title: Lung function, airway remodelling and inflammation in symptomatic infants: outcome at 3 years.
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.
authors.affiliation: Department of Allergy, Helsinki University Central Hospital, P O Box 160, FI-00029 Helsinki, Finland. kristiina.malmstrom@fimnet.fi
authors.forename: Kristiina
authors.initials: K
authors.lastname: Malmström
authors.forename: Anna S
authors.initials: AS
authors.lastname: Pelkonen
authors.forename: L Pekka
authors.initials: LP
authors.lastname: Malmberg
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Harry
authors.initials: H
authors.lastname: Lindahl
authors.forename: Merja
authors.initials: M
authors.lastname: Kajosaari
authors.forename: Markku
authors.initials: M
authors.lastname: Turpeinen
authors.forename: Sejal
authors.initials: S
authors.lastname: Saglani
authors.forename: Andy
authors.initials: A
authors.lastname: Bush
authors.forename: Tari
authors.initials: T
authors.lastname: Haahtela
authors.forename: Peter K
authors.initials: PK
authors.lastname: Jeffery
authors.forename: Mika J
authors.initials: MJ
authors.lastname: Mäkelä
mesh_terms: D056151:Airway Remodeling / Q000502:physiology*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D001485:Basement Membrane / Q000473:pathology; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D019819:Budesonide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000503:physiopathology; D007223:Infant; D008168:Lung / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D020545:Respiratory Mucosa / Q000473:pathology; D012135:Respiratory Sounds / Q000503:physiopathology; D012882:Skin Tests
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D019819:Budesonide