Introduction: Pulmonary surfactant is a unique mixture of lipids and surfactant-specific proteins. Phosphatidylcholine comprises almost 80% of the total surfactant lipids, about half of which is dipalmitoylphosphatidylcholine (DPPC). Alteration of surfactant composition and function is documented with various airway or lung parenchyma disorders.
Objective: To assess sputum concentration of DPPC as a major component of airways surfactant in asthmatic children compared to conventional airway inflammatory markers.
Methods: This case control study included 68 well-known asthmatic children of different grades of severity and 20 age- and sex-matched normal children as controls. All children were subjected to thorough clinical examination, pulmonary function tests, sputum induction and processing for cytology, DPPC level and eosinophil cationic protein (ECP) level assessment.
Results: Elevated DPPC levels were evident in all sputum samples of asthmatic children (mean value 626.6 +/- 189.7 mcg/mL) compared to controls (mean value 49.3 +/- 20.1 mcg/mL). Significant negative correlations (r = -0.83, -0.752 and -0.384) were found between asthmatics sputum DPPC levels and pulmonary function test parameters [% of forced expiratory volume in first second, % of forced vital capacity (FVC) and forced expiratory flow rate over 25%-75% part of FVC], respectively. Meanwhile, significant positive correlations were evident between asthmatics sputum DPPC levels and the sputum inflammatory cells and their sputum ECP levels.
Conclusion: Elevated DPPC levels are evident in induced sputum of all asthmatic children and they are significantly related to sputum ECP levels and pulmonary function test parameters. Nevertheless, the value of DPPC estimation in the clinical management of children with asthma remains to be determined.