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Evidence for different subgroups of difficult asthma in children

D N Payne1, N M Wilson, A James

  • 1Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.

Thorax
|April 20, 2001
PubMed

Insights

Difficult childhood asthma involves persistent airway inflammation, measurable by exhaled nitric oxide (NO). Oral prednisolone reduced NO levels in most children, but some showed steroid-resistant inflammation, indicating varied asthma patterns.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Immunology

Background:

  • Difficult childhood asthma often presents with persistent symptoms despite high-dose inhaled corticosteroids.
  • Airway inflammation, a key factor in persistent asthma, can be monitored using exhaled nitric oxide (NO).

Purpose of the Study:

  • To evaluate airway inflammation in children with difficult asthma using exhaled nitric oxide (NO).
  • To investigate the therapeutic response of difficult childhood asthma to oral prednisolone treatment.

Main Methods:

  • Exhaled nitric oxide (NO) levels were measured in 23 children with difficult asthma before and after a 2-week course of oral prednisolone.
  • Clinical outcomes, including spirometry, peak flow, bronchodilator use, and symptoms, were assessed.
  • Serum concentrations of prednisolone and cortisol were measured to evaluate treatment adherence.

Main Results:

  • Asthmatic children exhibited higher baseline exhaled NO levels compared to healthy controls.
  • Oral prednisolone treatment led to a significant reduction in NO levels and improved morning peak flow.
  • A subgroup of patients (five out of nine) maintained elevated NO levels post-treatment, suggesting steroid-insensitive inflammation.

Conclusions:

  • Difficult asthma in children often involves airway inflammation responsive to oral prednisolone.
  • Two distinct patient subgroups were identified: those with steroid-sensitive inflammation and those with persistent steroid-insensitive inflammation.
  • Persistent symptoms in both subgroups highlight the heterogeneity of difficult asthma in pediatric populations.
Abstract

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