analyzed via logistic regression. RESULTS: For adults, the likelihood of albuterol usage increased significantly with decreases in both FEV1 [odds ratio (OR) per standard deviation (SD) decline in FEV1=2.30, p=0.01] and PEF (OR per SD decline in PEF=2.26, p=0.005)]. In comparison, for children, albuterol use did not correlate with decreases in either FEV1 (OR 1.17, p=0.56) or PEF (OR 1.16, p=0.52). CONCLUSIONS: In children with asthma, day-to-day variation in FEV1 and PEF did not correlate with albuterol usage as it did with adults. This suggests that asthmatic children are less likely to recognize reductions in lung function and/or are less able to respond appropriately with albuterol usage. In children, albuterol usage may be a less reliable indicator of asthma severity; objective measures of daily variation in lung function may improve assessments of their disease severity and control. [Supported by MicroLife USA, EPA R825702, NIH K23-HL04272(Liu), National Jewish] Funding: EPA, Microlife, NIH
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The Effect of Vascular Endothelial Growth Factor on the Bronchial Hyper-Responsiveness in Children Asthma Patients H. Kim1, J. Choung2; 1Pediatrics, Korea University Hospital, Ansan, REPUBLIC OF KOREA, 2Pediatrics, Korea University Hospital, Seoul, REPUBLIC OF KOREA. RATIONALE: Vascular endothelial growth factor (VEGF) is highly expressed in the airway of asthmatic children patients. We investigated the relation between the sputum concentration of VEGF and the bronchial hyper-responsiveness(BHR). METHODS: 59 asthmatic children were enrolled, who were 6 years to 14 years and visited with asthmatic symptom in Korea University Hospital. We interviewed their parents to assess another medical history. 59 asthmatic children were investigated and we took their induced sputum samples. We measured VEGF levels and eosinophilic cationic protein (ECP) levels in the induced sputum samples from 59 asthmatic children, and then we performed methacholine provocation test. RESULTS: Asthmatic children with higher sputum VEGF levels showed lower values of PC20 (p=0.002). Asthmatic children groups with higher sputum levels of ECP had increased levels of the sputum VEGF levels (p=0.01). but the serum ECP levels were related neither to the levels of VEGF in the sputum nor to values of PC20. CONCLUSIONS: When the higher levels of VEGF were measured in their sputum, asthmatic children showed increased BHR. It seems that the increased level of sputum VEGF is responsible for increased BHR.
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SATURDAY
Abstracts S1
J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2
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Epidemiological Study on Allergy and Asthma Phenotypes: Subclinical and Severe Asthma C. D’Ambrosio1, P. Pierimarchi2, M. Bresciani1, C. Parisi1, D. Spina1, A. Torre2, M. Turbati3, G. Rasi2, S. Bonini1,2; 1IRCCS San Raffaele, Roma, ITALY, 2INMM-CNR, Roma, ITALY, 3ASSILT, Roma, ITALY. RATIONALE: Characterization of allergy and asthma phenotypes is crucial for better targeted management of individual patients. Allergic rhinitis may be a risk factor for asthma and is often associated with bronchial hyper-responsiveness (sub-clinical asthma). Severe asthma is a controversial nosological entity accountable for most social costs due to asthma. METHODS: An ongoing polycentric awareness and prevention campaign addressed to all workers of the major Italian telecommunication company was designed to select allergic rhinitis subjects and subjects with severe asthma (FEV1<70% than predicted after one month of optimal treatment, according to GINA-Guidelines). All workers that volunteered entering the study were administered a modified ISAAC/ECHRS questionnaire, and underwent physical examination and skin prick tests with a standard panel of 8 aero-allergens. Patients with allergic rhinitis, no clinical history of asthma and normal spirometric values were challenged with metacholine according to ATS-Guidelines. RESULTS: We report here data from the first population sample of 1,000 subjects: 554 volunteered to enter the study. Out of the 88 subjects with pure allergic rhinitis, 16 (18%) showed bronchial hyper-reactivity (BHR). No statistical difference was found between the persistent and intermittent rhinitis groups. Only one subject had severe asthma, according to set criteria. CONCLUSIONS: The high prevalence of subclinical asthma - as defined in our study - supports the soundness of ARIA recommendations to evaluate allergic rhinitis patients for asthma and to test whether rhinitis patients with BHR are proner to develop overt asthma. Severe asthma appears to be a rare disease, calling for collaborative multicentric studies on large populations.
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Declines in Daily Digital Measures of FEV1 and Peak Flow Correspond with Albuterol Usage in Adults, but not in Children K. D. Carel1,2, N. Rabinovitch1,2, M. Strand3, M. Gleason1, J. R. Mault4, A. H. Liu1,2; 1Pediatrics, National Jewish Medical and Research Center, Denver, CO, 2Pediatrics, University of Colorado School of Medicine, Denver, CO, 3Biostatistics, National Jewish Medical and Research Center, Denver, CO, 4MicroLife USA, Dunedin, FL. RATIONALE: Although asthma management guidelines recommend disease control assessments to include albuterol usage and daily peak flow monitoring, evidence correlating these measures in children is limited and unclear. We used daily electronic monitoring of both albuterol usage and lung function [peak flows (PEF) and FEV1] to determine their correlation in children and adults with asthma, when measured objectively. METHODS: For 6 weeks, 30 children and 15 adults with asthma used electronic, self-recording monitors of albuterol use (DOSER), and FEV1 and PEF (Microlife Digital Peak Flow FEV1 Meter) daily. Correlations were analyzed via logistic regression. RESULTS: For adults, the likelihood of albuterol usage increased significantly with decreases in both FEV1 [odds ratio (OR) per standard deviation (SD) decline in FEV1=2.30, p=0.01] and PEF (OR per SD decline in PEF=2.26, p=0.005)]. In comparison, for children, albuterol use did not correlate with decreases in either FEV1 (OR 1.17, p=0.56) or PEF (OR 1.16, p=0.52). CONCLUSIONS: In children with asthma, day-to-day variation in FEV1 and PEF did not correlate with albuterol usage as it did with adults. This suggests that asthmatic children are less likely to recognize reductions in lung function and/or are less able to respond appropriately with albuterol usage. In children, albuterol usage may be a less reliable indicator of asthma severity; objective measures of daily variation in lung function may improve assessments of their disease severity and control. [Supported by MicroLife USA, EPA R825702, NIH K23-HL04272(Liu), National Jewish] Funding: EPA, Microlife, NIH
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The Effect of Vascular Endothelial Growth Factor on the Bronchial Hyper-Responsiveness in Children Asthma Patients H. Kim1, J. Choung2; 1Pediatrics, Korea University Hospital, Ansan, REPUBLIC OF KOREA, 2Pediatrics, Korea University Hospital, Seoul, REPUBLIC OF KOREA. RATIONALE: Vascular endothelial growth factor (VEGF) is highly expressed in the airway of asthmatic children patients. We investigated the relation between the sputum concentration of VEGF and the bronchial hyper-responsiveness(BHR). METHODS: 59 asthmatic children were enrolled, who were 6 years to 14 years and visited with asthmatic symptom in Korea University Hospital. We interviewed their parents to assess another medical history. 59 asthmatic children were investigated and we took their induced sputum samples. We measured VEGF levels and eosinophilic cationic protein (ECP) levels in the induced sputum samples from 59 asthmatic children, and then we performed methacholine provocation test. RESULTS: Asthmatic children with higher sputum VEGF levels showed lower values of PC20 (p=0.002). Asthmatic children groups with higher sputum levels of ECP had increased levels of the sputum VEGF levels (p=0.01). but the serum ECP levels were related neither to the levels of VEGF in the sputum nor to values of PC20. CONCLUSIONS: When the higher levels of VEGF were measured in their sputum, asthmatic children showed increased BHR. It seems that the increased level of sputum VEGF is responsible for increased BHR.
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SATURDAY
Abstracts S1
J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2