Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV1, peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV1 and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV1. Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function.

Background. Soluble triggering receptor expressed on myeoid cells-1 (sTREM-1) has recently been found to be high in infected pleural fluid (PF).Objectives. Diagnostic accuracy of PF sTREM-1 for differentiating uncomplicated parapneumonic effusions (UPPEs) from complicated parapneumonic effusions (CPPEs) was evaluated prospectively.Methods. Serum and PF sTREM-1 were measured for 68 patients with parapneumonic and transudative pleural effusion.Results. PF (but not serum) sTREM-1 concentrations were significantly higher in CPPE than in UPPE. Serum and PF sTREM-1 levels were higher in parapneumonic than in transudative groups. PF sTREM-1 had a sensitivity of 85.19% and a specificity of 83.33% at cutoff value of 250.5 pg/mL for differentiating CPPE and UPPE with area under the curve (AUC) of 0.9336. After excluding purulent CPPE cases, sensitivity and specificity became 90.48% and 83.33%, respectively (at the same cutoff value) with AUC of 0.9444.Conclusion. High concentrations of PF sTREM-1 (above 250.5 pg/mL) help to early diagnose and differentiate CPPE from UPPE.