Research Doctorate - Doctor of Philosophy (PhD) / Airway inflammation is a key feature of asthma. Currently, airway inflammation can be detected through both invasive and non- invasive methods. Non invasive methods are safe, feasible and a potentially useful way to assess airway inflammatory markers in both healthy children and children with asthma. In this thesis, a variety of non-invasive markers (induced sputum, exhaled nitric oxide, and exhaled breath condensate) was used to investigate childhood asthma. The aim of the first study was to compare and contrast the different airway markers between healthy children and children with asthma. The second study described the different airway inflammatory phenotypes in children with asthma, and examined clinical predictors of these phenotypes; whereas the third study investigated the effects of environmental tobacco smoke (ETS) exposure on airway inflammation in childhood asthma. The final study assessed the knowledge and attitudes of parents of children with asthma towards passive smoking. The studies used both cross- sectional and longitudinal designs. Children with stable asthma aged between 7 - 17 years underwent clinical assessment, spirometry, exhaled nitric oxide (FeNO), exhaled breath condensate and sputum induction. Urinary cotinine was assayed to assess tobacco smoke exposure. These studies have found that children with asthma show differences in both clinical pattern and pathological pattern compared to healthy children. These differences were apparent with elevated FeNO and sputum eosinophils. In children with asthma, there was heterogeneity of airway inflammation. There were 2 stable inflammatory patterns: eosinophilic asthma and paucigranulocytic asthma. Unlike adult asthma, these phenotypes have different clinical features, which may facilitate detection of the phenotypes in clinical practice. ETS exposure in children with asthma was common and associated with a non- eosinophilic pattern of airway inflammation. In children who had a change in ETS exposure, sputum eosinophils were decreased whereas sputum neutrophils were increased during ETS exposure compared to a non- ETS exposure period. Fractional exhaled nitric oxide levels were decreased after exposure to ETS compared to those at the time of non- ETS exposure. The severity of asthma was increased in children living with parents who smoked. As a result, parents of children with asthma, especially smoking parents should be more aware about the harmful effects of smoking on their children’s health and themselves. Health risk awareness about tobacco smoke helps parental smokers alter their smoking behavior as well as protecting children from ETS exposure. In conclusion, the important findings of this thesis are the description of the inflammatory phenotypes in childhood asthma, the identification of clinical predictors of these phenotypes and the determination of the effects of ETS exposure on airway inflammatory patterns in childhood asthma. These results should facilitate understanding and management of childhood asthma and prompt treatment studies based on markers of airway inflammation.
| Identifer | oai:union.ndltd.org:ADTP/244354 |
| Date | January 2007 |
| Creators | Nguyen, Thi Dieu Thuy |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright 2007 Thi Dieu Thuy Nguyen |
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