| 1. |
- Björkstén, B
(författare)
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Immunological outcome measures
- 1996
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Ingår i: The European respiratory journal. Supplement. - 0904-1850. ; 21, s. 22s-27s
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Grigg, J., et al.
(författare)
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Inflammatory markers of outcome
- 1996
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Ingår i: The European respiratory journal. Supplement. - 0904-1850. ; 21, s. 16s-21s
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Tidskriftsartikel (refereegranskat)abstract
- A significant proportion of early childhood wheezing appears not to be due to atopy-induced pulmonary inflammation, and mediator studies in atopic adults and older children may not be relevant to this age group. The usefulness of inflammatory markers in young children is related to 1) whether atopic and nonatopic wheezing are associated with different patterns of pulmonary inflammation, and 2) whether indirect measurements truly reflect the inflammatory milieu within the lung. Both assumptions remain unproved. Bronchoalveolar lavage (BAL) directly samples the alveolar milieu and is a potential tool for defining both the pulmonary mediator profile, and to validate plasma mediator concentrations. BAL fluid (BALF) eosinophil cationic protein (ECP) concentrations accurately reflect pulmonary eosinophil activation, and the BALF interleukin-2 to interleukin-4 ratio may be helpful in defining those children with established pulmonary sensitization to allergen. Of the mediators that have been measured in the plasma, ECP eosinophil protein X (EPX) and major basic protein (MBP) correlate well with atopy-induced wheezing. However atopic activation in other sites may also increase the plasma concentrations of eosinophil-specific mediators. The profile of adhesion molecules in the plasma (e.g. soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1 and E-selection) reflects transmigration of specific types of leucocytes across the pulmonary endothelium. To date, the potential of this group of soluble markers to define the nature of pulmonary inflammation is unclear. More information is therefore required on pulmonary inflammation in early childhood to guide the future use of plasma markers.
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| 3. |
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| 4. |
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| 5. |
- Wennergren, Göran, 1947, et al.
(författare)
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Short- and long-term efficacy. Childhood asthma.
- 1998
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Ingår i: The European respiratory journal. Supplement. - 0904-1850. ; 27
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Forskningsöversikt (refereegranskat)abstract
- In clinical studies of asthma, great attention should be focused on the choice and validation of outcome measures. The outcome parameters to be used when evaluating efficacy of early intervention in childhood asthma treatment must be closely linked to the aims of the intervention and considered in the design of the study. In an interventional study, possible adverse consequences should also be considered as outcome measures when designing the study. The appropriate time span for assessing different types of interventions may vary from days to several decades, depending on the character of the intervention. Not only outcome parameters, such as improvement in symptom score and improvement of lung function, but also those that measure reduction in frequency and severity of acute exacerbations, reduction in morbidity and improvement in quality of life should be used. For some purposes, a more detailed approach to symptom severity is needed, such as separation of acute from chronic symptoms. Other outcome measures that need to be considered are: cost-effectiveness, normalization of inflammatory changes in the airways, control of airway hyperresponsiveness, airway growth and prevention of airway remodelling and importantly, whether an intervention against asthma can alter the natural course, or cure, the disease. Interventions should be evaluated to see to what extent such aims have been met.
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