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Airway eosinophilia in children with severe asthma: predictive values of noninvasive tests

Christiane Lex1, Flavia Ferreira, Angela Zacharasiewicz

  • 1Department of Pediatric Respiratory Medicine, Imperial College of Science, Technology, and Medicine at the Royal Brompton Hospital and National Heart and Lung Institute, Sydney Street, London SW3 6NP, UK.

American Journal of Respiratory and Critical Care Medicine
|September 16, 2006
PubMed

Insights

Fraction of exhaled nitric oxide (FeNO) and sputum eosinophils show moderate agreement with bronchoalveolar lavage eosinophils in children with severe asthma. These markers offer good negative predictive value but poor positive predictive value for airway eosinophilia.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Immunology

Background:

  • Children with severe asthma often have persistent symptoms despite maximal treatment.
  • Fraction of exhaled nitric oxide (FeNO) and sputum eosinophils are used to guide steroid therapy.
  • Reliability of FeNO and sputum eosinophils in predicting bronchoscopically assessed airway eosinophilia in children is not well-established.

Purpose of the Study:

  • To evaluate the predictive accuracy of FeNO and sputum eosinophils for airway eosinophilia.
  • To compare these markers against bronchoalveolar lavage (BAL) and endobronchial biopsy findings.

Main Methods:

  • Twenty-seven children with moderate to severe persistent asthma participated.
  • Measurements included FeNO, sputum eosinophils, bronchoscopy, BAL, and endobronchial biopsy within 24 hours.

Main Results:

  • Significant correlations were observed between sputum eosinophils and BAL eosinophils (r=0.45) and FeNO (r=0.42).
  • FeNO showed a stronger correlation with BAL eosinophils (r=0.54).
  • Positive predictive value for elevated BAL eosinophils using sputum eosinophils was 75%; negative predictive value was 63%.

Conclusions:

  • Moderate agreement exists between FeNO, sputum eosinophils, and BAL eosinophils.
  • These markers demonstrate good negative predictive value but poor positive predictive value for mucosal eosinophilia.
Abstract

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