Associations Between Different Eosinophil Activity Markers and Clinical Outcomes in Young Asthmatics

Identifying biomarkers for different aspects of asthma morbidity is crucial for effective disease monitoring and management. The performance of fractional exhaled nitric oxide (FeNO), blood eosinophil count (BEC), and eosinophil activity markers should be evaluated.

This study aimed to compare the associations of FeNO, BEC, serum and plasma eosinophil-derived neurotoxin (S- and P-EDN), and serum eosinophilic cationic protein (S-ECP) with important clinical outcomes in asthma.

In total, 390 individuals aged 10-35 years with physician-diagnosed asthma were included. Asthma control test (ACT), spirometry, and methacholine challenge tests were used to assess asthma morbidity. The biomarkers' associations with asthma outcomes: impaired spirometry (FEV₁ < 80% predicted, FEV₁/FVC < lower limit of normal), airway hyperresponsiveness (AHR), uncontrolled asthma (ACT < 20) were analysed with multiple logistic regression models adjusted for body mass index, sex, age, immunoglobulin E sensitisation, smoking, and controller medication. The Akaike information criterion (AIC) was calculated for each model, to compare biomarker performance.

S-EDN had the lowest AIC value of all biomarkers in models assessing the association with reduced lung function, showing better model fit than P-EDN and S-ECP. However, FeNO and BEC had the lowest AIC values for AHR. FeNO was the only biomarker associated with uncontrolled asthma.

S-EDN may serve as an alternative to BEC in research setting and could be relevant in assessing airway obstruction. However, adding S-EDN as a routine biomarker alongside FeNO and BEC may offer limited additional clinical value. Further research in larger cohorts is needed to validate these findings and establish optimal cut-offs.