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Published ahead of print on February 11, 2005, doi:10.1164/rccm.200409-1242OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 10, May 2005, 1077-1082

A more recent version of this article appeared on May 15, 2005
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Submitted on September 24, 2004
Accepted on January 21, 2005

Clinical Use of Non-Invasive Measurements of Airway Inflammation in Steriod Reduction in Children

Angela Zacharasiewicz1*, Nicola Wilson2, Christiane Lex3, Edward M Erin4, Albert M Li2, Trevor Hansel4, Mohammed Khan5, and Andrew Bush2

1 Department of Respiratory Pediatrics, Royal Brompton Hospital, London, United Kingdom; Department of Pediatric and Adolescent Medicine, Pulmonary and Infectious Diseases, Wilhelminenspital, Vienna, Austria, 2 Department of Respiratory Pediatrics, Royal Brompton Hospital, London, United Kingdom, 3 Department of Respiratory Pediatrics, Royal Brompton Hospital, London, United Kingdom; Department of Paediatric Cardiology and Pulmonology, Heinrich Heine University, Duesseldorf, Germany, 4 Department of Thoracic Medicine, Imperial College, Clinical Studies Unit, National Heart and Lung Institute (NHLI), London, United Kingdom, 5 Department of Health Services Research, Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, United Kingdom

* To whom correspondence should be addressed. E-mail: angela.zacharasiewicz{at}wienkav.at.

The use of non-invasive methods of monitoring airway inflammation such as exhaled nitric oxide (eNO) and induced sputum has been shown to improve asthma monitoring and optimize treatment in adult asthmatics. There is a lack of comparable data in children. 40 stable asthmatic children eligible for inhaled steroid reduction were reviewed every 8 weeks, and their inhaled steroid dose halved if clinically indicated. ENO, sputum induction (IS) combined with bronchial hyperreactivity testing (BHR) and exhaled breath condensate collection (EBC) was performed at each visit, in order to predict success or failure of reduction of inhaled steroids. 30/40 (75%) children tolerated at least one dose reduction, 12/40 (30%) were successfully weaned off and in total 15/40 (38%) children experienced loss of asthma control. Treatment reduction was successful in all children who had no eosinophils in induced sputum prior to attempted reduction. Using multiple logistic regression, increased eNO (OR 6.3, CI 3.75-10.58) and sputum eosinophils % (OR 1.38, CI 1.06-1.81) were significant predictors for failed reduction. These findings suggest that monitoring airway inflammation may be useful in optimizing treatment in children with asthma.
Key words: sputum eosinophil counts, exhaled nitric oxide, asthma, children




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