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Granulocyte proteins in serum in childhood asthma: relation to spirometry and therapy
H Scher1, D Berman, E G Weinberg
1Allergy Clinic, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Insights
Serum markers like eosinophil cationic protein (ECP) and eosinophil protein X (EPX) indicate airway inflammation in childhood asthma. Their correlation with lung function varies, with ECP/EPX levels offering some predictive value in steroid-dependent cases.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Biomarker Research
Background:
- Eosinophil activation markers in asthmatic patients reflect ongoing airway inflammation.
- Understanding these markers is crucial for assessing disease activity in childhood asthma.
Purpose of the Study:
- To investigate correlations between serum allergic inflammation markers and spirometry in asthmatic children.
- To compare these correlations across different asthma treatment groups.
Main Methods:
- Measured blood eosinophils, serum eosinophil cationic protein (ECP), eosinophil protein X (EPX), myeloperoxidase (MPO), and tryptase.
- Conducted serial spirometry (FEV1/FVC, FEF25-75, FEF) in 60 children with acute asthma over 60 days.
- Classified patients into three groups: bronchodilators only, sodium cromoglycate, and corticosteroids.
Main Results:
- Oral corticosteroid treatment initially reduced ECP and EPX levels, but reductions were not sustained.
- Inconsistent correlations were found between ECP, EPX, eosinophil counts, and spirometry parameters.
- ECP and EPX monitoring showed some predictive value for clinical outcomes in steroid-dependent asthma, but not in mild asthma.
Conclusions:
- Elevated serum ECP, EPX, and MPO suggest inflammation in childhood asthma and may inversely correlate with spirometry.
- The relationship between these inflammatory markers and lung function in asthmatic children is complex.
- Serial monitoring of ECP and EPX may aid in managing steroid-dependent asthma.
Background:
Measurement of markers of eosinophil activation in asthmatics provides information indicative of ongoing inflammatory processes in the airways.
Objectives:
This study was conducted to determine the correlations between serum markers of allergic inflammation with spirometry parameters in asthmatic children in different treatment groups.
Methods:
Blood eosinophils, serum levels of eosinophil cationic protein (ECP), eosinophil protein X (EPX), myeloperoxidase (MPO) and tryptase were measured simultaneously with serial measurements of FEV1/FVC, FEF25-75 and FEF in 60 children with acute asthma on admission and after 2, 14, 30 and 60 days. Group A received bronchodilators only (n = 20), group B received sodium cromoglycate (SCG) (n = 20) and group C received oral and/or inhaled corticosteroids (n = 20).
Results:
Oral steroid treatment (2 mg/kg/day), given at the onset of the asthma attack, resulted in significant reduction in the ECP and EPX levels in all the children. However, these reduced ECP and EPX levels were not sustained in the children, even in those who continued on maintenance steroid treatment. Significant, but inconsistent, correlations between ECP, EPX with total eosinophil count, Percentage eosinophils and spirometry parameters were observed at the different time-points. Tryptase levels were normal in all subjects. There were no significant correlations between myeloperoxidase levels and the spirometry parameters or eosinophil parameters. Serial monitoring of ECP and EPX levels was found to be of some use in predicting clinical outcome in certain steroid-dependent asthmatics (group C) but of no value in the mild asthmatics (group A).
Conclusion:
While elevation of ECP, EPX and MPO in the serum of childhood asthmatics suggests ongoing inflammation and may inversely correlate with spirometry parameters in some patients, the relationship between these markers and airway function is not a simple one.