Table of Contents
ISRN Pediatrics
Volume 2013, Article ID 824781, 7 pages
http://dx.doi.org/10.1155/2013/824781
Clinical Study

Clinical Asthma Phenotypes and Therapeutic Responses

1Allergy, Clinical Immunology and Respiratory Medicine Unit, Faculty of Medicine, Mansoura University, P.O. 35516 Box 50, Mansoura, Egypt
2Pediatric Department, Faculty of Medicine, Mansoura University, P.O. 35516, Mansoura, Egypt
3Clinical Pathology Department, Faculty of Medicine, Mansoura University, P.O. 35516, Mansoura, Egypt
4Pharmacology Department, Faculty of Pharmacy, Mansoura University, P.O. 35516, Mansoura, Egypt

Received 12 January 2013; Accepted 13 February 2013

Academic Editors: T. V. Brogan and S. Fanconi

Copyright © 2013 M. Zedan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Asthma is a heterogeneous disease that means not all asthmatics respond to the same treatment. We hypothesize an approach to characterize asthma phenotypes based on symptomatology (shortness of breath (SOB), cough, and wheezy phenotypes) in correlation with airway inflammatory biomarkers and FEV1. We aimed to detect whether those clinical phenotypes have an impact on the response to asthma medications. Two hundred three asthmatic children were allocated randomly to receive either montelukast (5 mg at bed time) or fluticasone propionate (100 ug twice daily) for 8 consecutive weeks. Serum concentrations of IL-2Rs, ICAM-1, VCAM-1, total IgE, eosinophilic %, eosinophil cationic protein (ECP), and FEV1 were done before and after treatment to patients and once to controls. Children who have SOB were found to have higher levels of total sIgE, older age, and longer disease duration, and they responded to fluticasone alone. Cough group was found to have higher levels of eosinophilic % and sECP, younger age, shorter disease duration and responded to montelukast alone. Wheezy group showed mixed pattern and responded to both medications. Conclusion. Although there is variability in response to ICS and LTRAs, we did identify characteristics of patient that should guide the clinician in the choice of asthma medications.