Serum interieukin-4 and 5 as parameters of improvement of lower airway obstruction in children following early noninvasive ventilation

ABSTRACT

Childhood diseases such as bronchial asthma and acute bronchiolitis have both been linked to lower airway obstruction with the possibility of developing acute lung injury. Management usually necessitates the intervention of mechanical ventilation with its risks and complications. In addition, serum levels of lnterleukin-4 [IL-4] and Interleukin-5 [IL-5] have been found to be associated in the pathogenesis of this condition and are known to be elevated in these patients. This study was designed to evaluate the use of IL-4 and IL-5 as predictive factors and markers of inflammation for a successful response to non-invasive ventilation [NIV] in children with acute severe lower airway obstruction. This iia prospective study that included 40 cases presented with acute respiratory distress secondary to lower airway obstruction including acute exacerbations of asthma and acute bronchiolitis. Cases were classified randomly into two groups; Group A patients who received NIV plus standard conventional therapy if needed, and Group B control patients who received only standard conventional therapy without NIV. Serum IL-4 and IL-5 were measured in all patients on admission and after treatment. We have found that there was significant improvement of all the clinical parameters in addition to a reduction in the need of invasive ventilation. There were also a significant reduction in the serum levels of the studied interleukins 4 and 5 after the completion of therapy as indicated by p<.001 in both cytokines. This may give a key for the importance of the early use of NIV as a first line of treatment of severe cases of lower airway obstruction and highlights the importance of using serum IL-4 and IL-5 as parameters of improvement