Imperial College London
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ProfessorAndrewBush

Faculty of Medicine, National Heart & Lung Institute

Professor of Paediatric Respirology
 
 
 
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Contact

 

+44 (0)20 7352 8121 ext 2255a.bush

 
 
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Location

 

Chelsea WingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bossley:2016:10.1016/j.jaci.2015.12.1347,
author = {Bossley, CJ and Fleming, L and Ullmann, N and Gupta, A and Adams, A and Nagakumar, P and Bush, A and Saglani, S},
doi = {10.1016/j.jaci.2015.12.1347},
journal = {Journal of Allergy and Clinical Immunology},
pages = {413--420.e6},
title = {Assessment of corticosteroid response in pediatric patients with severe asthma by using a multidomain approach.},
url = {http://dx.doi.org/10.1016/j.jaci.2015.12.1347},
volume = {138},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: There is no agreed upon definition of systemic corticosteroid response in asthmatic children. Moreover, pediatric severe therapy-resistant asthma (STRA) is heterogeneous, and thus response to steroids is unlikely to be uniform in all patients. OBJECTIVE: We sought to evaluate the utility of a multidomain approach incorporating symptoms, lung function, and inflammation to determine steroid responsiveness in pediatric patients with STRA. METHODS: Eighty-two children (median age, 12 years) with STRA received a clinically indicated dose of intramuscular steroid. Changes in 4 separate domains were assessed 4 weeks after intramuscular triamcinolone acetonide: normalization of (1) symptoms (Asthma Control Test score, >19/25 or 50% increase), (2) spirometric results (FEV1 ≥80% of predicted value or ≥15% increase), (3) fraction of exhaled nitric oxide levels (<24 ppb), and (4) sputum eosinophil counts (<2.5%). Fifty-four of 82 children had complete data in all 4 domains. RESULTS: Twenty-three (43%) of 54 children had a symptom response, 29 (54%) of 54 had a lung function response, 28 (52%) of 54 had a fraction of exhaled nitric oxide response, and 29 (54%) of 54 had a sputum eosinophil response. Although a similar proportion of children responded to systemic corticosteroids in each domain, there were no reliable predictors of a response pattern. Seven (13%) of 54 were complete responders (response in all domains), 8 (15%) of 54 were nonresponders (no response in any domain), and 39 (72%) of 54 were partial responders (response in ≥1 domain). CONCLUSIONS: A multidomain evaluation of systemic steroid responsiveness using pragmatic clinical assessments confirms childhood STRA is heterogeneous and that a complete response in symptoms and inflammatory and physiologic parameters is rare. Individual response patterns to systemic steroids might be useful in guiding the choice of add-on therapies in each child as a step toward achieving pe
AU  - Bossley,CJ
AU  - Fleming,L
AU  - Ullmann,N
AU  - Gupta,A
AU  - Adams,A
AU  - Nagakumar,P
AU  - Bush,A
AU  - Saglani,S
DO  - 10.1016/j.jaci.2015.12.1347
EP  - 420
PY  - 2016///
SN  - 1097-6825
SP  - 413
TI  - Assessment of corticosteroid response in pediatric patients with severe asthma by using a multidomain approach.
T2  - Journal of Allergy and Clinical Immunology
UR  - http://dx.doi.org/10.1016/j.jaci.2015.12.1347
UR  - http://hdl.handle.net/10044/1/39920
VL  - 138
ER  -
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