Indirect Airway Hyperresponsiveness Test Enhances Asthma Control in Children

Incorporating indirect airway hyperresponsiveness (AHR) test with hypertonic saline in the management of asthma in children can reduce the risk of mild exacerbations, suggests a new study published in the journal Pediatric Pulmonology.1,2 Eosinophil counts were associated with the risk for recurrent exacerbations.

Janusz Ciółkowski from the Allergology Outpatient Clinic at the Regional Public Hospital in Lesko, Poland and colleagues conducted this study to establish the usefulness of indirect airway hyperresponsiveness (AHR) testing with hypertonic saline in maintaining asthma control in children. For this, they enrolled 104 patients, aged 7-15 years, with mild-moderate atopic asthma in the study. All patients underwent spirometry and assessment of exhaled nitric oxide and blood eosinophils assessment at the start of the study and then every 3 months for one year. Patients were randomized to either a symptom-only monitored group and a group in which treatment was modified on the basis of symptoms and severity of AHR.

At the end of one year, the patients in the AHR group had fewer mild exacerbations compared to the symptom-only monitored group; 44 vs 85, respectively. The absolute rate per patient was 0.83 vs. 1.67. However, changes in clinical (except asthma control test) parameters including inflammatory and lung function measures were comparable in both groups. The baseline eosinophil count was found to be linked to AHR and was “a risk factor for recurrent exacerbation in all patients”, noted the authors. No significant difference was detected between the two groups when the final dose of inhaled corticosteroids (ICS) was being decided; 287 (AHR group) vs 243 (symptom-monitored group).

Performing a hypertonic saline test in children with asthma in addition to clinical monitoring of patients improves asthma control as evidenced by reduction in the number of mild exacerbations. The dose of ICS required to maintain asthma control was also comparable between the two groups. “The hypertonic saline test appears to be a simple, cheap, and safe tool for monitoring the treatment of mild-to-moderate asthma in children”, concluded the authors.

References

1.   Janusz Ciółkowski, et al. Childhood asthma treatment based on indirect hyperresponsiveness test: randomized controlled trial. Pediatr Pulmonol. 2023 Sep;58(9):2583-2591. doi: 10.1002/ppul.26556.

2.   Grossi G. https://www.hcplive.com/view/indirect-airway-hyperresponsiveness-test-optimizing-asthma-treatment-children. Dated June 28, 2023, Accessed on Oct. 19, 2023.