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Asthma severity and inflammation markers in children
1Department of Paediatrics, Royal Brompton and Harefield NHS Trust, Chelsea Wing, Sydney St., London SW3 6NP, UK. n.wilson@rbh.nthames.nhs.uk
Insights
Markers of airway inflammation did not correlate with asthma symptoms in children. However, lung function measures like FEV1 showed inverse relationships with exhaled nitric oxide and sputum eosinophil cationic protein.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Immunology
Background:
- The link between airway inflammation and asthma severity is not fully understood.
- Current methods for assessing inflammation in children with asthma require further validation.
Purpose of the Study:
- To correlate established inflammation markers with asthma control measures in children.
- To investigate the utility of exhaled nitric oxide, serum eosinophil cationic protein, and induced sputum analyses.
Main Methods:
- Cross-sectional study of 58 children with diverse asthma severity and treatments.
- Assessed exhaled nitric oxide (NO), serum eosinophil cationic protein (ECP), and induced sputum (eosinophils, ECP).
- Correlated inflammation markers with symptoms, lung function (FEV1), and bronchial responsiveness (PC20).
Main Results:
- No significant correlation found between inflammation markers and recent asthma symptoms.
- Inverse correlation observed between FEV1 and both NO and sputum ECP.
- Sputum eosinophils inversely related to bronchial responsiveness (PC20).
- Serum ECP showed no relation to any asthma control measure.
Conclusions:
- Recommended inflammation markers have limited association with current asthma symptoms and physiological measures in children.
- The clinical utility of these markers for asthma control assessment needs further investigation.
- Longitudinal studies are recommended to clarify the role of inflammation markers in asthma management.
Unlabelled:
The relationship of airway inflammation with asthma severity remains unclear. Our aim was to correlate the results of recommended methods of assessment of inflammation with measures of asthma control, in children with a wide range of asthma severity. The study was a cross-sectional investigation of 58 children receiving a wide range of treatment, including 10 treated without regular maintenance therapy and 29 treated with high-dose inhaled corticosteroids (CS). Exhaled nitric oxide (NO), serum eosinophil cationic protein (ECP), and induced sputum (processed for eosinophil count and ECP level) were related to recent symptoms, lung function, and bronchial responsiveness. There was no significant correlation between the results of any
Method:
Neither did any marker of airway inflammation relate to recent symptoms, unlike PC20, which did. There was a significant, inverse correlation between the forced expiratory volume in 1 s (FEV1) and both NO and sputum ECP (r=-0.46, p=<0.001; r=-0.48, p=0.004, respectively). Sputum eosinophils were inversely related to the dose of methacholine that corresponded to a 20% fall in FEV1 (PC20) (r=-0.57, p=0.02). Serum ECP did not relate to any measure of asthma control. There was no association of any recommended inflammation markers with current symptoms and only a weak relationship between them and physiological measures. The place of these markers remains unclear and their use in clinical practice needs further investigation by long-term longitudinal studies.