title: Clinical use of noninvasive measurements of airway inflammation in steroid reduction in children.
abstract: The use of noninvasive methods of monitoring airway inflammation, such as exhaled nitric oxide (eNO) and induced sputum, has been shown to improve asthma monitoring and optimize treatment in adult patients with asthma. There is a lack of comparable data in children. Forty children with stable asthma eligible for inhaled steroid reduction were reviewed every 8 weeks, and their inhaled steroid dose halved if clinically indicated. eNO, sputum induction combined with bronchial hyperreactivity testing, and exhaled breath condensate collection were performed at each visit to predict success or failure of reduction of inhaled steroids. Thirty of 40 (75%) children tolerated at least one dose reduction, 12 of 40 (30%) were successfully weaned off, and in total, 15 of 40 (38%) children experienced loss of asthma control. Treatment reduction was successful in all children who had no eosinophils in induced sputum before the attempted reduction. Using multiple logistic regression, increased eNO (odds ratio, 6.3; confidence interval, 3.75-10.58) and percentage of sputum eosinophils (odds ratio, 1.38; confidence interval, 1.06-1.81) were significant predictors of failed reduction. These findings suggest that monitoring airway inflammation may be useful in optimizing treatment in children with asthma.
authors.affiliation: Department of Respiratory Pediatrics, Clinical Trials and Evaluation Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. angela.zacharasiewicz@wienkav.at
authors.forename: Angela
authors.initials: A
authors.lastname: Zacharasiewicz
authors.forename: Nicola
authors.initials: N
authors.lastname: Wilson
authors.forename: Christiane
authors.initials: C
authors.lastname: Lex
authors.forename: Edward M
authors.initials: EM
authors.lastname: Erin
authors.forename: Albert M
authors.initials: AM
authors.lastname: Li
authors.forename: Trevor
authors.initials: T
authors.lastname: Hansel
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khan
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D016535:Bronchial Hyperreactivity / Q000378:metabolism; D002648:Child; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D009569:Nitric Oxide / Q000032:analysis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013183:Sputum / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D009569:Nitric Oxide