ORIGINAL ARTICLE Withdrawal of inhaled steroids in children with non-cystic fibrosis bronchiectasis T. Guran* MD, R. Ersu MD, B. Karadag MD, F. Karakoc MD, G. Y. Demirel à MD, N. Hekimà MD and E. Dagli  MD *Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul,  Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul and àPakize Tarzi Laboratories, Istanbul, Turkey SUMMARY Background: To study the effects of inhaled ste- roid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non-cystic fibrosis (non-CF) bronchiectasis. Objectives: To evaluate the role of inhaled ste- roids in the treatment of children with non-CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apop- tosis. Methods: Twenty-seven children with steady- state non-CF bronchiectasis were evaluated pri- marily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor-alpha (TNF-a), interleukin-8 (IL-8) levels and neutro- phil ratios in induced sputum before and after 12-week withdrawal of inhaled steroids. Results: There were 16 girls and 11 boys. Median (interquartile range) age was 11Æ4 (9Æ5–13Æ6) years, follow-up duration was 3Æ5 (2–6Æ5) years. Symptom scores (4 vs. 3; P =0Æ27), oxygen saturation (95% vs. 97%; P =0Æ06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P =0Æ73), spu- tum neutrophil ratios (29Æ9% vs. 46Æ8%; P =0Æ20), TNF-a (58 pg ⁄ mL vs. 44Æ5 pg ⁄ mL; P =0Æ55) and IL-8 (2Æ7 ng ⁄ mL vs. 2Æ4 ng ⁄ mL; P =0Æ82) levels in induced sputum were similar before and after 12-week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P =0Æ016) and neutrophilic apoptosis in induced sputum decreased (42Æ8% vs. 20Æ2%; P =0Æ03) after withdrawal. Conclusion: In this study, 12 week-withdrawal of inhaled steroid treatment resulted in a signifi- cant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non-CF bronchiectasis was observed. Keywords: apoptosis, bronchial hyperreactivity, bronchiectasis, children, interleukin-8, induced sputum, tumour necrosis factor-a INTRODUCTION Bronchiectasis is a disease of neutrophilic inflam- mation of the lung. Adult patients with bronchiec- tasis, even in stable condition, present an active neutrophilic inflammation in the airways through the presence of myeloperoxidase, tumour necrosis factor-alpha (TNF-a) and interleukin-8 (IL-8) (1). This persistent neutrophilic inflammation is one of the leading causes of bronchial hyperreactivity deteriorating the pulmonary functions in patients with bronchiectasis (2, 3). Although inflammation plays an important role in the pathogenesis of this disease, there is an ongoing debate about the effi- cacy of anti-inflammatory agents, especially inhaled steroids, in the treatment of bronchiectasis. In vitro studies of asthma showed that inhaled steroids improve inflammation by increasing eosinophilic apoptosis (4). There are no data about the influence of inhaled steroids on neutrophilic apoptosis in the management of bronchiectasis in vivo. Received 25 January 2008, Accepted 9 June 2008 Correspondence: T. Guran, MD, Ferah Mahallesi, Taslibayır Sokak, Camlica Ilke 2 Sitesi. No 65 ⁄ 5 34692 Uskudar ⁄ Istanbul, Turkey. Tel.: +902164612597; fax: +902163257217; e-mail: tulayguran@yahoo.com Journal of Clinical Pharmacy and Therapeutics (2008) 33, 603–611 Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Publishing Ltd 603