Imperial College London
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DrLouiseFleming

Faculty of Medicine, National Heart & Lung Institute

Honorary Senior Research Fellow
 
 
 
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Contact

 

+44 (0)20 7352 8121 ext 2938l.fleming

 
 
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Location

 

Department of Respiratory PaediaRoyal BromptonRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@inproceedings{Irving:2017:10.1136/thoraxjnl-2017-210983.76,
author = {Irving, S and Bingham, Y and Bossley, C and Fleming, L and Saglani, S and Bush, A},
doi = {10.1136/thoraxjnl-2017-210983.76},
pages = {A44--A45},
publisher = {BMJ Publishing Group},
title = {Change in lung clearance index and exhaled nitric oxide as markers of systemic corticosteroid response in children with severe asthma},
url = {http://dx.doi.org/10.1136/thoraxjnl-2017-210983.76},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - CPAPER
AB  - Introduction Children with severe therapy resistant asthma (STRA) have heterogeneous disease with variable response to steroids. Currently, spirometry (forced expiratory volume in 1 s (FEV1)) is most widely used to assess treatment response. We hypothesised lung clearance index (LCI) would more sensitively assess steroid response than FEV1 alone, using our multi-domain approach [JACI 2016;138:413–420] with the addition of LCI to measure response of distal airway disease.Methods 39 children with STRA were recruited during a clinically-indicated admission for bronchoscopy and intramuscular triamcinolone injection. Prior to triamcinolone, they performed LCI, spirometry, FeNO, and filled in the asthma control test (ACT). They were followed up at 4 weeks and these tests repeated. ACT was considered abnormal if <20, LCI if ≥7.1, FEV1 percent predicted below 80%, and FeNO if ≥24 parts per billion. Any domain which was abnormal at visit 2 was a non-response.Results 26/39 (67%) patients had at least a partial response, see Table. There was strongest concordance of Results between FeNO and LCI (70%). 11/39 (28%) of patients had a response in at least two domains, 4/39 (10%) at least three, and 1 patient responded in all four domains.Conclusions In this cohort, LCI, FeNO and FEV1 were equally likely to be abnormal at baseline. FeNO and LCI were most likely to respond, (36% and 33% respectively), whereas FEV1 was least responsive to systemic steroids. Using this multi-domain approach 67% improved over 4 weeks following treatment with systemic corticosteroid. The clinical significance of an LCI response remains to be determined. We speculate that this group may reflect a distal airway disease phenotype who may benefit from fine particle inhaled corticosteroids.
AU  - Irving,S
AU  - Bingham,Y
AU  - Bossley,C
AU  - Fleming,L
AU  - Saglani,S
AU  - Bush,A
DO  - 10.1136/thoraxjnl-2017-210983.76
EP  - 45
PB  - BMJ Publishing Group
PY  - 2017///
SN  - 1468-3296
SP  - 44
TI  - Change in lung clearance index and exhaled nitric oxide as markers of systemic corticosteroid response in children with severe asthma
UR  - http://dx.doi.org/10.1136/thoraxjnl-2017-210983.76
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000432666600077&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/64028
ER  -
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