Evaluation of a clinical algorithm involving serum eosinophil cationic protein for guiding the anti-inflammatory treatment of bronchial asthma in childhood

A pilot study was performed to investigate a clinical algorithm using serum -eosinophil cationic protein level (S-ECP) as an objective parameter for ta pering the anti-inflammatory treatment in chronic childhood asthma, We stud ied 21 outpatient asthmatic children (6 girls and 15 boys, mean age 9 yr, r ange 3-12 yr, all with initial S-ECP greater than or equal to 15 mu g/l) ov er a period of 12 months at monthly intervals. At each visit a short histor y, clinical examination, blood sample for S-ECP and eosinophil count, lung function tests and drug compliance were assessed. According to the initial S-ECP, patients were allocated to two anti-inflammatory treatment groups: p atients with S-ECP between 15 mu g/l and 30 mu g/l were treated with Budeso nide 200 mu g twice daily, while patients with S-ECP of 30 mu g/l and above received Budesonide 400 mu g twice daily. After this induction treatment t he anti-inflammatory medication was tapered at monthly intervals according to actually measured S-ECP: patients with S-ECP < 15 mu g/l received sodium cromoglycate (SCG) 10 mg twice daily per inhalation via spacer, patients w ith S-ECP greater than or equal to 15 mu g/l and < 30 mu g/l received Budes onide 200 mu g twice daily via spacer, and patients with S-ECP greater than or equal to 30 mu g/l received Budesonide 400 mu g twice daily. Prior to i nhalation of topical steroids or SCG all patients had to inhale 500 mu g Te rbutaline twice daily for optimal bronchodilatation. The use of medication was assessed by weighing the metered dose inhaler containers each month. Ou r results showed a decrease in symptoms (p = 0.0001) and in S-ECP (p = 0.02 ) and MEF50% predicted (p = 0.02) after the initial month of Budesonide tre atment. During a total of 246 months of investigation there was no need for emergency room treatment or hospital admission, acid no need for oral ster oids. During the whole study period there was a tendency for inhaled steroi ds to be more effective than SCG in reduction of markers of airway inflamma tion, improvement of symptoms and lung function. Inadequate use of medicati on was related to an increase in S-ECP in all treatment groups. From this o pen pilot study it is concluded that a clinical algorithm including S-ECP f or tapering the anti-inflammatory treatment may be helpful in childhood ast hma. These first observations should be confirmed by a controlled long-term study.