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a Department of
Paediatrics, Queen Mary's Hospital, Sidcup, Kent DA14 6LT, UK, b Department of
Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
Correspondence to: Dr Bush email: a.bush{at}rbh.nthames.nhs.uk
Accepted 6 March 2000
BACKGROUND
Acute
asthma is associated with elevated serum concentrations of products of
activated T cells and eosinophils.
AIMSTo compare the
changes in concentrations of these products with disease severity and
changes in lung function following oral prednisolone treatment.
METHODSTwenty
patients (mean age 8.7 years) were recruited on admission with acute
asthma to a district general hospital. Disease severity was recorded
before and after treatment with oral prednisolone using a validated
pulmonary index score. Serum concentrations of interleukin (IL)-4,
IL-5, soluble (s)CD25 (soluble IL-2 receptor), using a specific enzyme
linked immunosorbent assay, and eosinophil cationic protein (ECP),
using radioimmunoassay, were measured concomitantly. Non-asthmatic
children (n = 6, mean age 9.2 years) undergoing elective surgery were
recruited as controls, and serum samples were obtained on one occasion
without treatment. Main outcome measures were changes in serum
concentrations of cytokines and ECP, clinical asthma severity score,
and peak expiratory flow rate.
RESULTSAs expected,
oral glucocorticoid treatment in the children with asthma was
associated with clinical improvement and also with significant
reductions in serum concentrations of IL-5 (mean 5.59 to 2.19 pg/ml,
p = 0.0001), sCD25 (mean 2236 to 1772 pg/ml, p = 0.002), and ECP
(mean 54.3 to 33.1 pg/ml, p = 0.0001). Serum IL-4 concentrations, in
most patients and all the controls, remained below the sensitivity of
the assay. However, serum concentrations of IL-5, sCD25, and ECP
remained significantly higher than in controls, even after treatment
with oral glucocorticoids (p = 0.03).
CONCLUSIONSThese data
suggest that T cell mediated inflammation may persist in childhood
asthma despite apparent clinical remission associated with conventional
doses of prednisolone. The long term consequences of persistent
inflammation after an apparently treated acute attack of asthma require
clarification. Clinical assessment and pulmonary function are
inadequate surrogates for airway inflammation.
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