Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy

Abstract

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.

Cross-Talk between Human Mast Cells and Bronchial Epithelial Cells in Plasminogen Activator Inhibitor-1 Production via Transforming Growth Factor-β1

“…Although SP is widely known as a neuronally derived peptide, rodent studies have shown that eosinophils, lymphocytes, macrophages, and dendritic cells may also produce SP (40)(41)(42)(43). The content of SP in human airways is increased in asthma, suggesting that SP may be involved in MC activation in asthma (44). SP has recently been shown to be a potent activator and induces production of nanogram quantities of chemokines and TNF from human MCs (28).…”

Airway inflammation and injury in children with prevalent weakly acidic gastroesophageal refluxes

“…Diminishing the activity of neutral endopeptidase in the airways, ozone can increase the concentrations of substance P [35]. Substance P is a neuropeptides, secreted by sensory airway nerves but also by activated inflammatory cells, that plays a pivotal role in airway inflammation and bronchial hyperresponsiveness [36] also in children with difficult-to-treat bronchial asthma and GER [37]. In the present report, both WAR and AR children had high BAL levels of substance P, associated with a neutrophilic inflammatory response at airway level.…”