title: Assessment of corticosteroid response in pediatric patients with severe asthma by using a multidomain approach.
abstract: There is no agreed upon definition of systemic corticosteroid response in asthmatic children. Moreover, pediatric severe therapy-resistant asthma (STRA) is heterogeneous, and thus response to steroids is unlikely to be uniform in all patients.
  
  
  
  We sought to evaluate the utility of a multidomain approach incorporating symptoms, lung function, and inflammation to determine steroid responsiveness in pediatric patients with STRA.
  
  
  
  Eighty-two children (median age, 12 years) with STRA received a clinically indicated dose of intramuscular steroid. Changes in 4 separate domains were assessed 4 weeks after intramuscular triamcinolone acetonide: normalization of (1) symptoms (Asthma Control Test score, >19/25 or 50% increase), (2) spirometric results (FEV1 ≥80% of predicted value or ≥15% increase), (3) fraction of exhaled nitric oxide levels (<24 ppb), and (4) sputum eosinophil counts (<2.5%). Fifty-four of 82 children had complete data in all 4 domains.
  
  
  
  Twenty-three (43%) of 54 children had a symptom response, 29 (54%) of 54 had a lung function response, 28 (52%) of 54 had a fraction of exhaled nitric oxide response, and 29 (54%) of 54 had a sputum eosinophil response. Although a similar proportion of children responded to systemic corticosteroids in each domain, there were no reliable predictors of a response pattern. Seven (13%) of 54 were complete responders (response in all domains), 8 (15%) of 54 were nonresponders (no response in any domain), and 39 (72%) of 54 were partial responders (response in ≥1 domain).
  
  
  
  A multidomain evaluation of systemic steroid responsiveness using pragmatic clinical assessments confirms childhood STRA is heterogeneous and that a complete response in symptoms and inflammatory and physiologic parameters is rare. Individual response patterns to systemic steroids might be useful in guiding the choice of add-on therapies in each child as a step toward achieving personalized medicine.
authors.affiliation: Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Respiratory Paediatrics, Kings College Hospital, London, United Kingdom.
authors.forename: Cara J
authors.initials: CJ
authors.lastname: Bossley
authors.affiliation: Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: Fleming
authors.affiliation: Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Ullmann
authors.affiliation: Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Atul
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Adams
authors.affiliation: Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Prasad
authors.initials: P
authors.lastname: Nagakumar
authors.affiliation: Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
authors.affiliation: Respiratory Paediatrics, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College London, London, United Kingdom; Leukocyte Biology, National Heart & Lung Institute, Imperial College London, London, United Kingdom. Electronic address: s.saglani@imperial.ac.uk.
authors.forename: Sejal
authors.initials: S
authors.lastname: Saglani
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D015415:Biomarkers; D002648:Child; D004804:Eosinophils / Q000473:pathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D012720:Severity of Illness Index; D013147:Spirometry; D013183:Sputum / Q000166:cytology; D016896:Treatment Outcome; D057188:Workflow
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D009569:Nitric Oxide
keywords: Pediatric; inflammation; severe asthma; spirometry; steroid response