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1.6.5 Studies of inflammatory markers in blood and uine
Inflammatory markers have also been studied in blood and urine and I am going to briefly
review what has been found in this area. Blood and urine samples are relatively easy to obtain
when compared to the general anaesthesia or sedation required for bronchoscopy, lavage and
biopsy, are more consistently obtainable than induced sputum and less likely to cause side
effects than these other procedures. However blood testing is still seen as invasive by children
and most adults. Also, these compartments are removed from the direct area of interest and
reflect systemic findings, which may or may not be related to the lung.
As with results from sampling the lung, monitoring of inflammatory markers in blood have
shown an increase in eosinophils, ECP and EDN levels in children and adults with asthma
compared to control groups. In some studies these correlated with asthma severity or current
symptomatology (Krisdansson, Shimizu et al. 1994; Parra, Prieto et al. 1996; Rao, Frederick
et al. 1996; Remes, Korppi et al. 1998; Yazicioglu, Ones et al. 1999; Stelmach, Gorski et al.
2002), and although other studies also found higher levels, no such correlations were found
(Pizzichini,Pizzichini et al. 1997; Bacci, Cianchetti et al. 1998; Niimi and Matsumoto 1999;
Stelmach, Jerzynska et al. 2001; Stelmach, Jerzynska et al. 2001; Aldridge, Hancox et al.
2002; Reichenbach, Jarisch et al. 2002) or even mixed results were obtained (Currie, Syme_
Grant et al. 2o03). In adults, a large cross sectional study of almost 7000 subjects found
physician diagnosed asthma was significantly associated with serum eosinophil count
(Schwartz and Weiss 1993). Serum eosinophil and ECP levels during acute asthma were
corelated with more severe exacerbations and less bronchodilator responsiveness in 48 adults
(Lee, Ire et al. 1997). Plasma total IgE, plasma specific IgE, blood eosinophil percentage and
exhaled NO were thought to account for 55.5Vo of the variance seen in bronchial hyper-
reactivity (I-eung, Wong et al. 2005). Urinary levels of EDN did increase at time of asthma
exacerbation (Cottin, Deviller et al. l99g).
In children, ECP and eosinophilic peroxidase (EPO) in both serum and urine showed reduced
gradation in levels from asthmatics with current symptoms to symptom free asthmatic
children and to healthy children (Lonnkvist, Hellman et al. 2001). Both urinary EDN and
serum ECP were significantly higher in children with atopic asthma than control subjects
(Kristjansson, Strannegard et al. 1996). In both studies levels decreased with IHCS treatment
(Kristjansson, Strannegard et al. 1996;Lonnkvist, Hellman et al. 2001) and in one increased if
treatment was reduced (Lonnkvist, Hellman et al. 2001). Urinary EDN levels were increased
in 80 asthmatic children compared to 24 controls, and were higher in symptomatic than
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