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Improvement of clinical and immunopathologic parameters in asthmatic children treated for concomitant chronic
Maria Angela Tosca1, Cristina Cosentino, Eugenio Pallestrini
1Department of Internal Medicine, University of Genoa, Genoa, Italy.
Insights
Treating chronic rhinosinusitis in children with asthma improved respiratory symptoms and function. This intervention reduced inflammation and shifted the immune response from Th2 to Th1, aiding asthma management.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Otolaryngology
Background:
- Chronic rhinosinusitis (CRS) is a common comorbidity in pediatric asthma.
- A Th2 cytokine profile is often observed in children with coexisting CRS and asthma.
- Understanding the impact of CRS treatment on asthma control is crucial.
Purpose of the Study:
- To assess the effect of treating CRS on respiratory symptoms and function in children with asthma.
- To evaluate changes in immunopathological parameters, including cytokine profiles, following CRS treatment.
Main Methods:
- Eighteen children (5-12 years) with moderate, poorly controlled asthma and CRS received 14-day treatment with amoxicillin-clavulanate and fluticasone nasal spray.
- A short course of oral corticosteroids was administered.
- Symptom scores, spirometry, nasal cytology, and sinonasal lavage for cytokine analysis were performed before and after treatment.
Main Results:
- Significant improvements in respiratory symptoms and spirometry were observed post-treatment and at 1-month follow-up.
- Nasal endoscopy showed improvement in 15 children.
- Inflammatory cell counts decreased, and the cytokine pattern shifted from Th2 (decreased IL-4) to Th1 (increased IFN-γ).
Conclusions:
- Treating concomitant chronic rhinosinusitis effectively improves asthma control in children.
- CRS treatment in asthmatic children leads to reduced airway inflammation.
- The immunopathological shift towards a Th1 profile may contribute to improved asthma outcomes.
Background:
Chronic rhinosinusitis is frequently associated with asthma. A Th2 cytokine pattern has been recently reported in chronic rhinosinusitis in asthmatic children.
Objective:
To evaluate the effects of treating concomitant chronic rhinosinusitis on respiratory symptoms and function and immunopathological parameters in asthmatic children.
Methods:
Eighteen children with moderate asthma (age range, 5 to 12 years) poorly controlled by high doses of inhaled corticosteroids and chronic rhinosinusitis were evaluated for symptoms, spirometry, and inflammation at baseline, after treatment, and 1 month after suspension of treatment. All of the children were treated with a combination of amoxicillin and clavulanate (20 mg/kg twice daily) and fluticasone propionate aqueous nasal spray (100 microg/d) for 14 days. A short course of oral corticosteroids was also prescribed (deflazacort, 1 mg/kg daily for 2 days, 0.5 mg/kg daily for 4 days, and 0.25 mg/kg daily for 4 days). Rhinosinusal lavage for cytokine measurements and a nasal scraping for cytologic analysis were performed in all patients before and after medical treatment.
Results:
A negative endoscopy result was demonstrated in 15 children after treatment. Symptoms and respiratory function significantly improved after treatment and 1 month later; 8 children had intermittent asthma and 10 had mild asthma. A significant reduction of inflammatory cell numbers was detected in all asthmatic children. Interleukin 4 levels significantly decreased (P < 0.001), whereas interferon-y levels increased (P < 0.001).
Conclusion:
Treatment of chronic rhinosinusitis is able to improve symptoms and respiratory function in asthmatic children, reducing inflammatory cells and reversing the cytokine pattern from a Th2 toward a Th1 profile.
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