Evaluation of a clinical algorithm involving serum eosinophil cationic protein for guiding the anti-inflammatory treatment of bronchial asthma in childhood
Division of Immunology/Hematology, University Children's Hospital, Zürich, Switzerland. Pediatric Allergy and Immunology
(Impact Factor: 3.4).
05/2000; 11(2):87-94. DOI: 10.1111/j.1399-3038.2000.00079.x
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.
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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 ...
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ABSTRACT: The relationship of airway inflammation with asthma severity remains unclear. Our aim was to correlate the results of recommended methods of assessment of inflammation with measures of asthma control, in children with a wide range of asthma severity. The study was a cross-sectional investigation of 58 children receiving a wide range of treatment, including 10 treated without regular maintenance therapy and 29 treated with high-dose inhaled corticosteroids (CS). Exhaled nitric oxide (NO), serum eosinophil cationic protein (ECP), and induced sputum (processed for eosinophil count and ECP level) were related to recent symptoms, lung function, and bronchial responsiveness. There was no significant correlation between the results of any METHOD: Neither did any marker of airway inflammation relate to recent symptoms, unlike PC20, which did. There was a significant, inverse correlation between the forced expiratory volume in 1 s (FEV1) and both NO and sputum ECP (r=-0.46, p=<0.001; r=-0.48, p=0.004, respectively). Sputum eosinophils were inversely related to the dose of methacholine that corresponded to a 20% fall in FEV1 (PC20) (r=-0.57, p=0.02). Serum ECP did not relate to any measure of asthma control. There was no association of any recommended inflammation markers with current symptoms and only a weak relationship between them and physiological measures. The place of these markers remains unclear and their use in clinical practice needs further investigation by long-term longitudinal studies.
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ABSTRACT: Asthmatic children having their tracheas intubated with sevoflurane often have an increase in respiratory system resistance (Rrs). In this randomized, placebo-controlled, double-blinded study, we investigated the protective effect of an inhaled beta2-adrenergic agonist. Either salbutamol or placebo was administered 30 to 60 min before anesthesia to 30 mildly to moderately asthmatic children scheduled for elective surgery. Induction was performed with sevoflurane in a mixture of 50% nitrous oxide in oxygen and maintained at 3%, with children breathing spontaneously via a face mask and Jackson-Rees modification of the T-piece. Airway opening pressure and flow were measured before and after insertion of an oral endotracheal tube. Rrs and respiratory system compliance were calculated with multilinear regression analysis. The groups were comparable with respect to age, weight, asthma history, and breathing pattern. Intubation induced a different Rrs response in the two groups: children treated with salbutamol showed a 6.0% (-25.2% to +13.2%) decrease (mean, 95% confidence interval), whereas in the Placebo group there was a 17.7% (+4.4% to +30.9%) increase (P = 0.04). Neither asthma history nor the serum inflammation marker eosinophilic cationic protein was predictive for this response. We conclude that when using sevoflurane in mildly to moderately asthmatic children, a preanesthetic treatment with inhaled salbutamol is protective of an increase in Rrs. IMPLICATIONS: Tracheal intubation with sevoflurane as the sole anesthetic is now often performed in children. It can induce an increase in respiratory system resistance in children with asthma. This study shows that in children with mild to moderate asthma, a preanesthetic treatment with inhaled salbutamol can prevent the increase of respiratory system resistance.
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