Beneficial Effects of Inhaled Budesonide on Elevated Circulating Levels of Serum ECP, ICAM-1, VCAM-1, IL-6 and IL-6R in Children with Asthma

Kim, Ji Hye; Oh, Jae Won; Lee, Ha Baik

Abstract

PURPOSE
Allergic inflammation in the airway of asthmatics was characterized by recruitment and activation of inflammatory cells. The recognition of the underlying inflamatory nature of asthma led to suggestions that early intervention of the airway inflammation by inhaled corticosteroid could provide the key to improve a clinical outcome of asthma treatment in children. The assessment of airway inflammation may be indirectly achieved by measuring inflammatory markers in serum. We have tried to measure ECP, soluble (s) ICAM-1, sVCAM-1, IL-6 and sIL-6 receptor(R) levels in serum of children with acute asthma, to define efficacy of monitoring inflammation with soluble markers and then compare them in two treatment modalities of inhaled salbutamol or combined with budesonide.
METHODS
Thirty-five children with acute asthma were randomly classified into two study groups : group I consisted of 17 subjects with inhaled budesonide plus beta-agonist and the 18 subjects of group II with beta-agonis alone. Of two groups, eosinophil, ECP, sICAM-1, sVCAM-1, IL-6 and sIL-6R were quantitatively measured at acute and stable phases in asthma, and the results compared relevantly.
RESULTS
1) The initially elevated levels of the inflammatory markers such as ECP, sICAM-1, sVCAM-1 and sIL-6R except for IL-6 were significantly decreased in stable phase. However, there was no significant difference between two groups in ECP and inflammatory markers in acute asthmatics. 2) The observed reduction in symptom score and %PEFR followed by budesonide nebulization regularily until the improvement of clinical symptom was significant, whereas beta-agonist salbutamol inhalation has less effect on the variables. Interestingly, ECP levels depicted inverse correlation with %PEFR in acute phase of asthma, and ECP and infalmmatory markers were relevant to the clinical symptom in long-term follow-up. 3) There was a trend for some correlation between sICAM-1 and CRP, sVCAM-1 and CRP, but not ECP and IL-6 in two study groups, respectively.
CONCLUSION
Treatment with an inhaled steroid plus beta-agonist had significantly caused improvement of clinical symptoms, and the decrements of peak flow variability, eosinophil, ECP, sICAM-1, sVCAM-1 and sIL-6R as potential markers of the airway inflammation, when compared with a group treated with beta-agonist alone. The measurements of ECP and other inflammatory markers may be enormously useful for the evaluation of the successful anti-inflamatory therapy for asthma in children.