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Is a two-week trial of oral prednisolone predictive of target lung function in pediatric asthma?
Christiane Lex1, Donald N R Payne, Angela Zacharasiewicz
1Department of Respiratory Paediatrics, Imperial College of Science, Technology and Medicine at the Royal Brompton Hospital and National Heart and Lung Institute, London, UK.
Insights
A short prednisolone course doesn't predict future lung function in children with difficult asthma. Higher eosinophil counts were linked to exceeding target lung function, suggesting individual assessment is crucial.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Clinical Medicine
Background:
- Determining optimal lung function targets is crucial for managing difficult childhood asthma.
- A short course of prednisolone is often used to establish a baseline lung function.
- Predicting future lung function based on initial steroid response requires further investigation.
Purpose of the Study:
- To assess if children with difficult asthma exceed their "target" forced expiratory volume in 1 second (FEV1) after a prednisolone trial.
- To identify clinical or pathological features associated with exceeding the target FEV1.
- To evaluate the predictive value of a short-term steroid course for long-term lung function.
Main Methods:
- Children aged 6-16 with difficult asthma received a 2-week prednisolone trial.
- Spirometry and exhaled nitric oxide (FeNO) were measured pre- and post-treatment.
- Lung biopsies assessed subepithelial eosinophils and basement membrane thickness; highest FEV1 over 1 year was compared to target FEV1.
Main Results:
- 18% of children exceeded their target FEV1 (>9% increase) during follow-up without additional asthma medications.
- Three of seven children with persistent airflow limitation (PAL) improved to >80% predicted FEV1.
- Significantly higher subepithelial eosinophils were found in children who exceeded their target FEV1 (12.4 cells/mm2) compared to those who did not (1.4 cells/mm2).
Conclusions:
- A 2-week prednisolone trial is not fully predictive of "target" lung function in children with difficult asthma.
- Persistent airflow limitation (PAL) definitions may need regular, individual review.
- Subepithelial eosinophil levels may indicate potential for exceeding target lung function.
Abstract:
We used a 2-week trial of prednisolone to determine "target" lung function for subsequent asthma therapy. The aim of this study was to evaluate whether some children exceed their "target" forced expired volume in 1 sec (FEV1) on subsequent visits in the following year, and whether this is associated with particular clinical or pathological features. Children (aged 6-16 years) with difficult asthma underwent spirometry and exhaled nitric oxide (FE(NO)) measurements before and after 2 weeks of prednisolone 40 mg/day. At the end of the course, subepithelial eosinophils and reticular basement membrane thickness were assessed. The highest FEV1 obtained in a 1-year follow-up was compared with the poststeroid postbronchodilator ("target") FEV1. Four of 22 children (18%) demonstrated an increase of > 9% above their "target" FEV1 during follow-up. None of these children had been prescribed additional asthma medications. Three of 7 children with persistent airflow limitation (PAL; poststeroid postbronchodilator FEV1 < 80% predicted) recorded an FEV1 > 80% predicted during follow-up. The median (interquartile range) number of subepithelial eosinophils was significantly higher in children who exceeded their target FEV1 than in children who did not (12.4 (8.5-39.9) vs. 1.4 (0.0-4.8) cells/mm2, P = 0.018). In conclusion, a 2-week course of prednisolone is not necessarily predictive of "target" lung function. Definitions such as PAL should be regularly reviewed on individual basis.
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