National Heart & Lung Institute, Imperial College London, London, UK.
Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
Pediatr Allergy Immunol. 2022 Jan;33(1):e13697. doi: 10.1111/pai.13697. Epub 2021 Nov 24.
Management of preschool wheeze is based predominantly on symptom patterns.
To determine whether personalizing therapy using blood eosinophils or airway bacterial infection results in fewer attacks compared with standard care.
A proof-of-concept, randomized trial to investigate whether the prescription of inhaled corticosteroids (ICS) guided by blood eosinophils, or targeted antibiotics for airway bacterial infection, results in fewer unscheduled healthcare visits (UHCVs) compared with standard care. Children aged 1-5 years with ≥2 wheeze attacks in the previous year were categorized as episodic viral wheeze (EVW) or multiple trigger wheeze (MTW). The intervention group was prescribed ICS if blood eosinophils ≥3%, or targeted antibiotics if there is positive culture on induced sputum/cough swab. The control group received standard care. The primary outcome was UHCV at 4 months.
60 children, with a median age of 36.5 (range 14-61) months, were randomized. Median blood eosinophils were 5.2 (range 0-21)%, 27 of 60 (45%) children were atopic, and 8 of 60 (13%) had airway bacterial infection. There was no relationship between EVW, MTW and either blood eosinophils, atopic status or infection. 67% in each group were prescribed ICS. 15 of 30 control subjects and 16 of 30 patients in the intervention group had UHCV over 4 months (p = .8). The time to first UHCV was similar. 50% returned adherence monitors; in those, median ICS adherence was 67%. There were no differences in any parameter between those who did and did not have an UHCV.
Clinical phenotype was unrelated to allergen sensitization or blood eosinophils. ICS treatment determined by blood eosinophils did not impact UHCV, but ICS adherence was poor.
学龄前喘息的管理主要基于症状模式。
确定使用血液嗜酸性粒细胞或气道细菌感染进行个体化治疗是否比标准护理导致更少的发作。
一项概念验证、随机试验，旨在调查血液嗜酸性粒细胞指导下吸入皮质激素（ICS）或靶向抗生素治疗气道细菌感染是否比标准护理导致更少的非计划性医疗就诊（UHCV）。年龄在 1-5 岁、前一年有≥2 次喘息发作的儿童分为发作性病毒性喘息（EVW）或多种触发喘息（MTW）。如果血液嗜酸性粒细胞≥3%，干预组开具 ICS，如果诱导痰/咳嗽拭子培养阳性，则开具靶向抗生素。对照组接受标准护理。主要结局为 4 个月时 UHCV。
共 60 例儿童随机分组，中位年龄 36.5（14-61）个月。中位血嗜酸性粒细胞为 5.2（0-21）%，60 例儿童中有 27 例（45%）为特应性，60 例中有 8 例（13%）有气道细菌感染。EVW、MTW 与血嗜酸性粒细胞、特应性状态或感染均无关系。每组各有 67%的患儿开具 ICS。对照组和干预组各有 15 例和 16 例在 4 个月时有 UHCV（p=0.8）。首次 UHCV 的时间相似。50%的患儿返回了依从性监测器，其中 ICS 依从性中位数为 67%。在有或没有 UHCV 的患儿中，各参数均无差异。
临床表型与过敏原致敏或血嗜酸性粒细胞无关。根据血嗜酸性粒细胞确定的 ICS 治疗并未影响 UHCV，但 ICS 依从性较差。
