Asthma Symptom Control, Biomarkers Of Airway Inflammation And Spirometry In A Cohort Of Sri Lankan Children

Background: Asthma is common in children. Symptom control scores, spirometry, exhaled nitric oxide (FeNO) level and peripheral eosinophil count objectively assess airway inflammation and disease activity. We studied the association of inflammatory biomarkers and spirometry with asthma symptom control. Aims and Methods: A cross-sectional analytical study in a cohort of 7-14 years old asthmatics from Lady Ridgeway hospital, Sri Lanka. Demographics, asthma symptom control (GINA assessment), spirometry (portable EasyOneTM Spirometer), FeNO level (portable NObreath® FeNO breath test monitor) and peripheral eosinophil count was assessed and association analyzed by SPSSv20. Results: Ninety nine subjects (mean age 12±1.4yrs); 49.4% male, participated. Commonest presentation was wheezing (77%) followed by dry cough (76%). 96% were on inhaled corticosteroids, 58% demonstrated correct inhaler technique, whereas 54% had forgotten inhalers at least one day in the preceding month. Based on GINA symptom control assessment, 41.4%, 28.2% and 30.3% were well, partially and poorly controlled respectively. Correct inhaler technique and symptom control level showed significant correlation (r= 0 .318, p=0.001). Significant positive correlations were observed between asthma symptom control score (ASCS) with FeNO levels (r=0.643, P<0.0001) and eosinophil count (r=0.454, P<0.0001), and between FeNO levels and eosinophil counts (r= 0.652, p<0.0001). Negative correlations were noted between biomarkers and ASCS with spirometer parameters, though not statistically significant. Conclusions: Biomarkers of inflammation showed better association with asthma symptom control compared to spirometry.