title: Withdrawal of inhaled steroids in children with non-cystic fibrosis bronchiectasis.
abstract: BACKGROUND
  To study the effects of inhaled steroid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non-cystic fibrosis (non-CF) bronchiectasis.
  
  
  OBJECTIVE
  To evaluate the role of inhaled steroids in the treatment of children with non-CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apoptosis.
  
  
  METHODS
  Twenty-seven children with steady-state non-CF bronchiectasis were evaluated primarily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) levels and neutrophil ratios in induced sputum before and after 12-week withdrawal of inhaled steroids.
  
  
  RESULTS
  There were 16 girls and 11 boys. Median (interquartile range) age was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years. Symptom scores (4 vs. 3; P = 0.27), oxygen saturation (95% vs. 97%; P = 0.06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P = 0.73), sputum neutrophil ratios (29.9% vs. 46.8%; P = 0.20), TNF-alpha (58 pg/mL vs. 44.5 pg/mL; P = 0.55) and IL-8 (2.7 ng/mL vs. 2.4 ng/mL; P = 0.82) levels in induced sputum were similar before and after 12-week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P = 0.016) and neutrophilic apoptosis in induced sputum decreased (42.8% vs. 20.2%; P = 0.03) after withdrawal.
  
  
  CONCLUSIONS
  In this study, 12 week-withdrawal of inhaled steroid treatment resulted in a significant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non-CF bronchiectasis was observed.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey. tulayguran@yahoo.com
authors.forename: T
authors.initials: T
authors.lastname: Guran
authors.forename: R
authors.initials: R
authors.lastname: Ersu
authors.forename: B
authors.initials: B
authors.lastname: Karadag
authors.forename: F
authors.initials: F
authors.lastname: Karakoc
authors.forename: G Y
authors.initials: GY
authors.lastname: Demirel
authors.forename: N
authors.initials: N
authors.lastname: Hekim
authors.forename: E
authors.initials: E
authors.lastname: Dagli
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D017209:Apoptosis / Q000187:drug effects; D015415:Biomarkers / Q000378:metabolism; D016535:Bronchial Hyperreactivity / Q000209:etiology; D001987:Bronchiectasis / Q000188:drug therapy*; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008297:Male; D016210:Methacholine Chloride; D009504:Neutrophils / Q000378:metabolism; D013183:Sputum / Q000378:metabolism; D013375:Substance Withdrawal Syndrome / Q000209:etiology*
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D016210:Methacholine Chloride