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Nasopharyngeal eosinophil cationic protein in bronchiolitis: relation to viral findings and subsequent wheezing
T M Reijonen1, M Korppi, M Kleemola
1Department of Pediatrics, Kuopio University Hospital, Finland.
Insights
High eosinophil cationic protein (ECP) in nasal aspirates predicts post-bronchiolitis wheezing in children. Anti-inflammatory therapies may benefit children with elevated ECP levels, suggesting eosinophilic inflammation.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Bronchiolitis is a common childhood respiratory illness.
- Wheezing after bronchiolitis can indicate underlying asthma.
- Eosinophil cationic protein (ECP) is a marker of eosinophilic inflammation.
Purpose of the Study:
- To investigate the predictive value of eosinophil cationic protein (ECP) in nasopharyngeal aspirates (NPA) for post-bronchiolitis wheezing.
- To assess the impact of anti-inflammatory therapy on ECP levels and wheezing outcomes in children with bronchiolitis.
Main Methods:
- Prospective 4-month follow-up of 88 children hospitalized with bronchiolitis.
- Measurement of ECP concentrations in nasopharyngeal aspirates (NPA).
- Assessment of physician-diagnosed wheezing and hospital admissions for wheezing.
Main Results:
- Elevated NPA ECP concentrations were significantly associated with physician-diagnosed wheezing and hospital admissions for wheezing.
- Children with negative viral findings had higher initial ECP levels.
- Anti-inflammatory therapies (cromolyn sodium, budesonide) significantly reduced bronchial obstruction and tended to decrease hospital admissions for wheezing in children with high ECP.
Conclusions:
- High NPA ECP concentrations in children with bronchiolitis are predictive of subsequent wheezing and may indicate eosinophilic inflammation similar to asthma.
- Anti-inflammatory treatment may be beneficial for children with high ECP levels post-bronchiolitis.
Abstract:
A prospective 4-month follow-up of children hospitalized with bronchiolitis revealed that high concentrations of eosinophil cationic protein (ECP) in nasopharyngeal aspirates (NPA) are predictive of wheezing after bronchiolitis. In the 29 patients who received no anti-inflammatory therapy the median concentration of NPA ECP was 882 ng/g in those with physician-diagnosed wheezing (P = 0.02). The NPA ECP concentration of the whole study group of 88 children with and without subsequent hospital admissions for wheezing were 531 and 299 ng/g, respectively (P = 0.02). At entry the children with negative viral findings had significantly higher concentrations of respiratory tract ECP than those with positive viral findings (515 vs. 240 ng/g; P = 0.01). The concentration of ECP in respiratory secretions decreased significantly after bronchiolitis (P = 0.01) provided that no new viral or mycoplasmal infection occurred. NPA ECP values decreased in relation to time regardless of whether anti-inflammatory therapy was used or not. Children with high concentrations of respiratory tract ECP seemed to benefit from anti-inflammatory therapy with nebulized cromolyn sodium or budesonide; both drugs significantly decreased the number of subsequent physician-diagnosed bronchial obstruction (P = 0.0006), and they tended to decrease the number of hospital admissions for wheezing (P = 0.08). Our results suggest that high concentrations of ECP in respiratory tract secretions in children with bronchiolitis reflect the presence of eosinophilic inflammation also seen in asthma.