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asymptomatic patients independent of the presence of atopy or the treatment modality.
Urinary EDN levels in the asthmatics correlated to lung function, and in the subgroup of 15
children re-examined two months after commencement of treatment, the reduction of EDN
also correlated with the changes in lung function (Lugosi, Halmerbauer et al. 1997). While no
correlation was found between urinary EDN values and lung function in two other studies of
155 and 39 children, there was a similar reduction of EDN three months after commencing
IHCS treatment (Krisdansson, Strannegard et al. 1996; Labbe, Aublet-Cuvelier et al. 2001).
Circadian variations of the eosinophil proteins in urine samples have been demonstrated with
high early morning and nocturnal peaks compared to lower levels in the afternoon in both
asthmatic and non-atopic, non-asthmatic groups of children (Storm van's Gravesande, Mattes
et al. 1999; Wolthers and Heuck 2003).
A more explored area using these samples has been in measuring the levels of the leukotriene
goup of proteins, particularly in urine samples. These proteins were shown to increase early
in adult asthmatic groups following an airway challenge (Westcott, Smith et al. 1991; Kumlin,
Dahlen et al. 1992; O'Sullivan, Roquet et al. 1998; Bancalari, Conti et al. L999) with peak
excretion occurring at two hours (Kumlin and Dahlen 2000; Mai, Bottcher et al. 2005). The
results were more variable when assessing whether levels remained elevated during the late
asthmatic response - not seen in one study (Manning, Rokach et al. 1990) but documented in
two others (O'Sullivan, Roquet et al. 1998; Bancalari, Conti et al. 1999). LT& was high in
184 adults presenting with moderate to severe acute asthma and reduced two weeks later in
the 146 followed up during recovery (Green, Malice et al. 2OO4). Compared to control
subjects, there was an increase in the LTEI level in asthmatics with nocturnal asthma
exacerbations but not in asthmatics without, although the numbers in each group were less
than ten (Bellia, Bonanno et al. 1996). Patients with asthma did excrete more LT& over a24
hour period than normal subjects, again with less than ten subjects in each group (Asano,
Lilly et al. 1995). In 40 severe asthmatics, 25 mild to moderate asthmatics and 20 non-
asthmatic controls, there was a gradation LTE4 levels despite treatment with high dose IHCS
in the severe group (Vachier, Kumlin et al. 2003). LTE4 in urine was higher in 35 atopic
asthmatic than32 non-atopic children with RSV bronchiolitis and 23 controls (Oh, Shin et al.
200s).
Other studies have been less positive about the correlations between inflammatory markers
measured in blood and urine samples and asthmatic disease. In adults, no correlation between
clinical status, functional status and serum ECP was seen during five months in asthmatics
either admitted for acute asthma or who were seasonally sensitised to birch and tree pollens
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