A new approach to assess response to steroids in children with severe asthma: one size does not fit all!

Published Online: April 6, 2016

Children with severe asthma have persistent and troublesome symptoms and frequent acute attacks despite treatment with high dose steroid medication. To date, there has been no agreed way of optimally assessing their clinical response to steroids. But if we could determine this, it would help guide which treatments are best for each child. Previously, in adult studies, only lung function was considered in assessing the response to steroids. Bossley et al have investigated and proposed a very new approach to determining clinical response to steroids in children with severe asthma which

82 children (average age 12 years) with severe therapy resistant asthma, who remained poorly controlled despite high dose steroid treatment, underwent a clinical investigation protocol which included a bronchoscopy and steroid injection. Triamcinolone is slowly released into the body from the injection site for a period of up to 6 weeks. This method was used so administration of the steroid was assured, and was not dependent on patients remembering to take the medication.

Assessments were undertaken on the day of, and 4 weeks after the steroid injection. Changes in four different domains were assessed, change in symptoms, lung function, exhaled nitric oxide and number of eosinophils in sputum. Approximately half of the patients had an improvement in each domain after the steroid injection. Most (72%) patients improved after the steroid injection in at least one domain. 13% responded with an improvement in all domains, and 15% did not show an improvement after the steroid injection in any domain.  

There were no factors which were reliable predictors of a particular pattern of response to steroid treatment in children with severe asthma. These children do not have a uniform or predictable response to steroids, so assessing the specific pattern of response in each child is necessary, and will help to guide the type of new treatment from which they are most likely to benefit. Measuring steroid response in this way is the first step towards personalised medicine, better tailored to the individual child with severe asthma.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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