Detection of early signs of astma in children with airway problems.

Study synopsis:
Confirmed wheezing in infancy as basis for molecular fingerprinting in the prediction of asthma. EuroPA study.



Rationale:
Young children with confirmed wheeze do already exhibit the major histological features of asthma. There is increasing evidence that microbial and biological characteristics can improve the phenotyping of infants at risk of asthma. The aim of the present study is to use confirmed wheezing as the basis for the application of modern molecular profiling in the prediction of asthma in young children.



Hypothesis:
We postulate that the development of asthma in preschool children can be captured during the first 2 years of life by a minimally invasive ‘fingerprint’.



Methods:

Patients - 1000 infants (< 2 years):
An estimated:

1. 330 patients will present with parent reported wheeze of which 130 will exhibit confirmed wheeze;

2. 100 aged matched infants will be used as controls from the same cohort.

Study design:
3-phase 6 years prospective follow-up study:

1. Phase 1 (2 yrs duration): inclusion and baseline assessments in wheezy infants and their healthy age-matched controls during the first 2 years of life;

2. Phase 2 (2 yrs duration): monitoring of respiratory symptoms;

3. Phase 3 (2 yrs duration): outcome assessment of the children for the presence of objective criteria for asthma at age 5.



Primary outcome:
Asthma at the age of 5 years, objectively established on basis of a validated combination of symptoms and/or the use of asthma medication, in combination with spirometry and increased bronchial hyper responsiveness, based upon the then applicable international standards.



Methods:
Predictors will be gathered by means of:

1. Wheeze confirmation;

2. Exhaled air: Molecular pattern recognition by electronic nose;

3. Nasal aspirate and throat swab: Viral and typical/atypical bacterial detection by qPCR;

4. Molecular phenotyping: Quantitative PCR analysis, cellular and soluble immunological
markers, and multiplex antibody measurements in whole venous blood samples.



Analysis:
Associations between predictors and outcome will be examined by univariate analysis and predictive logistic models.



Relevance:

The concept of confirmed wheezing can be considered as a new clinical opportunity to provide phenotype-specific management in preschool children. By combining this with molecular profiling, our study aims to provide a clinical-molecular signature for the prediction of asthma. We hope that this can be applied for the development of focused treatment and prevention.

We postulate that the development of asthma in preschool children can be captured during the first 2 years of life by a minimally invasive ‘fingerprint’.

Asthma at age 6.

None, the study is purely observational.