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Paediatric Pulmonology and Allergology
2003 October, Vol. VI, No. 2 (pp.2236-2247)
Monitoring of airway inflammation in children
Andrew Bush
There has been an explosion of interest in the invasive and non-invasive monitoring of inflammation in paediatric lung disease. This article will review the various techniques available, and review in particular their relevance in asthma. Elevated exhaled nitric oxide (eNO) may be a marker of eosinophilic inflammation. A raised eNO and eosinophils in the induced sputum might suggest that increasing the dose of inhaled steroids would be appropriate, whereas persistent bronchial hyper-reactivity with a normal eNO might suggest that a long acting bronchodilator might be appropriate. The group in whom a measurement of eosinophilic airway inflammation would be most useful in order to plan treatment is the wheezy infant, as it is obvious that over treatment with inhaled steroids is harmful. The non-invasive nature of eNO measurements make them an appealing tool, but more research is needed before they come into clinical practice in this age group. Measurement of airway inflammation is worthwhile in monitoring asthma treatment. Our own paediatric data suggested that a 50perc. rise in eNO over baseline in a group of pollen sensitive asthmatics was strongly predictive of an asthma exacerbation. In pollen sensitive asthmatic children, a rise in eNO of 50perc. over baseline was strongly predictive of an asthma exacerbation within the next few days. In another study, in which inhaled steroids were reduced in children with known asthma who were well controlled, no child whose sputum was clear of eosinophils relapsed on reduction of inhaled steroid dosage. Taken together, these studies suggest clear proof of principle that the addition of a measure of airway inflammation to standard monitoring is beneficial to patients.