Diagnostic value of a pattern of exhaled breath condensate biomarkers in asthmatic children.
BACKGROUND
Diagnosing asthma in children is a challenge and using a single biomarker from exhaled breath condensate (EBC) showed the lack of improvement in it.


OBJECTIVE
The aim of this study was to assess the diagnostic potential of a pattern of simple chemical biomarkers from EBC in diagnosing asthma in children in a real-life setting, its association with lung function and gastroesophageal reflux disease (GERD).


METHODS
In 75 consecutive children aged 5-7 years with asthma-like symptoms the following tests were performed: skin prick tests, spirometry, impulse oscillometry (IOS), exhaled NO (FENO), 24-hour oesophageal pH monitoring and EBC collection with subsequent analysis of pH, carbon dioxide tension, oxygen tension, and concentrations of magnesium, calcium, iron and urates.


RESULTS
No significant differences were found for individual EBC biomarkers between asthmatics and non-asthmatics (p>0.05 for all). A pattern of six EBC biomarkers showed a statistically significant (p=0.046) predictive model for asthma (AUC=0.698, PPV=84.2%, NPV=38.9%). None to moderate association (R2up to 0.43) between EBC biomarkers and lung function measures and FENO was found, with IOS parameters showing the best association with EBC biomarkers. A significantly higher EBC Fe was found in children with asthma and GERD compared to asthmatics without GERD (p=0.049).


CONCLUSIONS
An approach that involves a pattern of EBC biomarkers had a better diagnostic accuracy for asthma in children in real-life settings compared to a single one. Poor to moderate association of EBC biomarkers with lung function suggests a complementary value of EBC analysis for asthma diagnosis in children.
Children's Hospital Srebrnjak, Srebrnjak 100, HR-10000 Zagreb, Croatia. Electronic address: ivanamaloca@gmail.com.
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Maloča Vuljanko
Children's Hospital Srebrnjak, Srebrnjak 100, HR-10000 Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 10/E, HR-31000 Osijek, Croatia. Electronic address: turkalj@bolnica-srebrnjak.hr.
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Turkalj
Children's Hospital Srebrnjak, Srebrnjak 100, HR-10000 Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 10/E, HR-31000 Osijek, Croatia. Electronic address: bolnica@bolnica-srebrnjak.hr.
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Nogalo
Children's Hospital Srebrnjak, Srebrnjak 100, HR-10000 Zagreb, Croatia. Electronic address: lokas@bolnica-srebrnjak.hr.
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Bulat Lokas
Children's Hospital Srebrnjak, Srebrnjak 100, HR-10000 Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 10/E, HR-31000 Osijek, Croatia. Electronic address: plavec@bolnica-srebrnjak.hr.
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Plavec
D001249:Asthma / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis*; D001944:Breath Tests / Q000379:methods; D002245:Carbon Dioxide / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D045853:Exhalation; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000032:analysis*; D011237:Predictive Value of Tests; D012882:Skin Tests; D013147:Spirometry
D015415:Biomarkers; D002245:Carbon Dioxide; D009569:Nitric Oxide
Asthma; Children; Diagnosis; Exhaled breath condrensate; Lung function test