title: Asthma-predictive-index, bronchial-challenge, sputum eosinophils in acutely wheezing preschoolers.
abstract: BACKGROUND
  Most preschoolers with viral wheezing exacerbations are not atopic.
  
  
  OBJECTIVE
  To test in a prospective controlled trial whether wheezing preschoolers presenting to the ED are different from the above in three different domains defining asthma: the atopic characteristics based on stringent asthma predictive index (S-API), the characteristics of bronchial hyper-responsiveness (BHR), and airway inflammation.
  
  
  METHODS
  The S-API was prospectively collected in 41 preschoolers (age 31.9 ± 17.4 months, range; 1-6 years) presenting to the ED with acute wheezing and compared to healthy preschoolers (n = 109) from our community (community control group). Thirty out of the 41 recruited preschoolers performed two sets of bronchial challenge tests (BCT)-(methacholine and adenosine) within 3 weeks and following 3 months of the acute event and compared to 30 consecutive ambulatory preschoolers, who performed BCT for diagnostic workup in our laboratory (ambulatory control group). On presentation, induced sputum (IS) was obtained from 22 of the 41 children.
  
  
  RESULTS
  Primary: S-API, secondary: BCTs characteristics and percent eosinophils in IS.
  
  
  RESULTS
  Significantly more wheezing preschoolers were S-API positive compared with the community control group: 20/41 (48.7%) versus 15/109 (13.7%, P < 0.001). All methacholine-BCTs-30/30 (100%) were positive compared with 13/14 (92.8%) in the ambulatory control group (P = 0.32). However, 23/27 (85.2%) were adenosine-BCT positive versus 3/17 (17.5%) in the ambulatory control group (P < 0.001). Diagnostic IS success rate was 18/22 (81.8%). Unexpectedly, 9/18 (50.0%) showed eosinophilia in the IS.
  
  
  CONCLUSIONS
  Wheezing preschoolers presenting to the ED is a unique population with significantly higher rate of positive S-API and adenosine-BCT compared with controls and frequently (50%) express eosinophilic airway inflammation.
authors.affiliation: Pediatric Pulmonary Unit, Wolfson Medical Centre, Holon, Israel; The Sackler School of Medicine, Tel Aviv University, Holon, Israel.
authors.forename: Dorit
authors.initials: D
authors.lastname: Ater
authors.forename: Bat-El
authors.initials: BE
authors.lastname: Bar
authors.forename: Nir
authors.initials: N
authors.lastname: Fireman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fireman
authors.forename: Hanita
authors.initials: H
authors.lastname: Shai
authors.forename: Diana
authors.initials: D
authors.lastname: Tasher
authors.forename: Ilan
authors.initials: I
authors.lastname: Dalal
authors.forename: Avigdor
authors.initials: A
authors.lastname: Mandelberg
mesh_terms: D001249:Asthma / Q000175:diagnosis*; D016535:Bronchial Hyperreactivity / Q000175:diagnosis; D001985:Bronchial Provocation Tests; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004804:Eosinophils / Q000378:metabolism*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology*; D013183:Sputum / Q000166:cytology*
keywords: BHR: induced sputum; adenosine; asthma; asthma predictive index; bronchial challenge test; controlled clinical trial; methacholine; preschool children; wheezing