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Airway inflammation and bronchial hyperreactivity in steroid naive children with intermittent and mild persistent
Muge Toyran1, Arzu Bakirtas, Funda Dogruman-Al
1Department of Pediatric Allergy and Immunology, Ankara Pediatric Health and Disease Hematology Oncology Research and Education Hospital, Ankara, Turkey.
Insights
Mild persistent asthma in children shows increased neutrophilic airway inflammation and bronchial hyperresponsiveness to indirect stimuli compared to intermittent asthma. Eosinophilic inflammation and direct BHR were similar between groups.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Clinical Research
Background:
- Asthma classification distinguishes intermittent and mild persistent types based on symptoms and spirometry, influencing treatment approaches.
- Current research lacks comparative data on airway inflammation between these pediatric asthma classifications.
- Understanding these differences is crucial for targeted pediatric asthma management.
Purpose of the Study:
- To compare airway inflammation markers and bronchial hyperresponsiveness (BHR) in children with intermittent versus mild persistent asthma.
- To investigate differences in eosinophilic and neutrophilic inflammation.
- To assess BHR to direct and indirect stimuli.
Main Methods:
- A comparative study involving children aged 7-16 years diagnosed with intermittent asthma, mild persistent asthma, or no asthma (control group).
- Exhaled nitric oxide (NO) measurement, sputum induction for cell counts, and bronchial provocation tests (adenosine monophosphate and methacholine) were performed.
- Clinical history, spirometry with reversibility, and symptom recording were conducted.
Main Results:
- No significant differences were observed in eosinophil counts or exhaled nitric oxide levels between the intermittent and mild persistent asthma groups.
- Children with mild persistent asthma exhibited higher neutrophil counts in sputum compared to those with intermittent asthma (P=0.003).
- Bronchial hyperresponsiveness to adenosine monophosphate (AMP) was lower in the mild persistent group (P=0.102), while methacholine response showed no significant difference (P=0.058).
Conclusions:
- Eosinophilic airway inflammation and direct bronchial hyperresponsiveness do not appear to differ significantly between children with intermittent and mild persistent asthma.
- Neutrophilic airway inflammation and bronchial hyperresponsiveness to indirect stimuli are more pronounced in children with mild persistent asthma.
- These findings suggest distinct inflammatory pathways may be involved in different pediatric asthma classifications.
Background:
Intermittent and mild persistent asthma are defined according to symptom frequency and spirometry and treated differently. To our knowledge, there is no study comparing airway inflammation between intermittent and mild persistent asthmatic children.
Materials And Methods:
Children aged 7-16 years, referred to our pediatric allergy clinic for recurrent respiratory complaints underwent a detailed clinical history and spirometry with reversibility. None of the subjects had been using regular anti-inflammatory treatment. After a 2-week run-in period during which asthma symptoms were recorded, exhaled NO measurement, bronchial provocation test with adenosine monophosphate and methacholine and sputum induction were performed. Data of patients with intermittent and mild persistent asthma and a control group were compared.
Results:
Thirty intermittent, 26 mild persistent asthmatic children, and 21 control subjects were studied. Sputum was obtained from 19 of intermittent asthmatics (63.3%), 18 of mild persistent asthmatics (69.2%), and 13 of control subjects (61.9%). Eosinophil count and exhaled nitric oxide were not different between asthmatic groups. Neutrophil count of children with mild persistent asthma was higher than the intermittent asthmatic group (P = 0.003). Geometric mean of PC20 methacoline values were not different between groups (P = 0.058). Geometric mean of PC20 AMP was lower among patients with mild persistent asthma (P = 0.102).
Conclusion:
Eosinophilic airway inflammation and direct BHR may not be significantly different in intermittent asthmatic children from their peers with mild persistent disease. Neutrophilic airway inflammation and BHR to an indirect stimuli are more pronounced in the mild persistent group.
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