Asthma severity and inflammation markers in children

Wilson, Nicola; James, Anna; Uasuf, Carina Gabriela; Payne, Donald; Hablas, Hatem Refaat; Agrofioti, Catherine; Bush, Andrew

doi:10.1034/j.1399-3038.2001.012003125.x

Cited by 58 publications

(53 citation statements)

References 30 publications

(47 reference statements)

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“…Since airway responsiveness below the level of AHR was only associated with asthma symptoms, it is suggested that airway responsiveness to hypertonic saline also reflects longer-term airway abnormalities. Other explanations may be a lack of sensitivity for blood eosinophilic markers to detect bronchial inflammation [23], or the possibility that airway responsiveness and eosinophilic activation represent different inflammatory pathways [24,25].…”

Section: Discussionmentioning

confidence: 99%

Airway responsiveness to hypertonic saline: dose-response slope or PD15?

Meer

Marks²,

Jongste³

et al. 2005

European Respiratory Journal

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The result of airway challenge test with hypertonic saline (HS) is expressed as the dose causing a 15% fall in forced expiratory volume in one second (FEV1; PD15). A noncensored measure, such as the dose-response slope (DRS), allows the evaluation of the risk of asthma for subjects with a fall in FEV1 ,15%. The aim of this study was to assess the relationship between airway responsiveness to HS by PD15 or DRS, asthma symptoms and markers of eosinophilic inflammation.Data on current wheeze and airway responsiveness were obtained for 1,107 children (aged 8-13 yrs). Blood eosinophils and serum eosinophil cationic protein (ECP) were assessed in subsets (n5683 and 485). PD15 was assessed if FEV1 fell o15%, and the DRS was calculated for all tests. Graphs were constructed to visualise relationships with current wheeze, blood eosinophils and serum ECP. Odds ratios and Spearman's correlation coefficients were calculated to quantify these relationships.Children with features of asthma had lower PD15 and higher DRS, and separation was most pronounced for DRS. Prevalence of current wheeze increased continuously over the entire range of DRS values. Blood eosinophils were significantly higher only for the highest values of DRS.In conclusion, the continuous relationship between airway responsiveness and asthma symptoms is in favour of a noncensored measure of airway responsiveness, such as the doseresponse slope.KEYWORDS: Airway hyperresponsiveness, childhood asthma, dose-response slope, epidemiology, hypertonic saline, provocative dose causing a 15% fall in forced expiratory volume in one second W orldwide, airway challenge with hypertonic saline (HS) is performed in childhood population studies that adhere to the International Study on Allergy and Asthma in Childhood (ISAAC) [1]. HS is an indirect stimulus that causes bronchoconstriction, presumably by the release of inflammatory mediators from intermediary cells. There is evidence to suggest that, in children with asthma, airway hyperresponsiveness (AHR) to HS is more closely related to the underlying airway inflammation than AHR to direct stimuli, such as methacholine or histamine [2,3].Conventionally, AHR to HS is considered to be present if the forced expiratory volume in one second (FEV1) falls by o15% fall after inhalation of a provocative dose of f23 g HS (PD15 f23 g), which is the cumulative dose after 15.5 min inhalation at a minimal nebuliser output of 1.5 mL?min -1 [1]. According to this definition, the presence of AHR to HS has a specificity of up to 92% for asthma symptoms in the past 12 months and a doctor's diagnosis of asthma [4]. In children with AHR, the PD15 provides a measure of severity of airway hyperresponsiveness. However, PD15 can only be assessed in individuals with AHR and will be of limited value in general population studies in which the prevalence of AHR is modest. It is not clear whether subjects who have a sub-threshold (i.e. ,15%) fall in FEV1 have an increased probability of asthma symptoms and pathology compared to nonresponsive ...

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Section: Discussionmentioning

confidence: 99%

Airway responsiveness to hypertonic saline: dose-response slope or PD15?

Meer

Marks²,

Jongste³

et al. 2005

European Respiratory Journal

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“…More recently, there have been attempts to determine the relationship of FENO levels with other markers of asthma severity (8,9) and to separate asthma into subgroups using FENO levels and response to oral prednisolone (10). These studies have supported the role of FENO in monitoring disease control (9) and identification of subgroups of steroid-insensitive asthma (10).…”

mentioning

confidence: 97%

Exhaled nitric oxide reflects asthma severity and asthma control

Delgado-Corcoran¹,

Kissoon²,

Murphy³

et al. 2004

Pediatric Critical Care Medicine

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“…4,5 The induced sputum test has been shown to be a safe method, with the potential to characterize the intensity and development of the inflammatory process. However, the peculiarities of the cytology at different degrees of asthma intensity and the differences between stable and exacerbated states have not been fully evaluated in children.…”

Section: Introductionmentioning

confidence: 99%

Escarro induzido em crianças e adolescentes com asma: segurança, aplicabilidade clínica e perfil de células inflamatórias em pacientes estáveis e durante exacerbação

Palomino¹,

Bussamra²,

Saraiva-Romanholo³

et al. 2005

J. Pediatr. (Rio J.)

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Objectives: To determine the safety of sputum induction in asthmatic children and adolescents, to characterize sputum inflammatory cells while clinically stable and during exacerbation and to correlate sputum inflammatory cells with peripheral blood eosinophils, serum IgE and the degree of bronchial obstruction.Methods: Ninety-six asthmatic patients aged 6 to 18 years were recruited for the present cross-sectional study. Spirometry was performed before and after administration of a bronchodilator. Sputum was collected spontaneously or after induction by the inhalation of saline solution at increasing concentrations. Blood samples were obtained for serum IgE and eosinophil quantification.Results: Sputum samples adequate for analysis were obtained from 68 (70.8%) of the patients recruited. No relevant bronchoconstriction was observed during induction. The presence of a larger number of eosinophils in sputum did not correlate with more clinically severe asthma. No correlation was observed between the degree of bronchial obstruction, measured based on FEV 1 , and inflammatory cells in sputum, peripheral blood eosinophils or serum IgE. Larger numbers of neutrophils were observed in the asthma exacerbation group (p < 0.05).Conclusions: Sputum induction was found to be a safe procedure for obtaining clinical samples from children and adolescents even during exacerbations, allowing for clinical and functional limitations. The 67% induction success rate was considered satisfactory. In this group of patients, receiving inhaled corticosteroids, eosinophil quantification did not distinguish between the clinical and functional severity of asthma and was independent of the degree of airway obstruction. A proportional predominance of neutrophils was observed in the sputum of patients with asthma exacerbation.

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Asthma severity and inflammation markers in children

Cited by 58 publications

References 30 publications

Airway responsiveness to hypertonic saline: dose-response slope or PD15?

Airway responsiveness to hypertonic saline: dose-response slope or PD15?

Exhaled nitric oxide reflects asthma severity and asthma control

Escarro induzido em crianças e adolescentes com asma: segurança, aplicabilidade clínica e perfil de células inflamatórias em pacientes estáveis e durante exacerbação

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