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. 2009 Nov;34(5):1052-9.
doi: 10.1183/09031936.00186508. Epub 2009 Jun 18.

Corticosteroid responsiveness and clinical characteristics in childhood difficult asthma

C J Bossley  1 , S Saglani, C Kavanagh, D N R Payne, N Wilson, L Tsartsali, M Rosenthal, I M Balfour-Lynn, A G Nicholson, A Bush
Affiliations

Corticosteroid responsiveness and clinical characteristics in childhood difficult asthma

C J Bossley et al. Eur Respir J. 2009 Nov.

Abstract

This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (F(eNO)) and no bronchodilator responsiveness (BDR <12%)) is uncommon in paediatric DA. We report on 102 children, mean+/-sd age 11.6+/-2.8 yrs, with DA in a cross-sectional study. 89 children underwent spirometry, BDR and F(eNO) before and after 2 weeks of systemic corticosteroids (corticosteroid response study). Bronchoscopy was performed after the corticosteroid trial. Of the 102 patients in the cross-sectional study, 88 (86%) were atopic, 60 (59%) were male and 52 (51%) had additional or alternative diagnoses. Out of the 81 patients in the corticosteroid response study, nine (11%) were complete responders. Of the 75 patients with symptom data available, 37 (49%) responded symptomatically, which was less likely if there were smokers in the home (OR 0.31, 95% CI 0.02-0.82). Of the 75 patients with available spirometry data, 35 (46%) had normal spirometry, with associations being BAL eosinophilia (OR 5.43, 95% CI 1.13-26.07) and high baseline forced expiratory volume in 1 s (FEV(1)) (OR 1.08, 95% CI 1.02-1.12). Of these 75 patients, BDR data were available in 64, of whom 36 (56%) had <12% BDR. F(eNO) data was available in 70 patients, of whom 53 (75%) had normal F(eNO). Airflow limitation data was available in 75 patients, of whom 17 (26%) had persistent airflow limitation, which was associated with low baseline FEV(1) (OR 0.93, 95% CI 0.90-0.97). Only 11% of DA children exhibited complete corticosteroid responsiveness. The rarity of complete corticosteroid responsiveness suggests alternative therapies are needed for children with DA.

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Figures

FIGURE 1
FIGURE 1
Difficult asthma investigation protocol. Ig: immunoglobulin; RAST: radioallergosorbent assay; SPT: skin prick testing; BDR: bronchodilator reversibility; FeNO: exhaled nitric oxide fraction; FOB: fibreoptic bronchoscopy; EB: endobronchial biopsy; BAL: bronchoalveolar lavage; CT: computed tomography. #: prednisolone n=65, triamcinolone n=16.
FIGURE 2
FIGURE 2
Distribution of immunoglobulin (Ig)E in children with difficult asthma and eligibility for anti-IgE therapy.
FIGURE 3
FIGURE 3
The number of parameters with corticosteroid response for each patient divided according to sex. The tested parameters included symptom improvement, absent bronchodilator reversibility, normal forced expiratory volume in 1 s and normal exhaled nitric oxide fraction at the end of corticosteroid trial. □: female; ■: male.
FIGURE 4
FIGURE 4
Forced expiratory volume in 1 s (FEV1) pre and post a 2-week trial of systemic corticosteroids. % pred: % predicted. p<0.001.
FIGURE 5
FIGURE 5
Exhaled nitric oxide fraction (FeNO) pre and post a 2-week systemic cortiosteroid trial. p<0.01.
See this image and copyright information in PMC

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