To study some inflammatory markers before and after inhaled corticosteroid (ICS)therapy in children with moderate persistent bronchial asthma and to correlate the changes in their levels, if any, with recurrence of the clinical manifestations.
30 children aged 5–15 year with bronchial asthma and 20 age and sex matched healthy children (control group) were subjected to measurement of the levels of hypertonic saline-induced sputum eosinophils , absolute eosinophilic count AEC, eosinophilic cationic protein ECP, and tumor necrosis factor-∼ TNF-∼ in addition to measurement of forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC). the first sample was taken from the patients and control before the start of therapy while in the patients group two other samples were taken. The second sample was taken after 3 months of ICS therapy ( after control of the clinical manifestations) and the third was taken with reappearance of the clinical manifestations either during or after complete withdrawal of the ICS therapy (over 4 months.
Our patients in the pretreatment sample had significantly higher levels of sputum eosinophis, AEC, ECP, TNF- ∼, and FEV1/FVC compared to the controls (P = 0.001 for the five variants). Compared to the pretreatment values these values except AEC decreased significantly after 3 months of ICS (P = 0.001, 0.07, 0.001, 0.001, and 0.001 respectively). Relapse occurred in 25 patients during withdrawal of the ICS therapy and 5 patients remained free of symptoms after complete stoppage of the treatment. Relapse was associated with significant increase in the levels of TNF-∼ and sputum eosinophils in the third sample compared to the second sample (P = 0.02, and 0.045 respectively).
Inflammation in bronchial asthma is evidenced by increased levels of the inflammatory markers. ICS therapy is effective against this inflammation. TNF-∼ followed by sputum eosinophils are sensitive predictors of relapse in the children suffering from bronchial asthma.
Physicians can monitor bronchial asthma using non-invasive measurements. Researches to find out specific anti-inflammatory markers therapy should be activated.
Mohammed Ragab, No Financial Disclosure Information; No Product/Research Disclosure Information