Exhaled NO and eosinophil markers in blood, nasal lavage and sputum in children with asthma after withdrawal of budesonide.
BACKGROUND
There is a need for controlled trials among children with asthma to evaluate and compare different markers of inflammation.


OBJECTIVE
Our goal was to investigate the effect of withdrawal of inhaled budesonide on repeated measurements of exhaled NO (ENO), peripheral blood eosinophils (PBE), sputum/NAL/serum-eosinophil cationic protein (ECP), bronchial hyperresponsiveness (BHR) and forced expiratory volume in 1 s (FEV(1)) in children with allergic asthma.


METHODS
Eighteen asthmatic children were randomly allocated to continue or discontinue use of inhaled budesonide. They were followed up, at six visits for 4 months with regular blood, serum, sputum, and NAL samples. Sixteen age-matched healthy children served as controls.


RESULTS
ENO, PBE, and S-ECP increased significantly in the withdrawal group (p < 0.05) but not in the continuous treatment group. No trend could be observed during the study for markers in sputum or in NAL in either group.


CONCLUSIONS
The present data provide evidence for the clinical usefulness of measuring ENO, PBE, and S-ECP and when combined they could help to avoid over- and undertreatment with corticosteroids in the growing child.
Astrid Lindgren Children's Hospital, Karolinska Hospital, Stockholm, Sweden. karin.lonnkvist@kbh.ki.se
Karin
K
Lönnkvist
Martin
M
Anderson
Gunilla
G
Hedlin
Magnus
M
Svartengren
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis*; D016535:Bronchial Hyperreactivity / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D019819:Budesonide / Q000627:therapeutic use*; D002648:Child; D047150:Eosinophil Cationic Protein / Q000032:analysis; D004804:Eosinophils / Q000378:metabolism*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D008297:Male; D017817:Nasal Lavage Fluid / Q000737:chemistry / Q000276:immunology; D009569:Nitric Oxide / Q000032:analysis* / Q000378:metabolism; D013183:Sputum / Q000737:chemistry / Q000276:immunology
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D009569:Nitric Oxide; D019819:Budesonide; D047150:Eosinophil Cationic Protein