Evaluation of a clinical algorithm involving serum eosinophil cationic protein for guiding the anti-inflammatory treatment of bronchial asthma in childhood.
ABSTRACT A pilot study was performed to investigate a clinical algorithm using serum-eosinophil cationic protein level (S-ECP) as an objective parameter for tapering the anti-inflammatory treatment in chronic childhood asthma. We studied 21 outpatient asthmatic children (6 girls and 15 boys, mean age 9 yr, range 3-12 yr, all with initial S-ECP > or = 15 microg/l) over a period of 12 months at monthly intervals. At each visit a short history, clinical examination, blood sample for S-ECP and eosinophil count, lung function tests and drug compliance were assessed. According to the initial S-ECP, patients were allocated to two anti-inflammatory treatment groups: patients with S-ECP between 15 microg/l and 30 microg/l were treated with Budesonide 200 microg twice daily, while patients with S-ECP of 30 microg/l and above received Budesonide 400 microg twice daily. After this induction treatment the anti-inflammatory medication was tapered at monthly intervals according to actually measured S-ECP: patients with S-ECP < 15 microg/l received sodium cromoglycate (SCG) 10 mg twice daily per inhalation via spacer, patients with S-ECP > or = 15 microg/l and < 30 microg/l received Budesonide 200 microg twice daily via spacer, and patients with S-ECP > or = 30 microg/l received Budesonide 400 microg twice daily. Prior to inhalation of topical steroids or SCG all patients had to inhale 500 microg Terbutaline twice daily for optimal bronchodilatation. The use of medication was assessed by weighing the metered dose inhaler containers each month. Our results showed a decrease in symptoms (p = 0.0001) and in S-ECP (p= 0.02) and MEF50% predicted (p= 0.02) after the initial month of Budesonide treatment. During a total of 246 months of investigation there was no need for emergency room treatment or hospital admission, and no need for oral steroids. During the whole study period there was a tendency for inhaled steroids to be more effective than SCG in reduction of markers of airway inflammation, improvement of symptoms and lung function. Inadequate use of medication was related to an increase in S-ECP in all treatment groups. From this open pilot study it is concluded that a clinical algorithm including S-ECP for tapering the anti-inflammatory treatment may be helpful in childhood asthma. These first observations should be confirmed by a controlled long-term study.
- SourceAvailable from: europepmc.org[Show abstract] [Hide abstract]
ABSTRACT: Asthma is a heterogeneous disease that means not all asthmatics respond to the same treatment. We hypothesize an approach to characterize asthma phenotypes based on symptomatology (shortness of breath (SOB), cough, and wheezy phenotypes) in correlation with airway inflammatory biomarkers and FEV1. We aimed to detect whether those clinical phenotypes have an impact on the response to asthma medications. Two hundred three asthmatic children were allocated randomly to receive either montelukast (5 mg at bed time) or fluticasone propionate (100 ug twice daily) for 8 consecutive weeks. Serum concentrations of IL-2Rs, ICAM-1, VCAM-1, total IgE, eosinophilic %, eosinophil cationic protein (ECP), and FEV1 were done before and after treatment to patients and once to controls. Children who have SOB were found to have higher levels of total sIgE, older age, and longer disease duration, and they responded to fluticasone alone. Cough group was found to have higher levels of eosinophilic % and sECP, younger age, shorter disease duration and responded to montelukast alone. Wheezy group showed mixed pattern and responded to both medications. Conclusion. Although there is variability in response to ICS and LTRAs, we did identify characteristics of patient that should guide the clinician in the choice of asthma medications.ISRN pediatrics. 01/2013; 2013:824781.
Article: Aleitamento materno e asma[Show abstract] [Hide abstract]
ABSTRACT: Dissertação de Mestrado em Ciências de Enfermagem, área de especialização em Pediatria, apresentada à Faculdade de Medicina da Universidade do Porto A asma constitui uma das patologias importantes na infância, tornando-se, conjuntamente com outras doenças imunoalérgicas, numa preocupação constante; o aumento da sua prevalência, com principal incidência nos países ocidentais e desenvolvido. Apesar de nos últimos anos se ter verificado um aumento dos conhecimentos da etiopatogenia da asma e dos avanços nas técnicas de biologia molecular e genética, as condições do seu aumento permanecem obscuras.A multiplicidade de factores que podem coexistir na génese da asma só recentemente começou a ser especificada em diferentes estudos epidemiológicos e anatomopatológicos, permitindo uma exploração mais real e pormenorizada.É do conhecimento da comunidade científica que o leite materno é o único alimento para a criança nos primeiros meses de vida, não só porque contém os nutrientes necessários ao óptimo crescimento e desenvolvimento, como também contribui de forma acentuada para a prevenção de patologias infecciosas e alérgicas.O aleitamento materno constitui, também, um dos primeiros actos de comunicação interactiva Mãe-Filho de forma gratificante, pois cria laços de vinculação extremamente fortes, aumentando a estabilidade emocional e afectiva de ambos, contribuindo para um desenvolvimento equilibrado do Filho e da Família.As propriedades protectoras do leite materno podem ser divididas em factores celulares e factores humorais, no entanto, os dois actuam de forma complementar.Vários estudos demonstraram que o aleitamento materno exclusivo pode levar à menor incidência de doença atópica e alergias alimentares. Os anticorpos passam para as crianças através do leite materno fazendo parte do que chamamos sistema imune enteromamário .Este estudo tem como finalidade estudar a relação entre a duração do aleitamento materno e a manifestação de asma na criança.A população sobre a qual o nosso estudo incidiu foi o das crianças que frequentam a Consulta de Imuno-Alergologia do Departamento de Pediatria do Hospital de S. João ...
- [Show abstract] [Hide abstract]
ABSTRACT: Eosinophil cationic protein (ECP) has been widely investigated as a potential biomarker of airway inflammation. A systematic review was performed using Medline with key terms eosinophil cationic protein and asthma, limiting the search to titles or abstracts. Out of 688 potential papers found, abstracts were reviewed based on the following criteria: (1) ECP was used as a biological marker, (2) asthma was the index disease studied, (3) it was a controlled clinical study and (4) ECP was assessed as a diagnostic, assessment or management tool. One hundred and sixty-nine articles satisfied the selection criteria and their full-text versions were reviewed. Only 53 papers were found to provide clinically useful information. ECP has been measured in serum, plasma, sputum, saliva and broncho-alveolar lavage fluids but serum and sputum are the most established. Levels of ECP in normal and asthmatic subjects in various body fluids were identified. ECP correlates well with airway inflammation but not airway hyper-responsiveness. It is raised in other atopic diseases and hence is not diagnostic for asthma. However, it has been shown to be useful in assessing asthma severity, compliance with anti-inflammatory asthma therapy and as a guide to tailing down inhaled corticosteroid therapy. Although there is some evidence that ECP levels are affected by age, smoking, circadian rhythm and seasonal variation, only smoking appears to be of clinical significance. Despite its limitations, ECP remains potentially useful in asthma management. Future research on ECP should focus on using serial measurements and combining it with other markers of asthma which may increase its clinical usefulness.Respiratory Medicine 05/2007; 101(4):696-705. · 2.59 Impact Factor