Bronchial Remodeling-based Latent Class Analysis Predicts Exacerbations in Severe Preschool Wheezers
Rationale: Children with preschool wheezing represent a very heterogeneous population with wide variability regarding their clinical, inflammatory, obstructive, and/or remodeling patterns. We hypothesized that assessing bronchial remodeling would help clinicians to better characterize severe preschool wheezers. Objectives: The main objective was to identify bronchial remodeling-based latent classes of severe preschool wheezers. Secondary objectives were to compare cross-sectional and longitudinal clinical and biological data between classes and to assess the safety of bronchoscopy. Methods: This double-center prospective study (NCT02806466) included severe preschool wheezers (1-5 yr old) requiring fiberoptic bronchoscopy. Bronchial remodeling parameters (i.e., epithelial integrity, reticular basement membrane [RBM] thickness, mucus gland, fibrosis and bronchial smooth muscle [BSM] areas, the density of blood vessels, and RBM-BSM distance) were assessed and evaluated by latent class analysis. An independent cohort of severe preschool wheezers (NCT04558671) was used to validate our results. Measurements and Main Results: Fiberoptic bronchoscopy procedures were well tolerated. A two-class model was identified: Class BR1 was characterized by increased RBM thickness, normalized BSM area, the density of blood vessels, decreased mucus gland area, fibrosis, and RBM-BSM distance compared with Class BR2. No significant differences were found between classes in the year before fiberoptic bronchoscopy. By contrast, Class BR1 was associated with a shorter time to first exacerbation and an increased risk of both frequent (3 or more) and severe exacerbations during the year after bronchoscopy in the two cohorts. Conclusions: Assessing bronchial remodeling identified severe preschool wheezers at risk of frequent and severe subsequent exacerbations with a favorable benefit to risk ratio.
| Errataetall: |
CommentIn: Am J Respir Crit Care Med. 2023 Feb 15;207(4):381-382. - PMID 36170640 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:207 |
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| Enthalten in: |
American journal of respiratory and critical care medicine - 207(2023), 4 vom: 15. Feb., Seite 416-426 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fayon, Michael [VerfasserIn] |
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| Links: |
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| Themen: |
Asthma |
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| Anmerkungen: |
Date Completed 17.02.2023 Date Revised 22.02.2023 published: Print ClinicalTrials.gov: NCT04558671, NCT02806466 CommentIn: Am J Respir Crit Care Med. 2023 Feb 15;207(4):381-382. - PMID 36170640 Citation Status MEDLINE |
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| doi: |
10.1164/rccm.202205-0913OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM346249023 |
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| 100 | 1 | |a Fayon, Michael |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Bronchial Remodeling-based Latent Class Analysis Predicts Exacerbations in Severe Preschool Wheezers |
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| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT04558671, NCT02806466 | ||
| 500 | |a CommentIn: Am J Respir Crit Care Med. 2023 Feb 15;207(4):381-382. - PMID 36170640 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: Children with preschool wheezing represent a very heterogeneous population with wide variability regarding their clinical, inflammatory, obstructive, and/or remodeling patterns. We hypothesized that assessing bronchial remodeling would help clinicians to better characterize severe preschool wheezers. Objectives: The main objective was to identify bronchial remodeling-based latent classes of severe preschool wheezers. Secondary objectives were to compare cross-sectional and longitudinal clinical and biological data between classes and to assess the safety of bronchoscopy. Methods: This double-center prospective study (NCT02806466) included severe preschool wheezers (1-5 yr old) requiring fiberoptic bronchoscopy. Bronchial remodeling parameters (i.e., epithelial integrity, reticular basement membrane [RBM] thickness, mucus gland, fibrosis and bronchial smooth muscle [BSM] areas, the density of blood vessels, and RBM-BSM distance) were assessed and evaluated by latent class analysis. An independent cohort of severe preschool wheezers (NCT04558671) was used to validate our results. Measurements and Main Results: Fiberoptic bronchoscopy procedures were well tolerated. A two-class model was identified: Class BR1 was characterized by increased RBM thickness, normalized BSM area, the density of blood vessels, decreased mucus gland area, fibrosis, and RBM-BSM distance compared with Class BR2. No significant differences were found between classes in the year before fiberoptic bronchoscopy. By contrast, Class BR1 was associated with a shorter time to first exacerbation and an increased risk of both frequent (3 or more) and severe exacerbations during the year after bronchoscopy in the two cohorts. Conclusions: Assessing bronchial remodeling identified severe preschool wheezers at risk of frequent and severe subsequent exacerbations with a favorable benefit to risk ratio | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a asthma | |
| 650 | 4 | |a bronchoscopy | |
| 650 | 4 | |a child | |
| 650 | 4 | |a exacerbation | |
| 650 | 4 | |a latent class analysis | |
| 700 | 1 | |a Beaufils, Fabien |e verfasserin |4 aut | |
| 700 | 1 | |a Esteves, Pauline |e verfasserin |4 aut | |
| 700 | 1 | |a Campagnac, Maryline |e verfasserin |4 aut | |
| 700 | 1 | |a Maurat, Elise |e verfasserin |4 aut | |
| 700 | 1 | |a Michelet, Marine |e verfasserin |4 aut | |
| 700 | 1 | |a Siao-Him-Fa, Valerie |e verfasserin |4 aut | |
| 700 | 1 | |a Lavrand, Frederic |e verfasserin |4 aut | |
| 700 | 1 | |a Simon, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Begueret, Hugues |e verfasserin |4 aut | |
| 700 | 1 | |a Berger, Patrick |e verfasserin |4 aut | |
| 700 | 0 | |a P’tit Asthme Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Auriol, Françoise |e investigator |4 oth | |
| 700 | 1 | |a Blanchon, Sylvain |e investigator |4 oth | |
| 700 | 1 | |a Carles, Dominique |e investigator |4 oth | |
| 700 | 1 | |a Boisserie-Lacroix, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Brémont, François |e investigator |4 oth | |
| 700 | 1 | |a Bui, Stéphanie |e investigator |4 oth | |
| 700 | 1 | |a Choukroun, Marie-Luce |e investigator |4 oth | |
| 700 | 1 | |a Debelleix, Stéphane |e investigator |4 oth | |
| 700 | 1 | |a Feghali, Hala |e investigator |4 oth | |
| 700 | 1 | |a Labouret, Géraldine |e investigator |4 oth | |
| 700 | 1 | |a Blondel, Audrey Martin |e investigator |4 oth | |
| 700 | 1 | |a Marais, Sébastien |e investigator |4 oth | |
| 700 | 1 | |a Mittaine, Marie |e investigator |4 oth | |
| 700 | 1 | |a Nacka, Fabienne |e investigator |4 oth | |
| 700 | 1 | |a Ousova, Olga |e investigator |4 oth | |
| 700 | 1 | |a Rouquette, Isabelle |e investigator |4 oth | |
| 700 | 1 | |a Semjen, François |e investigator |4 oth | |
| 700 | 1 | |a Sgoifo, Frédérique |e investigator |4 oth | |
| 700 | 1 | |a Trian, Thomas |e investigator |4 oth | |
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