title: Use of sputum eosinophil counts to guide management in children with severe asthma.
abstract: BACKGROUND
  Previous studies in adults with asthma incorporating the control of sputum eosinophils into management strategies have shown significant reductions in exacerbations. A study was undertaken to investigate whether this strategy would be successful in children with severe asthma.
  
  
  METHODS
  55 children (7-17 years) with severe asthma were randomised to either a conventional symptom-based management strategy or to an inflammation-based strategy (principally sputum eosinophils). Children were seen 3-monthly over a 1-year period.
  
  
  RESULTS
  The annual rate of total and major exacerbations (courses of oral corticosteroids) was non-significantly lower in the inflammatory management group compared with the symptom management group (3.6 vs. 4.8, incident rate ratio (IRR) 0.75, 95% CI 0.54 to 1.04, p=0.082; and 1.9 vs. 2.7 IRR 0.73, 95% CI 0.42 to 1.28, p=0.274 for total and major exacerbations, respectively). Significantly fewer subjects in the inflammatory management group experienced an exacerbation within 28 days of a study visit. There were small non-significant differences in measures of asthma control (symptom-free days and short-acting β agonist use) favouring the inflammatory management group. There was no significant difference in the inhaled corticosteroid dose prescribed over the course of the study.
  
  
  CONCLUSIONS
  Incorporating the control of sputum eosinophils into the management algorithm did not significantly reduce overall exacerbations or improve asthma control. Exacerbations were reduced in the short term, suggesting that more frequent measurements would be needed for a clinically useful effect and that controlling inflammation may have a role to play in subgroups of children with severe asthma.
authors.affiliation: National Heart and Lung Institute, Respiratory Paediatrics, Imperial College, London, UK. l.fleming@imperial.ac.uk
authors.forename: Louise
authors.initials: L
authors.lastname: Fleming
authors.forename: Nicola
authors.initials: N
authors.lastname: Wilson
authors.forename: Nicolas
authors.initials: N
authors.lastname: Regamey
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000465:Algorithms; D000730:Androstadienes / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D004804:Eosinophils / Q000187:drug effects* / Q000473:pathology; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D013183:Sputum / Q000166:cytology*
chemical_list: D000318:Adrenergic beta-Agonists; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D000068298:Fluticasone