C. S. Mott Children's Hospital
Pulmonology: Research
Amy Goldstein Filbrun, M.D.
Pathogenesis of persistent wheezing in infants.
Little is known about the pathogenesis of recurrent wheezing in infants. Infantile wheezing may not be a single condition, but instead may occur as a consequence of allergies, viral infection and/or congenitally small or dysfunctional airways. Because bronchodilators and inhaled steroids improve airflow and reduce airways hyperresponsiveness in older children and adults, they are therefore also used regularly to treat infants with moderate to severe persistent wheezing. However, the efficacy of these medications in the treatment of each of the above subgroups of wheezy infants has not been well studied.
Dr. Goldstein is quantifying pulmonary function (spirometry and plethysmography), airway inflammation (exhaled hydrogen peroxide and serum ICAM-1 and IL-2 receptor levels) and allergic sensitization (serum IgE, skin prick testing, peripheral blood monocyte stimulation studies) in infants with moderate-to-severe persistent wheezing. She is testing the general hypotheses that: i) recurrent wheezing in infants with a family history of asthma or allergy or evidence of allergic sensitization is due to inflammation of the airways, and should therefore respond to inhaled steroid treatment; and ii) wheezy infants with allergic sensitization will continue to have recurrent wheezing and pulmonary function abnormalities in later childhood. The proposed studies, funded by the National Institutes of Health, will provide insight into the pathogenesis of wheezing in infants, and inform the medical care of these patients.
Assessment of Lung Function and Non-Invasive Markers of Airway Inflammation in Infants with Bronchopulmonary Dysplasia
Dr. Goldstein is also assessing lung function and airway inflammation in infants and young children with bronchopulmonary dysplasia (BPD). Lung function is assessed using the raised volume rapid thoracoabdominal compression technique, and airway inflammation is assessed by measuring inflammatory markers in the exhaled breath condensate and serum. She hypothesizes that these patients will exhibit abnormal lung function and lower airway inflammation, and that the degree of airway inflammation will correlate with the level of lung function abnormalities. This work is funded by the American Lung Association of Metropolitan Chicago.
Recent publications:
- Goldstein A, Goldstein L, Perl M, Haug M, Arroliga A, Stillwell P. Comparison of cystic fibrosis patients with and without central nervous system complications following lung transplantation. Pediatr Pulmonol 30:203-206, 2000.
- Jones M, Castile R, Davis S, Kisling J, Filbrun D, Flucke R, Goldstein A, Emsley C, Ambrosius W, Tepper R. Forced expiratory flows and volumes in infants: Normative data and lung growth. Am J Respir Crit Care Med 161:353-359, 2000.
- Goldstein A, Castile R, Davis S, Filbrun D, Flucke R, McCoy K, Tepper R. Bronchodilator responsiveness in normal infants and young children. Am J Respir Crit Care Med 164:447-454, 2001.
