title: Can exhaled inflammatory markers predict a steroid response in wheezing preschool children?
abstract: BACKGROUND
  The efficacy of inhaled corticosteroids (ICS) varies among wheezing preschool children. Currently, it is not possible to predict which fraction of wheezing children will benefit from an ICS treatment.
  
  
  OBJECTIVE
  We explored whether fractional exhaled nitric oxide (FeNO) and inflammatory markers in exhaled breath condensate (EBC) can predict an ICS response in preschool wheezers.
  
  
  METHODS
  An 8-week ICS study (registered at Clinicaltrial.gov: NCT 00422747; 200 μg; beclomethasone extra-fine daily) was performed in 93 wheezing children (age range 2.0-4.4 years). At baseline, FeNO was determined off-line. EBC was collected using a closed glass-condenser. The acidity of EBC was determined and other EBC markers [interleukin (IL)-1α, IL-2, IL-4, IL-5, IL-10, soluble intercellular adhesion molecule, interferon-γ, eotaxin] were measured using a multiplex immunoassay. The change in airway resistance (Rint) and symptom score following ICS treatment was related to atopy (positive Phadiatop Infant test), FeNO and EBC markers.
  
  
  RESULTS
  Airway resistance and symptoms mildly improved after ICS treatment [median (IQR): 1.4 (1.2-1.7) to 1.3 (1.1-1.5) kPa s/L, symptom score: 26 (23-28) to 28 (24-29), P < 0.01, respectively]. Only IL-10 and atopy had limited predictive value regarding a change in symptoms [β (SE) =-0.13 (0.07), P = 0.08, β (SE) = 2.05 (1.17), P = 0.08, respectively].
  
  
  CONCLUSIONS
  We did not find convincing evidence that FeNO and EBC markers could predict an ICS response in preschool wheezers. Recommendations for future studies on this topic are given.
authors.affiliation: Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands. kim.vande.kant@mumc.nl
authors.forename: K D G
authors.initials: KD
authors.lastname: van de Kant
authors.forename: K
authors.initials: K
authors.lastname: Koers
authors.forename: G T
authors.initials: GT
authors.lastname: Rijkers
authors.forename: V
authors.initials: V
authors.lastname: Lima Passos
authors.forename: E M M
authors.initials: EM
authors.lastname: Klaassen
authors.forename: M
authors.initials: M
authors.lastname: Mommers
authors.forename: P C
authors.initials: PC
authors.lastname: Dagnelie
authors.forename: C P
authors.initials: CP
authors.lastname: van Schayck
authors.forename: E
authors.initials: E
authors.lastname: Dompeling
authors.forename: Q
authors.initials: Q
authors.lastname: Jöbsis
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012135:Respiratory Sounds / Q000187:drug effects* / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D009569:Nitric Oxide