title: Lung function, airway remodeling, and inflammation in infants: outcome at 8 years.
abstract: BACKGROUND
  Associations between early deficits of lung function, infant airway disease, and outcome at school age in symptomatic infants are still unclear.
  
  
  OBJECTIVE
  To report follow-up data on a unique cohort of children investigated invasively in infancy to determine predictive value of airway disease for school-aged respiratory outcomes.
  
  
  METHODS
  Fifty-three infants previously studied using bronchoscopy and airway conductance were approached at 8 years of age. Symptoms, lung volumes, and airway responsiveness were reassessed. Data on lifetime purchase of asthma medication were obtained. Lung function was compared with that of 63 healthy nonasthmatic children.
  
  
  RESULTS
  Forty-seven children were reevaluated. Physician-diagnosed asthma was present in 39 children (83%). Twenty-five children (53%) had current and 14 children (30%) had past asthma. No pathologic feature in infancy correlated with any outcome parameter. As expected, study children had significantly reduced lung function and increased airway responsiveness compared with healthy controls, and very early symptoms were risk factors for reduced lung function. Current asthma was associated with reduced infant lung function and parental asthma. Reduced lung function in infancy was associated with purchase of inhaled corticosteroids when 6 to 8 and 0 to 8 years of age.
  
  
  CONCLUSIONS
  The lack of predictive value of any pathologic measure in infancy, reported here for the first time to our knowledge, demonstrates that pathologic processes determining the inception of asthma, which are as yet undescribed, are different from the eosinophilic inflammation associated with ongoing disease.
authors.affiliation: Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: kristiina.malmstrom@fimnet.fi.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Malmström
authors.affiliation: Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: L Pekka
authors.initials: LP
authors.lastname: Malmberg
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom.
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Reilly
authors.affiliation: Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Harry
authors.initials: H
authors.lastname: Lindahl
authors.affiliation: Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Kajosaari
authors.affiliation: Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Kristiina M
authors.initials: KM
authors.lastname: Saarinen
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom.
authors.forename: Sejal
authors.initials: S
authors.lastname: Saglani
authors.affiliation: Institute of Pathology, University of Oslo, Oslo, Norway.
authors.forename: Frode L
authors.initials: FL
authors.lastname: Jahnsen
authors.affiliation: Department of Pediatrics, Imperial College London, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
authors.affiliation: Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Tari
authors.initials: T
authors.lastname: Haahtela
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.affiliation: Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Pelkonen
authors.affiliation: Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland.
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 / Q000453:epidemiology* / Q000276:immunology; D016535:Bronchial Hyperreactivity / Q000453:epidemiology* / Q000503:physiopathology; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000276:immunology; D008168:Lung / Q000503:physiopathology*; D008170:Lung Compliance; D008297:Male; D011379:Prognosis; D012123:Pulmonary Ventilation; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics; D011795:Surveys and Questionnaires
chemical_list: D018927:Anti-Asthmatic Agents