الفهرس 
Epidemiology of bronchial asthmaOnly 14 pages are availabe for public view
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Abstract
This study was carried out in order to evaluate the degree of eosinophil activation in the airway
of children with bronchial asthma by measuring certain cytokines as granulocyte/ macrophage-colony
stimulating factor (GM-CSF) an interleukin-3 (IL-3) in the serum, and measuring GM-CSF and
eosinophil cationic protein (ECP) (a marker of eosinophi 1 activation) in the sputum. Subjects
included 53 children and were divided into 2 groups: group (1) included 33 asthmatic children.
These patients were recruited from Pediatric Allergy and Immunology Clinic, Children Hospital, Ain
Shams University. These patients were studied both during exacerbation of asthma as well as in
remission. They were divided into two subgroups according to asthma severity. Subgroup (1-A)
comprised eighteen children with severe asthma. Nine were males and nine were females. Their ages
ranged from 6 to 15 years (mean ±SD = 10.78 ±3.39 years). The chronicity of asthma ranged from 4
to 14 years (mean
±SD = 8.97 ±3.65 years). Subgroup (1-b) comprised fifteen children with moderate degree of asthma.
Ten were males and five were females. Their ages ranged from 6 to 15 years (mean
±SD = 9.13 ±3.23 years). The chronicity of asthma ranged
from 4 to 11 years (mean ±SO= 6.73 ±2.46 years). In addition, 20 healthy children were included in
this study to serve as control group. They were age and sex matched with patients under the study.
After complete history taking, clinical evaluation - for the duration of illness, clinical severity
of manifestations, family history of atopy, presence of other allergies and previous
hospitalization - and measuring total serum lgE in relation to the age, sputum and peripheral blood
samples were obtained from all subjects under the study for determining the concentrations of
sputum and blood eosinohil percentage, sputum and serum GM-CSF by enzyme immunoassay (EIA), serum
IL-3 by EIA, and sputum ECP by radioimmunoassay (RIA). During acute asthma, significant elevation
of sputum GM-CSF and ECP concentrations were observed in patients with moderate degree of asthma
(27.17
±11.3 pg/ml and 247.3 ±191.1 Jlg/L respectively) and in
patients with severe asthma (32.31 ±12.52 pg/ml and 299.4
±271.41 !Jg/L respectively) than in remission. Moreover, during remission, sputum GM-CSF and ECP
values were still significantly higher among patients with moderate asthma
(11.83 ±4.93 pg/ml and 90.86 ±54.4 Jlg/L respectively) and
severe asthma (12.92 ±5.74 pg/ml and 90.72 ±67.3 Jlg/L respectively) as compared to the control
levels of GM-CSF
(3.17 ±2.49 pg/ml) and ECP (27 .18 ± 17.38 Jlg/L). Peripheral blood tests for GM-CSF and IL-3
concentrations revealed significant increase of these parameters during acute asthma than in
remission and were significantly higher than the control values. Meanwhile, no significant
differences in serum values of IL-3 and GM-CSF and sputum concentrations of GM-CSF and ECP were
observed among asthmatic patients (13 cases) who received oral corticosteroids versus other
patients (20 cases) who were treated with corticosteroids by inhalation. In this study, sputum
GM-CSF showed positive correlation with serum IL-3 (r=0.53; P<0.05), serum GM-CSF (r=0.49;
P<0.05) and sputum ECP (r=0.72, P<0.05).
Meanwhile, sputum ECP did not show significant correlation with either sputum eosinophi I
percentage (r=0.15; P>0.05) or blood eosinophil percentage (r=0.05, P>0.05). These findings suggest
that continuous pnmmg of eosinophils occurs in ’
asthmatic children reg ·dless to the severity of1asthma or the
quiescence of the disease. This activation can be detected simply by sputum analysis for GM-CSF and
ECP, both should be considered as useful markers for the evaluation of the efficacy and response to
therapy in asthmatic children.