Imperial College London
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DrLouiseFleming

Faculty of Medicine, National Heart & Lung Institute

Honorary Senior Research Fellow
 
 
 
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Contact

 

+44 (0)20 7352 8121 ext 2938l.fleming

 
 
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Location

 

Department of Respiratory PaediaRoyal BromptonRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Saglani:2022:10.1111/pai.13697,
author = {Saglani, S and Bingham, Y and Balfour-Lynn, I and Goldring, S and Gupta, A and Banya, W and Moreiras, J and Fleming, L and Bush, A and Rosenthal, M},
doi = {10.1111/pai.13697},
journal = {Pediatric Allergy and Immunology},
pages = {1--8},
title = {Blood eosinophils in managing preschool wheeze: Lessons learnt from a proof-of-concept trial},
url = {http://dx.doi.org/10.1111/pai.13697},
volume = {33},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundManagement of preschool wheeze is based predominantly on symptom patterns.ObjectiveTo determine whether personalizing therapy using blood eosinophils or airway bacterial infection results in fewer attacks compared with standard care.MethodsA 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.Results60 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.ConclusionClinical phenotype was unrelated to allergen sensitization or blood eosinophils. ICS treatment determined by blood eosinophils did not impact UHCV, but ICS adherence was poor.
AU  - Saglani,S
AU  - Bingham,Y
AU  - Balfour-Lynn,I
AU  - Goldring,S
AU  - Gupta,A
AU  - Banya,W
AU  - Moreiras,J
AU  - Fleming,L
AU  - Bush,A
AU  - Rosenthal,M
DO  - 10.1111/pai.13697
EP  - 8
PY  - 2022///
SN  - 0905-6157
SP  - 1
TI  - Blood eosinophils in managing preschool wheeze: Lessons learnt from a proof-of-concept trial
T2  - Pediatric Allergy and Immunology
UR  - http://dx.doi.org/10.1111/pai.13697
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000722150500001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://onlinelibrary.wiley.com/doi/10.1111/pai.13697
UR  - http://hdl.handle.net/10044/1/92955
VL  - 33
ER  -
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