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GÜRAN, TÜLAY

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Author: KARADAĞ, BÜLENT TANER × Subject: children ×

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    Withdrawal of inhaled steroids in children with non-cystic fibrosis bronchiectasis
    (WILEY, 2008) KARADAĞ, BÜLENT TANER; Guran, T.; Ersu, R.; Karadag, B.; Karakoc, F.; Demirel, G. Y.; Hekim, N.; Dagli, E.
    To study the effects of inhaled steroid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non-cystic fibrosis (non-CF) bronchiectasis. To evaluate the role of inhaled steroids in the treatment of children with non-CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apoptosis. Twenty-seven children with steady-state non-CF bronchiectasis were evaluated primarily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) levels and neutrophil ratios in induced sputum before and after 12-week withdrawal of inhaled steroids. There were 16 girls and 11 boys. Median (interquartile range) age was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years. Symptom scores (4 vs. 3; P = 0.27), oxygen saturation (95% vs. 97%; P = 0.06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P = 0.73), sputum neutrophil ratios (29.9% vs. 46.8%; P = 0.20), TNF-alpha (58 pg/mL vs. 44.5 pg/mL; P = 0.55) and IL-8 (2.7 ng/mL vs. 2.4 ng/mL; P = 0.82) levels in induced sputum were similar before and after 12-week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P = 0.016) and neutrophilic apoptosis in induced sputum decreased (42.8% vs. 20.2%; P = 0.03) after withdrawal. In this study, 12 week-withdrawal of inhaled steroid treatment resulted in a significant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non-CF bronchiectasis was observed.
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    Association between inflammatory markers in induced sputum and clinical characteristics in children with non-cystic fibrosis bronchiectasis
    (WILEY-LISS, 2007) KARADAĞ, BÜLENT TANER; Guran, Tulay; Ersu, Refika; Karadag, Buient; Akpinar, Ihsan Nuri; Demirel, Gulderen Yanikkaya; Hekim, Nezih; Dagli, Elif
    To study clinical, radiological and laboratory features of children with non-cystic fibrosis (non-CF) bronchiectasis (BE) and the association between symptom scores, spirometry, high-resolution computed tomography (HRCT) findings and inflammatory markers in induced sputum in these children. Twenty-seven children with steady-state non-CF BE were cross-sectionally evaluated by symptom scores, pulmonary function tests, anatomic extension and severity scores of BE in HRCT and tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) levels in induced sputum. There were 16 girls and 11 boys. Median (interquartile range) age of study group was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years and symptom scores were 4 (3-6). Pulmonary function tests revealed FEV1 of 82%pred (72-93), FVC of 82%pred (74-92), and FEF25-75% of 82%pred (68-95). According to anatomic extent of BE on HRCT; 2 patients had mild, 4 had moderate and 21 had severe BE. Based on severity scores of HRCT; 10 patients had mild, 10 had moderate and 7 had severe BE. Neutrophils consisted 29.9% (14.9-53.7) of the total leucocytes in induced sputum samples. Sputum concentration of TNF-alpha was 58 pg/ml (9.2-302) while IL-8 concentration was 2.7 ng/ml (1.7-2.8). Symptom scores correlated with FEV1 and sputum IL-8 levels (r=-0.49, r=0.67, P < 0.05). There was a significant correlation between HRCT severity scores and symptoms, FEV1, sputum IL-8 and TNF-alpha levels (r=0.64, r=-0.68, r=0.41, r=0.41, respectively, P < 0.05). In children BE is associated with ongoing inflammation. This inflammation can be reliably monitored by radiological scores, spirometry, as well as sputum inflammatory markers. Follow-up of children with BE using these clinical tools may improve patient care.