FLAME: Airway Inflammation Monitoring in Asthma and Cystic Fibrosis
FLAME: Airway Inflammation Monitoring in Asthma and Cystic Fibrosis
Background By means of measurements of series of non-invasive inflammatory markers in exhaled
 breath (condensate), a reflection of inflammatory processes and oxidative stress, can be
 obtained. Thereby, these techniques could be important in monitoring asthma and CF lung
 disease in children. Fractional exhaled nitric oxide (FeNO) and inflammatory markers in
 exhaled breath condensate (EBC) reflect ongoing inflammation and oxidative stress in the
 airways. These markers have a promising capacity for monitoring diagnoses of CF and asthma
 lung disease.

 Aim To study the course of inflammatory markers in time in children with asthma and CF, in
 stable periods and during pulmonary exacerbations. In addition, we study the ability of
 inflammatory markers to predict safe tapering of medical treatment in both populations.

 1. To study the course of inflammatory markers in EBC during an exacerbation.

 2. To study which IM are already elevated before a clinical exacerbation is evident and can
 predict exacerbations in time.

 3. To study which inflammatory markers can predict safe discontinuation of antibiotics in
 children with CF, or tapering of inhaled corticosteroids in children with asthma.

 4. To study the relationship between inflammatory markers in EBC, the severity and control
 of CF and asthma, the symptoms and lung function within patients will be analysed.

 Methods Children with CF (n=30) and children with asthma (n=40) were recruited included from
 our outpatient clinic. During this longitudinal study patients visit the outpatient clinic
 were followed-up for 12 months; every two months during one year. patients visited our
 outpatient clinic. In addition to these standard visits, During exacerbations patients four
 extra visits were planned during an exacerbation. were asked to visit the University Hospital
 Maastricht four times. These additional visits were planned with a maximum of two times
 during the study. By means of a home monitor, children were asked to assess measurements of
 Besides measurements in the University Hospital, children measured forced expiratory volume
 in one second (FEV1) at home using a home monitor, to record medication use, and, to record
 presence and severity of pulmonary symptoms. Outcome parameters were: 1) FeNO assessment in
 exhaled air, 2) inflammatory markers in EBC, 3) lung function parameters, 4) specific
 questionnaires to assess asthma and CF control and severity, 5) data originating from the
 home monitor.
Inclusion Criteria:

 -  Asthma is defined as a chronic inflammatory disorder, leading to recurrent episodes of
 wheezing, breathlessness, chest tightness, and/or coughing, based on variable airway
 obstruction [18]. Children with docter-diagnosed asthma known at the department of
 Paediatric Pulmonology, were recruited from the University Hospital Maastricht. Atopic
 and not atopic asthmatic children were allowed; treatment with inhalation
 corticosteroïd (ICS) was not obliged.

 -  Children known with CF were recruited from University Hospital Maastricht. CF was
 defined as a combination of typical clinical features and an abnormal sweat test
 (Chloride > 60 mM). CF lung disease was treated according to the CBO consensus ref.
 Main aspects of treatment were:

 -  antibiotic treatment,

 -  agents to promote airway secretion clearance, such as DNase,

 -  bronchodilators, and,

 -  physiotherapy. All alternations of medical therapy were allowed and accurately
 documented.

 Exclusion Criteria:

 -  Diseases that may interfere with the results of the study (e.g. upper airway
 infection, cor vitium, anatomic abnormalities of the airway and other chronic
 inflammatory diseases, such as Morbus Crohn and rheumatoid arthritis),

 -  Mental retardation,

 -  Inability to perform measurements properly,

 -  Active smoking and,

 -  Use of the following medication: papaverin, sodium nitroprusside,
 angiotensin-converting enzyme (ACE) inhibitors, oxymetazoline, L-arginine, or nitric
 oxide synthase (NOS) inhibitors