This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Pediatric asthma is both under-recognized and under-treated. Children from birth-4 years of age have the highest hospitalization rates for any age group, as well as the most substantial increase in prevalence rates in every region in the US. Nevertheless, children have not been the focus of research. One of the great challenges in pediatric respiratory medicine is to identify children in early stages of asthma, who presumably have early allergy induced airway hyperactivity, during the first years of life. Inflammatory markers are increasingly used in practice as an objective tool to aid in the diagnosis and monitoring of asthma. Consequently, the role of serum eosinophil cationic protein (sECP) and urine eosinophil protein X (uEPX) as biomarkers of latent effect could potentially lead to a medical breakthrough permitting the diagnosis of asthma early in infancy and childhood than is presently possible. Remarkably, the relationships between serum eosinophilic protein (sECP), urinary eosinophilic protein X (uEPX), in infants and very young children exposed to environmental tobacco smoke (ETS) have never been investigated in young children. In a 3-year collaborative, prospective study, we will follow 200 children (birth-4 years) with newly-diagnosed asthma, and a comparison group of 200 healthy children matched for age (+ 3 months), sex, and race. We hypothesize that in infants and children, (sECP and/or uEPX may be valuable measures of eosinophil activation in asthmatics, particularly those exposed to environmental tobacco smoke during pregnancy and postnatally. We expect to find that asthmatic infants exposed to ETS in utero should have the highest sECP and uEPX values, unexposed asthmatics and ETS exposed healthy children will have intermediate values, and healthy unexposed infants will have the lowest sECP and uEPX values at baseline; the latter define the low dose area of the dose-response curve. Inflammatory markers are simple, non-invasive tests, which have the potential for an immediate impact in an age group who are extremely difficult to diagnose and treat.
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