Asthma diagnosis and treatment
Effects of inhaled corticosteroids on exhaled leukotrienes and prostanoids in asthmatic children

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Background

Lipid mediators play an important pathophysiologic role in atopic asthmatic children, but their role in the airways of atopic nonasthmatic children is unknown.

Objective

We sought (1) to measure leukotriene (LT) E4, LTB4, 8-isoprostane, prostaglandin E2, and thromboxane B2 concentrations in exhaled breath condensate in atopic asthmatic and atopic nonasthmatic children; (2) to measure exhaled nitric oxide (NO) as an independent marker of airway inflammation; and (3) to study the effect of inhaled corticosteroids on exhaled eicosanoids.

Methods

Twenty healthy children, 20 atopic nonasthmatic children, 30 steroid-naive atopic asthmatic children, and 25 atopic asthmatic children receiving inhaled corticosteroids were included in a cross-sectional study. An open-label study with inhaled fluticasone (100 μg twice a day for 4 weeks) was undertaken in 14 steroid-naive atopic asthmatic children.

Results

Compared with control subjects, exhaled LTE4 (P < .001), LTB4 (P < .001), and 8-isoprostane (P < .001) levels were increased in both steroid-naive and steroid-treated atopic asthmatic children but not in atopic nonasthmatic children (LTE4, P = .14; LTB4, P = .23; and 8-isoprostane, P = .52). Exhaled NO levels were increased in steroid-naive atopic asthmatic children (P < .001) and, to a lesser extent, in atopic nonasthmatic children (P < .01). Inhaled fluticasone reduced exhaled NO (53%, P < .0001) and, to a lesser extent, LTE4 (18%, P <.01) levels but not LTB4, prostaglandin E2, or 8-isoprostane levels in steroid-naive asthmatic children.

Conclusions

Exhaled LTE4, LTB4, and 8-isoprostane levels are increased in atopic asthmatic children but not in atopic nonasthmatic children. In contrast to exhaled NO, these markers seem to be relatively resistant to inhaled corticosteroids.

Section snippets

Study subjects

Four groups of white children were studied: 20 healthy nonatopic nonasthmatic children, 20 atopic nonasthmatic children, 30 steroid-naive atopic children with stable mild intermittent asthma, and 25 atopic children with stable mild-to-moderate persistent asthma who were receiving inhaled corticosteroids (Table I). Atopic nonasthmatic children and atopic asthmatic children were recruited from the Allergy outpatient Clinic of the Istituto Dermopatico dell'Immacolata, IDI, Rome, Italy, and the

Results

No α-amylase concentrations were detected in any study sample, excluding significant salivary contamination.

Discussion

Because its capture is completely noninvasive, EBC is potentially useful for long-term monitoring of lung inflammation in children with asthma,20 but there is no information on the utility of this technique in atopic nonasthmatic children or whether atopy per se affects the measurements of exhaled eicosanoids. Previous studies reported increased concentrations of LTs and 8-isoprostane in EBC in children with asthma, but these values were not compared with those in atopic nonasthmatic children.6.

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  • Cited by (0)

    This work was performed at the Catholic University of the Sacred Heart, Rome, Italy.

    Supported by academic funds 2003-2004 from the Catholic University of the Sacred Heart, Rome, Italy.

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