title: Effect of oral glucocorticoid treatment on serum inflammatory markers in acute asthma.
abstract: BACKGROUND
  Acute asthma is associated with elevated serum concentrations of products of activated T cells and eosinophils.
  
  
  OBJECTIVE
  To compare the changes in concentrations of these products with disease severity and changes in lung function following oral prednisolone treatment.
  
  
  METHODS
  Twenty patients (mean age 8.7 years) were recruited on admission with acute asthma to a district general hospital. Disease severity was recorded before and after treatment with oral prednisolone using a validated pulmonary index score. Serum concentrations of interleukin (IL)-4, IL-5, soluble (s)CD25 (soluble IL-2 receptor), using a specific enzyme linked immunosorbent assay, and eosinophil cationic protein (ECP), using radioimmunoassay, were measured concomitantly. Non-asthmatic children (n = 6, mean age 9.2 years) undergoing elective surgery were recruited as controls, and serum samples were obtained on one occasion without treatment. Main outcome measures were changes in serum concentrations of cytokines and ECP, clinical asthma severity score, and peak expiratory flow rate.
  
  
  RESULTS
  As expected, oral glucocorticoid treatment in the children with asthma was associated with clinical improvement and also with significant reductions in serum concentrations of IL-5 (mean 5.59 to 2.19 pg/ml, p = 0.0001), sCD25 (mean 2236 to 1772 pg/ml, p = 0.002), and ECP (mean 54.3 to 33. 1 pg/ml, p = 0.0001). Serum IL-4 concentrations, in most patients and all the controls, remained below the sensitivity of the assay. However, serum concentrations of IL-5, sCD25, and ECP remained significantly higher than in controls, even after treatment with oral glucocorticoids (p = 0.03).
  
  
  CONCLUSIONS
  These data suggest that T cell mediated inflammation may persist in childhood asthma despite apparent clinical remission associated with conventional doses of prednisolone. The long term consequences of persistent inflammation after an apparently treated acute attack of asthma require clarification. Clinical assessment and pulmonary function are inadequate surrogates for airway inflammation.
authors.affiliation: Department of Paediatrics, Queen Mary's Hospital, Sidcup, Kent DA14 6LT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sahid El-Radhi
authors.forename: C L
authors.initials: CL
authors.lastname: Hogg
authors.forename: J K
authors.initials: JK
authors.lastname: Bungre
authors.forename: A
authors.initials: A
authors.lastname: Bush
authors.forename: C J
authors.initials: CJ
authors.lastname: Corrigan
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000097:blood* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins / Q000032:analysis*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D015847:Interleukin-4 / Q000097:blood; D015848:Interleukin-5 / Q000097:blood; D007378:Interleukins / Q000097:blood*; D008297:Male; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D011239:Prednisolone / Q000627:therapeutic use*; D011863:Radioimmunoassay; D015375:Receptors, Interleukin-2 / Q000097:blood; D012260:Ribonucleases; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D005938:Glucocorticoids; D015848:Interleukin-5; D007378:Interleukins; D015375:Receptors, Interleukin-2; D015847:Interleukin-4; D011239:Prednisolone; D012260:Ribonucleases