Feasibility Study On Early Diagnosis Of Assessment And Intervention Therapy In Wheezing Infants

adults with asthma, recurrent infant wheezing is more likely related with acuterespiratory viral infection, and develops individualized treatment strategies based onthe respite clinical phenotype reached the top of wheezing/asthma optimal clinicalcontrol. In-depth understanding of the relationship between viral infection andwheezing infants, contribute to understanding the the inherent immunologicalmechanisms between infection and allergic inflammation, can help you betterunderstand the similarities and differences of wheezing infants with asthma, andultimately achieve asthma individualized treatment plan implementation.The majority of children with asthma for the first time wheezing in preschool,but the respite of about50%complete remission by the age of six. With the peak ageof respiratory viral infections, has been confirmed to induce acute attack of wheezinginfants the most common virus is RSV, and older children and adults. Virus infection-induced recurrent episodes of wheezing is a risk major factor for children asthma,observed wheezing infants, accurate assessment and early intervention therapy and thedevelopment and changes of their condition, is useful to reduce the incidence ofasthma and to improve the situation of children’s respiratory healthy. But the problemof missing plagued clinicians is early diagnosis to determine the need for earlytreatment and airway inflammation and functional evaluation.In recent years, the prevalence of asthma in a clear upward trend, a seriousimpact on children’s physical and mental health. Eosinophil is considered to be thebasic characteristics of the main effector cells, eosinophils in the inflammatoryresponse of asthma asthma has proven eosinophil inflammation is a good predictor ofasthma exacerbations, and that eosinophils to viral infection no response, however,the study revealed that eosinophils can promote viral clearance and enhanced theability of the host defense eosinophils in the case of lack of adaptive immuneresponses in a way to stimulate the primary host antiviral defense response. Already,many studies have proven that children with asthma sputum cell type can objectively phenotype that eosinophils and eosinophil-type, in the clinical treatment strategiesbased on these two phenotypes have gained success in adult asthma. However, thediagnosis of asthma in children with complex child asthma treatment programs todetermine very different than adults. It is increasingly recognized that a singletreatment for all children with asthma is unlikely to obtain clinical success, becausethere is a large group of “childhood asthma” is not truly part as respiratory recurrentinfections in patients treated extremely may be neglected asthma, therefore, todetermine the clinical phenotype of childhood asthma/wheezing disease, providepotential therapeutic targets and more personalized treatment for children wheezingrelated diseases. Therefore, we have adopted the liquid based cytology producertechnical study of asthma in high-risk groups-have repeated episodes of wheezinginfant with atopic by sputum cell phenotype, the findings of wheezing in childrencompared with mild, moderate to severe. Patient inclusion criteria: age <2years ofage, a previous history of recurrent wheezing≥3; never received oral montelukastsodium or ICS therapy. Exclusion criteria: acute upper respiratory tract infection3weeks,1week for treatment of patients with wheezing emergency. Referring Douwessuch research, the sputum the EOS%>2.5%as sputum EOS higher referenceSmipson research results, depending on the sputum NEU%>54%NEU increasedbinding EOS%increased or normal divided into4groups:①eosinophil celltype(EOS%>2.5%);②neutrophil-type(NEU%>54%);③less neutrophil-type(NEU%≤54%+EOS%≤2.5%); the④mixed myeloid(EOS%>2.5%+NEU%>54%). Detect serum EDN airway inflammatory markers and the tidal lungfunction tests, and contrast the wheezing infants airway inflammation and functionalchanges before and after the intervention therapy, in order to investigate thepathogenesis of the similarities and differences between wheezing infants with asthma,on infants and young children with asthma to achieve early diagnosis and propertreatment, improve the health of children.In this study, we use of liquid-based thin-layer cell production technology,combination of EDN enzyme-linked immunosorbent assay and tidal lung functiondetection technology, clinical manifestations of recurrent wheezing infantscomprehensive evaluation of the phenotype of airway inflammation and airwayfunction, in order to confirm wheezing infants is different from the common feature of the pathogenesis of asthma and asthma are closely related, and the discovery of thecharacteristics of the prognosis of wheezing infants.The results are as follows:1Wheezing infants are closely related with respiratory viral infections. Sevencommon respiratory viral pathogen screening, they found that about76.0%of thechildren with wheezing nasopharyngeal aspirates in the detection of respiratoryviruses, single RSV infection for the virus (48.0%), parainfluenza virus1,2, and3accounted for16.0%of influenza virus A, B (4.5%), adenovirus (7.5%), mixedinfection common accounted for9.0%, and visible triple-infected persons, almost15.0%of the children were not detected viral pathogens.2A neutrophil-type recurrent wheezing infants inflammatory celltype(65.2%), eosinophils type accounted for30.6%,4.2%mixed cell type, thesevere group showed the obvious advantage of eosinophils(accounting for25%),while the mild group eosinophils type accounted for only4.0%(p<0.05).3Serum EDN levels is different from the group of different inflammatory cells,eosinophils group (104.8±39.4) μg/l, sequentially mixed cell group(112.6±41.2)μg/l, neutrophils group(88.2±36.6) μg/l, and less neutrophil cell type(60.9±34.6)μg/l, serum EDN levels among the groups the difference was significant (p <0.05).4Although the peripheral blood eosinophil count in each inflammatory celltype had no significant differences(p>0.05)，but there was a significantly positivecorrelation between serum EDN levels and peripheral blood mononuclear cells(γ=0.781, p<0.05).5The tidal lung function prompts reduce recurrent wheezing children tidalvolume, low tidal volume and serum EDN levels related (γ=0.499, p<0.05).6Recurrent wheezing Infants had significantly respiratory rate increased thanthe control group of the same age, tidal volume indicators reflect airway obstructionsuch as TPTEF/TE, VPEF/VE is also lower than that of the control groupsignificantly(p<0.05). Remission in children with respiratory frequency decline,VT/kg, TPTEF, VPEF, TPTEF/TE, VPEF/VE rebounded significantly, indicatorsbefore and after treatment the difference was significant(p <005); remission periodVT/kg with the control group, no significant difference(p>0.05), but the differencewas significant in TPTEF/TE, VPEF/VE(p<0.05).7After treatment with montelukast sodium in106patients for12weeks，we found of the clinical symptoms improved in42.5%(45/106), after4weeks oftreatment and12weeks in recurrent wheezing Infants, coughing, wheezing, activities,tidal lung function and other Index were differences statistically significant comparedwith the control group(p<0.05). In two groups the the number of episodes ofwheezing, the average annual number of hospital days, with an average annualPrescription β2AG days, lung function improvement compared with baseline valuesshowed a significant difference (p<0.05). Follow-up of2years of treatment group,11cases(10.4%), the diagnosis of asthma control group of19patients (39.6%), thedifference was statistically significant(χ2=38.3967, p<0.05).8The end of the three months of treatment observation(end point), notmontelukast the Stener treatment group eosinophils respite serum EDN levels thancompared to the treatment group was significantly increased(p<0.05), and comparedwith the initial levels significantly increased(p <0.05); the treatment serum EDNlevels than before treatment decreased significantly(p <0.05).9Tidal volume in infants with wheezing before treatment significantly reduced,same to the significantly lower indicators reflect airway obstruction such asTPTEF/TE VPEF/VE， indicators before and after treatment differences weresignificant(p<0.05). After treatment for12weeks by montelukast sodium, we foundPTEF(ml/s), VT/kg, TPTEF and VPEF TPTEF/TE of VPEF/VE reboundedsignificantly in the treatment group compared with the control group(p<0.05),untreated group showed an improving PTEF(ml/s) after12weeks(p <0.05), butTPTEF/TE, VPEF/VE decline observed no significant changes before and after theend of observation, the difference was not statistically significant(p>0.05).In this study, wheezing infant’s common respiratory virus was screened by DFA.This study is the first to adopt the producers of liquid based cytology technologywheezing infants in patients with inflammatory parting with EDN as markers ofairway inflammation as an evaluation, and application of the tidal lung function ininfants with obstructive airway disease diagnosis and prognosis. We found that theinflammatory phenotype was unstable in wheezing infants compared to adult’s asthma.Eosinophil activation is difficult to early detection, so EDN because of its moresensitive can be used as a non-invasive evaluation of airway function markers. Tidallung function monitoring and assessment of airway function worth promoting.Montelukast sodium blocking eosinophil degranulation may be an effectively optional for early intervention therapy in wheezing infants.