Background: Plasminogen activator inhibitor (PAI)-1 is the main inhibitor of the fibrinolytic system and is known to play an essential role in tissue remodeling. Chronic asthma may lead to tissue remodeling such as subepithelial fibrosis and extracellular matrix deposition in the airways. However, the role of PAI-1 in bronchial asthma is unknown. Our objective is to investigate the correlation between plasma activator inhibitor-1 and childhood bronchial asthma severity, and whether steroid medications could affect its level. The present study included 40 asthmatic children divided into 2 groups (20 patients in each); the asymptomatic group (controlled asthma) where patients were free of symptoms and the symptomatic group, where patients were suffering from acute exacerbation of their asthma and sub-classified into mild and moderate subgroups, each of 10 patients according to severity of acute exacerbation compared to 20 healthy non-asthmatic, age and sex matched. All patients were subjected to full history taking, thorough clinical examinations, peak expiratory flow rate estimation, laboratory investigating: CBC, total serum Ig E, stool analysis and estimation of plasma PAI-1. There was a significant increase of PAI-1 in all asthmatic groups in comparison to control group. The moderate subgroups (A symptomatic and symptomatic) showed highly significant increase in comparison to mild subgroups. On the other hand, there was no significant difference between mild asymptomatic and symptomatic or moderate subgroups to each other. Also there was a significant decrease in PAI-1 levels in patients receiving inhaled corticosteroids than those not receiving inhaled corticosteroids. We conclude that PAI-1 may play an important role in the pathogenesis of asthma and further
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