Kansal Prachi, Nandan Devki, Agarwal Sheetal, Patharia Neha, Arya Narendra
a Department of Pediatrics , PGIMER and RML Hospital , Delhi , India.
J Asthma. 2018 Apr;55(4):385-390. doi: 10.1080/02770903.2017.1338725. Epub 2017 Jul 11.
Treatment decisions in asthma are currently based on clinical assessment and spirometry. Sputum eosinophil, being a marker of airway inflammation, can serve as a tool for assessing severity and response to treatment in asthma patients.
To measure eosinophil percentage in induced sputum in children with asthma and correlate it with clinical asthma parameters.
A prospective observational study was performed at tertiary care hospital on 91 children aged 7-18 years with newly diagnosed mild or moderate persistent asthma. Theinduced sputum eosinophil percentage was obtained at the time of enrollment and three months after treatment with inhaled budesonide. Patients were specifically evaluated for five clinical parameters of asthma, i.e., days of acute exacerbations, use of salbutamol as rescue medication, emergency visits, nighttime cough and days of school absence.
Sputum eosinophil percentage was high (3.1 ± 0.515%) at the time of enrollment which reduced significantly after three months of inhaled budesonide therapy [0.06 ± 0.164% (p < 0.0005)]. Children with moderate persistent asthma had significantly higher values of sputum eosinophil levels than children with mild persistent asthma at the time of enrollment (3.38 ± 0.64% vs. 2.99 ± 0.42%, p = 0.001) but the difference was not significant after three months of inhaled steroid therapy (0.07 ± 0.18 vs. 0.04 ± 0.12, p = 0.5104). A significant negative correlation was found between reduction in sputum eosinophil levels and improvement in FEV1 (r = -0.400, p = 0.0001). All the clinical asthma parameters also correlated significantly with the reduction in sputum eosinophil levels after three months of inhaled steroid therapy.
Eosinophil levels in induced sputum correlate well with clinical asthma parameters and asthma severity in children. It is a simple, noninvasive and cheap method which can be used for the monitoring of asthma in a resource-limited setting.
目前哮喘的治疗决策基于临床评估和肺功能测定。痰液嗜酸性粒细胞作为气道炎症的标志物，可作为评估哮喘患者病情严重程度及治疗反应的一种工具。
测定哮喘儿童诱导痰中嗜酸性粒细胞百分比，并将其与临床哮喘参数进行关联。
在一家三级护理医院对91名7 - 18岁新诊断为轻度或中度持续性哮喘的儿童进行了一项前瞻性观察研究。在入组时及吸入布地奈德治疗3个月后获取诱导痰嗜酸性粒细胞百分比。对患者进行了哮喘的五个临床参数的专门评估，即急性加重天数、使用沙丁胺醇作为急救药物的情况、急诊就诊次数、夜间咳嗽及缺课天数。
入组时痰液嗜酸性粒细胞百分比很高（3.1±0.515%），吸入布地奈德治疗3个月后显著降低[0.06±0.164%（p<0.0005）]。入组时，中度持续性哮喘儿童的痰液嗜酸性粒细胞水平值显著高于轻度持续性哮喘儿童（3.38±0.64%对2.99±0.42%，p = 0.001），但吸入类固醇治疗3个月后差异不显著（0.07±0.18对0.04±0.12，p = 0.5104）。发现痰液嗜酸性粒细胞水平降低与FEV1改善之间存在显著负相关（r = -0.400，p = 0.0001）。吸入类固醇治疗3个月后，所有临床哮喘参数也与痰液嗜酸性粒细胞水平降低显著相关。
诱导痰中的嗜酸性粒细胞水平与儿童临床哮喘参数及哮喘严重程度密切相关。它是一种简单、无创且廉价的方法，可用于资源有限环境下的哮喘监测。
