Improvement of clinical and immunopathologic parameters in asthmatic children treated for concomitant chronic rhinosinusitis.
BACKGROUND
Chronic rhinosinusitis is frequently associated with asthma. A Th2 cytokine pattern has been recently reported in chronic rhinosinusitis in asthmatic children.


OBJECTIVE
To evaluate the effects of treating concomitant chronic rhinosinusitis on respiratory symptoms and function and immunopathological parameters in asthmatic children.


METHODS
Eighteen children with moderate asthma (age range, 5 to 12 years) poorly controlled by high doses of inhaled corticosteroids and chronic rhinosinusitis were evaluated for symptoms, spirometry, and inflammation at baseline, after treatment, and 1 month after suspension of treatment. All of the children were treated with a combination of amoxicillin and clavulanate (20 mg/kg twice daily) and fluticasone propionate aqueous nasal spray (100 microg/d) for 14 days. A short course of oral corticosteroids was also prescribed (deflazacort, 1 mg/kg daily for 2 days, 0.5 mg/kg daily for 4 days, and 0.25 mg/kg daily for 4 days). Rhinosinusal lavage for cytokine measurements and a nasal scraping for cytologic analysis were performed in all patients before and after medical treatment.


RESULTS
A negative endoscopy result was demonstrated in 15 children after treatment. Symptoms and respiratory function significantly improved after treatment and 1 month later; 8 children had intermittent asthma and 10 had mild asthma. A significant reduction of inflammatory cell numbers was detected in all asthmatic children. Interleukin 4 levels significantly decreased (P < 0.001), whereas interferon-y levels increased (P < 0.001).


CONCLUSIONS
Treatment of chronic rhinosinusitis is able to improve symptoms and respiratory function in asthmatic children, reducing inflammatory cells and reversing the cytokine pattern from a Th2 toward a Th1 profile.
Tosca
Maria Angela
MA
Department of Internal Medicine, University of Genoa, Genoa, Italy.
Cosentino
Cristina
C
Pallestrini
Eugenio
E
Caligo
Giacomo
G
Milanese
Manlio
M
Ciprandi
Giorgio
G
D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D000730:Androstadienes / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004724:Endoscopy; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D015847:Interleukin-4 / Q000378:metabolism; D008297:Male; D009504:Neutrophils / Q000378:metabolism; D011282:Pregnenediones / Q000627:therapeutic use; D012221:Rhinitis, Allergic, Perennial / Q000150:complications* / Q000188:drug therapy; D012852:Sinusitis / Q000150:complications* / Q000188:drug therapy
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D011282:Pregnenediones; D015847:Interleukin-4; D019980:Amoxicillin-Potassium Clavulanate Combination; D007371:Interferon-gamma; D000068298:Fluticasone; C021988:deflazacort