Markers of systemic and lung inflammation in childhood asthma.
OBJECTIVE
To compare different biomarkers of inflammation in children with controlled and uncontrolled asthma and to investigate their relationship with other clinical indices of asthma control (symptoms, lung function, serum IgE, and prn beta-agonist use).


METHODS
A total of 62 consecutive asthmatic children (age 11 +/- 3.3 years, 32 girls) with controlled ([C], n = 19) and uncontrolled asthma ([NC], n = 43) were studied. Measured lung function and inflammatory biomarkers included: spirometry, exhaled NO (F(E)NO), high-sensitivity C-reactive protein (hs-CRP), peripheral blood white blood cells (WBC) counts, and differentials.


RESULTS
Hs-CRP was significantly higher in uncontrolled than in controlled asthma (hs-CRP, median [IQR], mg/L; 0.56 [0.60] vs 0.25 [0.34], p = 0.008). Discriminant analysis (backward stepwise) depicted hs-CRP and lymphocytes (as Z-score for absolute count) as significant discriminative factors for asthma control (F = 8.319, p = 0.0007) with 82.3% diagnostic accuracy. Divided into quartiles hs-CRP showed the significant inverse association with F(E)NO (F = 7.359, p = 0.003, ANOVA) with no significant difference for asthma control (F = 1.032, p = 0.386). Post-hoc analysis revealed that F(E)NO values were significantly lower in the third and the fourth quartile of hs-CRP in comparison to the first and the second one (p < 0.05 for all).


CONCLUSIONS
In asthmatic children with uncontrolled asthma serum hs-CRP was increased compared to children with controlled asthma. Although F(E)NO values were also increased (insignificantly) and inversely correlated with hs-CRP they were probably reflecting different etiology underlying the loss of control. The role of peripheral blood biomarkers in asthmatics is still poorly investigated so new studies are required.
Srebrnjak Children's Hospital, Reference Center for Clinical Pediatric Allergology of the Ministry of Health and Social Welfare, Zagreb, Croatia.
M
M
Navratil
D
D
Plavec
S
S
Dodig
Z
Z
Jelcic
B
B
Nogalo
D
D
Erceg
M
M
Turkalj
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000097:blood / Q000188:drug therapy / Q000276:immunology* / Q000378:metabolism; D001944:Breath Tests; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007249:Inflammation / Q000188:drug therapy / Q000276:immunology*; D007958:Leukocyte Count; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D013147:Spirometry
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D009569:Nitric Oxide; D007073:Immunoglobulin E; D002097:C-Reactive Protein