Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
Clin Exp Allergy. 2011 Aug;41(8):1076-83. doi: 10.1111/j.1365-2222.2011.03774.x. Epub 2011 May 30.
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.
We explored whether fractional exhaled nitric oxide (FeNO) and inflammatory markers in exhaled breath condensate (EBC) can predict an ICS response in preschool wheezers.
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.
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].
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.
吸入性皮质类固醇（ICS）在学龄前喘息儿童中的疗效存在差异。目前，尚无法预测哪部分喘息儿童将从 ICS 治疗中获益。
我们探讨呼出气一氧化氮分数（FeNO）和呼气冷凝液（EBC）中的炎症标志物是否可预测学龄前喘息儿童对 ICS 的反应。
对 93 例（年龄 2.0-4.4 岁）喘息儿童进行为期 8 周的 ICS 研究（在 Clinicaltrial.gov 注册：NCT 00422747；200μg；倍氯米松精氨酸每日）。在基线时离线测定 FeNO。使用封闭的玻璃冷凝器收集 EBC。测定 EBC 的酸度，并使用多重免疫测定法测量其他 EBC 标志物[白细胞介素（IL）-1α、IL-2、IL-4、IL-5、IL-10、可溶性细胞间黏附分子、干扰素-γ、嗜酸性粒细胞趋化因子]。ICS 治疗后气道阻力（Rint）和症状评分的变化与特应性（阳性 Phadiatop 婴儿试验）、FeNO 和 EBC 标志物相关。
ICS 治疗后气道阻力和症状轻度改善[中位数（IQR）：1.4（1.2-1.7）至 1.3（1.1-1.5）kPa·s/L，症状评分：26（23-28）至 28（24-29），P<0.01]。仅 IL-10 和特应性对症状变化有一定的预测价值[β（SE）=-0.13（0.07），P=0.08，β（SE）=2.05（1.17），P=0.08]。
我们没有发现令人信服的证据表明 FeNO 和 EBC 标志物可预测学龄前喘息儿童对 ICS 的反应。为此提出了关于这一主题的未来研究建议。
