Yonsei Med J.  2016 May;57(3):690-697. 10.3349/ymj.2016.57.3.690.

High-Sensitivity C-Reactive Protein Can Reflect Small Airway Obstruction in Childhood Asthma

• Ko AR
• Kim YH
• Sol IS
• Kim MJ
• Yoon SH
• Kim KW
• Kim KE

• KMID: 2374090
• DOI: http://doi.org/10.3349/ymj.2016.57.3.690

Abstract

PURPOSE
High-sensitivity assays enabled the identification of C-reactive protein (hs-CRP) at levels that were previously undetectable. We aimed to determine if hs-CRP could reflect airway inflammation in children, by comparing hs-CRP with spirometry and impulse oscillometry (IOS) parameters and symptomatic severities.
MATERIALS AND METHODS
A total of 276 asthmatic children who visited Severance Children's Hospital from 2012-2014 were enrolled. Serum hs-CRP and pulmonary function tests were performed on the same day. Patients were divided into hs-CRP positive and negative groups (cut-off value, 3.0 mg/L).
RESULTS
Of the 276 asthmatic children [median age 7.5 (5.9/10.1) years, 171 boys (62%)], 39 were hs-CRP positive and 237 were negative. Regarding spirometry parameters, we observed significant differences in maximum mid-expiratory flow, % predicted (FEF25-75) (p=0.010) between hs-CRP positive and negative groups, and a negative correlation between FEF25-75 and hs-CRP. There were significant differences in the reactance area (AX) (p=0.046), difference between resistance at 5 Hz and 20 Hz (R5-R20) (p=0.027), resistance at 5 Hz, % predicted (R5) (p=0.027), and reactance at 5 Hz, % predicted (X5) (p=0.041) between hs-CRP positive and negative groups. There were significant positive correlations between hs-CRP and R5 (r=0.163, p=0.008), and X5 (r=0.164, p=0.007). Spirometry and IOS parameters had more relevance in patients with higher blood neutrophil levels in comparison to hs-CRP.
CONCLUSION
Hs-CRP showed significant correlation with FEF25-75, R5, and X5. It can reflect small airway obstruction in childhood asthma, and it is more prominent in neutrophil dominant inflammation.

Keyword

High-sensitivity C-reactive protein; asthma; childhood

MeSH Terms

Airway Obstruction/*diagnosis/etiology
Asthma/*diagnosis/physiopathology
C-Reactive Protein/*analysis
Child
Child, Preschool
Female
Forced Expiratory Volume
Humans
Inflammation/*etiology
Male
Neutrophils/metabolism
Oscillometry/*methods
Respiratory Function Tests/*methods
Respiratory System
Sensitivity and Specificity
*Spirometry
C-Reactive Protein

Figure

• 

  Fig. 1 Comparisons of forced expiratory volume in 1 second, % predicted (FEV1) and maximum midexpiratory flow, % predicted (FEF25–75) between high-sensitivity C-reactive protein (hs-CRP) positive and negative groups. FEV1 (p=0.046) and FEF25–75 (p=0.010) were significantly lower in the hs-CRP positive group than in the negative group.

• 

  Fig. 2 Comparisons of impulse oscillometry (IOS) parameters between high-sensitivity (hs-CRP) positive and negative groups. (A) Reactance area (AX) was significantly higher in the hs-CRP positive group than in the negative group (p=0.046). (B) Difference between resistance at 5 Hz and 20 Hz (R5–R20) was significantly higher in the hs-CRP positive group than in the negative group (p=0.027). (C) Resistance at 5 Hz, % predicted (R5) was significantly higher in the hs-CRP positive group than in the negative group (p=0.027). (D) Reactance at 5 Hz, % predicted (X5) was significantly higher in the hs-CRP positive group than in the negative group (p=0.041).

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