Improvement of clinical and immunopathologic parameters in asthmatic children treated for concomitant chronic rhinosinusitis.

Abstract

BACKGROUND:

Chronic rhinosinusitis is frequently associated with asthma. A Th2 cytokine pattern has been recently reported in chronic rhinosinusitis in asthmatic children.

OBJECTIVE:

To evaluate the effects of treating concomitant chronic rhinosinusitis on respiratory symptoms and function and immunopathological parameters in asthmatic children.

METHODS:

Eighteen children with moderate asthma (age range, 5 to 12 years) poorly controlled by high doses of inhaled corticosteroids and chronic rhinosinusitis were evaluated for symptoms, spirometry, and inflammation at baseline, after treatment, and 1 month after suspension of treatment. All of the children were treated with a combination of amoxicillin and clavulanate (20 mg/kg twice daily) and fluticasone propionate aqueous nasal spray (100 microg/d) for 14 days. A short course of oral corticosteroids was also prescribed (deflazacort, 1 mg/kg daily for 2 days, 0.5 mg/kg daily for 4 days, and 0.25 mg/kg daily for 4 days). Rhinosinusal lavage for cytokine measurements and a nasal scraping for cytologic analysis were performed in all patients before and after medical treatment.

RESULTS:

A negative endoscopy result was demonstrated in 15 children after treatment. Symptoms and respiratory function significantly improved after treatment and 1 month later; 8 children had intermittent asthma and 10 had mild asthma. A significant reduction of inflammatory cell numbers was detected in all asthmatic children. Interleukin 4 levels significantly decreased (P < 0.001), whereas interferon-y levels increased (P < 0.001).

CONCLUSION:

Treatment of chronic rhinosinusitis is able to improve symptoms and respiratory function in asthmatic children, reducing inflammatory cells and reversing the cytokine pattern from a Th2 toward a Th1 profile.

• Authors: Maria Angela Tosca, Cristina Cosentino, Eugenio Pallestrini, Giacomo Caligo, Manlio Milanese, Giorgio Ciprandi
• Journal: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 91 Issue 1 Pg. 71-8 (Jul 2003) ISSN: 1081-1206 [Print] United States
• PMID: 12877453 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Androstadienes
• Anti-Inflammatory Agents
• Pregnenediones
• Interleukin-4
• Amoxicillin-Potassium Clavulanate Combination
• Interferon-gamma
• Fluticasone
• deflazacort

Topics

• Amoxicillin-Potassium Clavulanate Combination (therapeutic use)
• Androstadienes (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Asthma (complications, drug therapy)
• Child
• Child, Preschool
• Drug Therapy, Combination (therapeutic use)
• Endoscopy
• Female
• Fluticasone
• Forced Expiratory Volume
• Humans
• Interferon-gamma (metabolism)
• Interleukin-4 (metabolism)
• Male
• Neutrophils (metabolism)
• Pregnenediones (therapeutic use)
• Rhinitis, Allergic, Perennial (complications, drug therapy)
• Sinusitis (complications, drug therapy)