Original Article

Is a two-week trial of oral prednisolone predictive of target lung function in pediatric asthma?

  1. Christiane Lex MD1,2,
  2. Donald N.R. Payne MD, MRCPCH1,
  3. Angela Zacharasiewicz MD1,
  4. Albert M. Li MRCPCH1,
  5. Andrew G. Nicholson DM, MRCPath3,
  6. Nicola M. Wilson FRCPCH1,
  7. Andrew Bush MD, FRCP, FRCPCH1,*

Article first published online: 11 MAR 2005

DOI: 10.1002/ppul.20189

Issue

Pediatric Pulmonology

Pediatric Pulmonology

Volume 39, Issue 6, pages 521–527, June 2005

Additional Information

How to Cite

Lex, C., Payne, D. N., Zacharasiewicz, A., Li, A. M., Nicholson, A. G., Wilson, N. M. and Bush, A. (2005), Is a two-week trial of oral prednisolone predictive of target lung function in pediatric asthma?. Pediatric Pulmonology, 39: 521–527. doi: 10.1002/ppul.20189

Author Information

  1. 1

    Department of Respiratory Paediatrics, Imperial College of Science, Technology and Medicine at the Royal Brompton Hospital and National Heart and Lung Institute, London, UK

  2. 2

    Department of Paediatric Cardiology and Pulmonology, Heinrich-Heine-University, Düsseldorf, Germany

  3. 3

    Department of Histopathology, Imperial College of Science, Technology and Medicine at the Royal Brompton Hospital and National Heart and Lung Institute, London, UK

*Department of Respiratory Paediatrics, Imperial College of Science, Technology and Medicine at the Royal Brompton Hospital and National Heart and Lung Institute, Sydney Street, London SW3 6NP, UK.

Publication History

  1. Issue published online: 27 APR 2005
  2. Article first published online: 11 MAR 2005
  3. Manuscript Revised: 8 NOV 2004
  4. Manuscript Accepted: 8 NOV 2004
  5. Manuscript Received: 16 AUG 2004

Funded by

  • European Respiratory Society
  • Asthma UK
  • Society of Paediatric Pneumology (German, Austrian, and Swiss)

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Keywords:

  • difficult asthma;
  • children;
  • steroid trial;
  • airway inflammation;
  • FENO;
  • remodeling

Abstract

We used a 2-week trial of prednisolone to determine “target” lung function for subsequent asthma therapy. The aim of this study was to evaluate whether some children exceed their “target” forced expired volume in 1 sec (FEV1) on subsequent visits in the following year, and whether this is associated with particular clinical or pathological features. Children (aged 6–16 years) with difficult asthma underwent spirometry and exhaled nitric oxide (FENO) measurements before and after 2 weeks of prednisolone 40 mg/day. At the end of the course, subepithelial eosinophils and reticular basement membrane thickness were assessed. The highest FEV1 obtained in a 1-year follow-up was compared with the poststeroid postbronchodilator (“target”) FEV1. Four of 22 children (18%) demonstrated an increase of >9% above their “target” FEV1 during follow-up. None of these children had been prescribed additional asthma medications. Three of 7 children with persistent airflow limitation (PAL; poststeroid postbronchodilator FEV1 <80% predicted) recorded an FEV1 >80% predicted during follow-up. The median (interquartile range) number of subepithelial eosinophils was significantly higher in children who exceeded their target FEV1 than in children who did not (12.4 (8.5–39.9) vs. 1.4 (0.0–4.8) cells/mm2, P = 0.018). In conclusion, a 2-week course of prednisolone is not necessarily predictive of “target” lung function. Definitions such as PAL should be regularly reviewed on individual basis. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc.

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