Background: Systemic corticosteroids are the standard of care for acute asthma exacerbation. Respiratory infections are known as common triggers of asthma exacerbation, but the risk of immune suppression from frequent periodic use of systemic steroids in poorly controlled asthmatic children is not well studied. Materials and Methods: We conducted a retrospective chart review of 26 children, 3-15 years old with poorly controlled, moderate-to-severe persistent asthma who received ≥2 systemic corticosteroid/year. The data collected include absolute T cell, B cell, and natural killer (NK) cell counts; lymphocyte proliferation studies to phytohemagglutinin (PHA), concanavalin A (CON A), and pokeweed mitogen; immunoglobulin G and M; and antibody titers to tetanus, diphtheria, and pneumococcus. Frequency tables and crosstabs were used to analyze the data. Results: Low CD4+ T cell counts were found in 47.8% of the patients, and 45.8% had low CD3+ T cell counts. The lymphocyte proliferation studies data exhibited variability, but 21.4%-75% of the subjects who demonstrated normal T cell counts had decreased lymphocyte proliferation studies to PHA and CON A. All the patients had normal immunoglobulins, B cell, and NK cell counts. All but 1 patient had adequate antibody responses to Streptococcus pneumoniae. Conclusions: Frequent systemic corticosteroid use may suppress T cell number and function in asthmatic children. This can potentially lead to increase susceptibility for future infections and asthma exacerbations. Depressed lymphocyte proliferations are observed even in patients who demonstrated normal T cell counts. This emphasizes the importance of adherence to asthma controller medications, and control of asthma triggers, to limit the frequency of steroid use.

中文翻译：

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患有反复感染的城市哮喘儿童的系统性类固醇爆炸后的T细胞概况。

背景：全身性皮质类固醇激素是急性哮喘加重的标准治疗方法。呼吸道感染被认为是哮喘急性发作的常见诱因，但对于控制不佳的哮喘儿童频繁定期使用全身性类固醇激素造成的免疫抑制风险尚未得到很好的研究。材料和方法：我们对26例3-15岁控制不佳，中度至重度持续性哮喘的儿童（每年接受≥2的全身性皮质类固醇）进行了回顾性图表审查。收集的数据包括绝对T细胞，B细胞和自然杀伤（NK）细胞计数；对植物血凝素（PHA），伴刀豆球蛋白A（CON A）和商陆有丝分裂原的淋巴细胞增殖研究；免疫球蛋白G和M；以及针对破伤风，白喉和肺炎球菌的抗体滴度。频率表和交叉表用于分析数据。结果：47.8％的患者中CD4 + T细胞计数低，而CD3 + T细胞计数低则占45.8％。淋巴细胞增殖研究数据显示出变异性，但有21.4％-75％的正常T细胞计数受试者的淋巴细胞增殖研究相对于PHA和CON A有所减少。所有患者的免疫球蛋白，B细胞和NK细胞计数均正常。除1名患者外，所有患者均对肺炎链球菌具有足够的抗体反应。结论：频繁使用全身性糖皮质激素可抑制哮喘儿童的T细胞数量和功能。这有可能导致对未来感染和哮喘加重的敏感性增加。即使在显示正常T细胞计数的患者中，也观察到了淋巴细胞增殖的降低。这强调了遵守哮喘控制药物的重要性，