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25th May 2022
A probiotic mixture given to preschool children suffering from wheeze resulted in a significant reduction in the number of episodes over a 16 week period, according to the findings of a subgroup analysis of data by Italian researchers.
Wheezing is a musical sound, high-pitched and continuous, emitting from the chest during breath exhalation. It is not a specific disorder, but rather a symptom with the two most common causes in young children being bronchiolitis and asthma. Wheeze is a relatively common with one study of over a million preschool children, finding a prevalence of 7.7%. Almost 50% of children experiences wheeze in the first 6 years of life but only 40% of these will continue to experience the condition after childhood.
Increasingly, research suggests an important link between viral infections and the microbiome, which is increasingly recognised as a significant player in the host immune system, influencing immunity and host defence mechanisms. Moreover, there appears to be a link between the respiratory microbiota in early life and an increased risk and frequency of subsequent respiratory infections, and occurrence of wheeze in later childhood. Furthermore, there is mounting evidence to suggest that probiotics containing Lactobacillus rhamnosus GG modestly reduces the duration of respiratory tract infections in children.
As a result, the Italian team wondered if probiotics could reduce the level of wheeze experienced by young children. In trying to answer this, they turned to a subgroup of patients included in the PRObiotics in Pediatric Management (PROPAM) trial. This randomised, double-blind, placebo-controlled trial, was designed to explore the potential role of probiotics in reducing wheeze episodes and asthma exacerbations in children. For the present analysis, the team focused on children between the ages of 3 and 6 years and who had with a history of persistent wheeze (> 3 episodes in their lifetime) but who were not diagnosed with asthma. The children were randomised 1:1, to either a probiotic mixture or placebo and which was taken twice daily for a total of 8 weeks and then once daily for a further 8 weeks. The mixture contained live cells of B. breve B632 and L. salivarius LS01 and the primary outcome of interest was a reduction in the number of wheezing episodes.
Probiotic mixture and wheeze episodes
A total of 160 children with a mean age of 4.3 years (42.5% female) were included, of whom, 64.4% had a family history of atopy. At the end of the study, children taking the probiotic mixture were significantly less likely to experience one wheezing episode compared to those assigned to placebo (odds ratio, OR = 0.42, 95% CI 0.18 – 0.95, p = 0.037). In addition, a higher proportion of those using the probiotic mixture experienced no wheezing episodes (87.6% vs 74.6%, probiotic vs placebo). However, the mean duration of wheezing episodes was not significantly different (3.7 vs 4.1 days, p = 0.58, probiotic vs placebo). Interestingly, children taking the probiotic mixture used inhaled corticosteroids less frequently (40% vs 56.5%, p < 0.05).
The authors concluded that the probiotic mixture may prevent wheezing episodes in preschool children and that it was safe and well tolerated.
Ciprandi G et al. The PRObiotics in Pediatric Asthma Management (PROPAM) study: A post hoc analysis in preschoolers Pediatr Pulmonol 2022