Lung clearance index and steroid response in pediatric severe asthma

TY - JOUR

T1 - Lung clearance index and steroid response in pediatric severe asthma

AU - Irving, Samantha

AU - Fleming, Louise

AU - Ahmad, Fatima

AU - Biggart, Elizabeth

AU - Bingham, Yvvone

AU - Cook, James

AU - Hall, Pippa

AU - Jamalzadeh, Angela

AU - Nagakumar, Prasad

AU - Bossley, Cara

AU - Gupta, Atul

AU - Macleod, Kenneth

AU - Saglani, Sejal

AU - Bush, Andrew

PY - 2020/4/1

Y1 - 2020/4/1

N2 - Introduction: Lung clearance index (LCI) is a measure of airway disease that has been shown to be abnormal in asthma. We hypothesized that LCI would be higher (worse) in children with severe therapy-resistant asthma (STRA) compared with difficult asthma (DA) and healthy controls and that LCI would fall in response to parenteral steroids in STRA. Methods: Sixty-four children with asthma who were prescribed high-dose asthma therapy (GINA steps 4 or 5) performed LCI and spirometry. Forty-three had STRA and 21 DA. Thirty-nine of forty-three STRA patients attended for a clinically indicated bronchoscopy during which an intramuscular injection of triamcinolone was given. LCI, spirometry, and fractional exhaled nitric oxide (FeNO) were performed on the day of the bronchoscopy and repeated 4 weeks later. Results: LCI was more abnormal in STRA (median: 7.40, range: 5.58-12.34) than in DA (6.55, 5.77-7.75), P =.0006, and healthy controls (6.53, 5.57-7.35), P =.005. In contrast to the first second forced expired volume (FEV1), LCI improved following systemic steroids; of 20 STRA patients with an abnormal LCI at baseline, 13 improved following triamcinolone. LCI and FeNO responses were concordant. Conclusions: There is a subgroup of children with STRA in whom LCI is elevated who improve following parenteral steroids. LCI may be a valuable additional domain in assessing steroid response in pediatric asthma.

AB - Introduction: Lung clearance index (LCI) is a measure of airway disease that has been shown to be abnormal in asthma. We hypothesized that LCI would be higher (worse) in children with severe therapy-resistant asthma (STRA) compared with difficult asthma (DA) and healthy controls and that LCI would fall in response to parenteral steroids in STRA. Methods: Sixty-four children with asthma who were prescribed high-dose asthma therapy (GINA steps 4 or 5) performed LCI and spirometry. Forty-three had STRA and 21 DA. Thirty-nine of forty-three STRA patients attended for a clinically indicated bronchoscopy during which an intramuscular injection of triamcinolone was given. LCI, spirometry, and fractional exhaled nitric oxide (FeNO) were performed on the day of the bronchoscopy and repeated 4 weeks later. Results: LCI was more abnormal in STRA (median: 7.40, range: 5.58-12.34) than in DA (6.55, 5.77-7.75), P =.0006, and healthy controls (6.53, 5.57-7.35), P =.005. In contrast to the first second forced expired volume (FEV1), LCI improved following systemic steroids; of 20 STRA patients with an abnormal LCI at baseline, 13 improved following triamcinolone. LCI and FeNO responses were concordant. Conclusions: There is a subgroup of children with STRA in whom LCI is elevated who improve following parenteral steroids. LCI may be a valuable additional domain in assessing steroid response in pediatric asthma.

KW - asthma

KW - pediatrics

KW - physiology

UR - http://www.scopus.com/inward/record.url?scp=85079132533&partnerID=8YFLogxK

U2 - 10.1002/ppul.24675

DO - 10.1002/ppul.24675

M3 - Article

C2 - 32027471

AN - SCOPUS:85079132533

SN - 8755-6863

VL - 55

SP - 890

EP - 898

JO - Pediatric pulmonology

JF - Pediatric pulmonology

IS - 4

ER -