Correlation study of cytokine levels in alveolar lavage fluid with exhaled nitric oxide and lung function in children with bronchial asthma

Abstract

Background: The associations between cytokines in the bronchoalveolar lavage fluid (BALF), lung cytokine expression, fractional exhaled nitric oxide (FeNO) and pulmonary function test results in pediatric asthmatics have not been extensively characterized. This study sought to explore correlations between cytokines BALF, FeNO, and pulmonary function test results.

Methods: From October 2018 to October 2020, a prospective study was conducted on 42 children with asthma and 17 children with pulmonary foreign bodies that required bronchoscopy. Pulmonary function tests and FeNO tests were performed on all patients. Patients were divided into a high FeNO group or low FeNO group based on their FeNO results. Interleukin (IL)-4, IL-5, IL-6, IL-8, IL-13, and IL-17 in the BALF were measured by enzyme-linked immunosorbent assays. Pearson correlations were used to assess the correlations between the cytokines in BALF, the pulmonary function test results, and the FeNO results. Pearson correlation was used to calculate the correlation coefficient "r" among alveolar lavage fluid cytokines, lung function, and FeNO. Receiver operating characteristic (ROC) curves were used to determine the area under the curve (AUC), sensitivity, and specificity of BALF cytokines for the high and low FeNO groups.

Results: IL-4, IL-5, IL-6, IL-8, IL-13, and IL-17 in BALF were significantly correlated with FeNO, but were not significantly correlated with the pulmonary function test results. Cytokine IL-4, IL-5, IL-6, IL-8, IL-13, and IL-17 in BALF were significantly different in the high FeNO, low FeNO, and control groups (all P<0.05). The AUCs for differentiating between low and high FeNO based on BALF cytokines ranged from 0.72 to 0.95. The sensitivity and specificity for discriminating between low and high FeNO based on IL-5 and IL-13 reached 95.7% and 100%, respectively.

Conclusions: The cytokine levels of the BALF of children with asthma were significantly elevated, correlated with FeNO, and can be used evaluate airway inflammation in children with asthma.

Keywords: Bronchial asthma; cytokine; nitric oxide; pulmonary function.

Figure 1

The ability of cytokines in the BALF of asthmatic children to differentiate between low FeNO and high FeNO. The circle on the ROC curve represents the best cutoff point. BALF, bronchoalveolar lavage fluid; FeNO, fractional exhaled nitric oxide; ROC, receiver operating characteristic.