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}
}
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 -
--tojpeg_1473680102479_x4.jpg)