Withdrawal of inhaled steroids in children with non-cystic fibrosis bronchiectasis

• Published in: Journal of clinical pharmacy and therapeutics Vol. 33; no. 6; pp. 603 - 611
• Main Authors: Guran, T., Ersu, R., Karadag, B., Karakoc, F., Demirel, G. Y., Hekim, N., Dagli, E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2008; Blackwell
• Subjects: Administration, Inhalation; Adolescent; apoptosis; Apoptosis - drug effects; Biological and medical sciences; Biomarkers - metabolism; bronchial hyperreactivity; Bronchial Hyperreactivity - etiology; bronchiectasis; Bronchiectasis - drug therapy; Child; children; Errors of metabolism; Female; Glucocorticoids - administration & dosage; Humans; induced sputum; Inflammation - etiology; interleukin-8; Male; Medical sciences; Metabolic diseases; Methacholine Chloride; Miscellaneous hereditary metabolic disorders; Neutrophils - metabolism; Pharmacology. Drug treatments; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Sputum - metabolism; Substance Withdrawal Syndrome - etiology; tumour necrosis factor-α; Steroid; Angiogenic factor; Hyperreactivity; interleukin-8; Respiratory system; Respiratory tract; children; Bronchus disease; Child; bronchial hyperreactivity; Tumor necrosis factor α; Interleukin 8; Pancreatic disease; Human; Respiratory disease; Cytokine; Bronchus; Metabolic diseases; Cystic fibrosis; Bronchiectasis; Genetic disease; Inhalation; tumour necrosis factor-α; Cell death; Digestive diseases; Apoptosis; Induced sputum
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/j.1365-2710.2008.00951.x

Summary Background:  To study the effects of inhaled steroid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non‐cystic fibrosis (non‐CF) bronchiectasis. Objectives:  To evaluate the role of inhaled steroids in the treatment of children with non‐CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apoptosis. Methods:  Twenty‐seven children with steady‐state non‐CF bronchiectasis were evaluated primarily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor‐alpha (TNF‐α), interleukin‐8 (IL‐8) levels and neutrophil ratios in induced sputum before and after 12‐week withdrawal of inhaled steroids. Results:  There were 16 girls and 11 boys. Median (interquartile range) age was 11·4 (9·5–13·6) years, follow‐up duration was 3·5 (2–6·5) years. Symptom scores (4 vs. 3; P = 0·27), oxygen saturation (95% vs. 97%; P = 0·06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P = 0·73), sputum neutrophil ratios (29·9% vs. 46·8%; P = 0·20), TNF‐α (58 pg/mL vs. 44·5 pg/mL; P = 0·55) and IL‐8 (2·7 ng/mL vs. 2·4 ng/mL; P = 0·82) levels in induced sputum were similar before and after 12‐week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P = 0·016) and neutrophilic apoptosis in induced sputum decreased (42·8% vs. 20·2%; P = 0·03) after withdrawal. Conclusion:  In this study, 12 week‐withdrawal of inhaled steroid treatment resulted in a significant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non‐CF bronchiectasis was observed.