title: Effect of budesonide on the perception of induced airway narrowing in subjects with asthma.
abstract: The perception of bronchoconstriction may be modulated by airway inflammation. However, the effect of inhaled corticosteroid (ICS) treatment on perception in subjects with asthma has received limited study. The aim of this study was to determine the effect of inhaled budesonide on the perception of breathlessness induced by histamine challenge. Thirty-five subjects with poorly controlled asthma were randomized to receive budesonide (1,600 or 3,200 microg/d) for 8 wk, followed by 8 wk at 1,600 microg/d and subsequent downtitration according to a clinical algorithm. Borg scores were recorded during histamine challenges performed at baseline and at 8, 16, 24, 48, and 72 wk. Perception was estimated as the slope of Borg/% fall FEV(1). The Borg/FEV(1) slope increased significantly after 8 wk of budesonide (0.09 [0.08-0.12] to 0.15 [0.11-0.19], p = 0.002), and remained increased compared with baseline values at all subsequent visits. There were no significant differences in Borg/ FEV(1) slope between subjects who were and were not taking ICS at study entry. The magnitude of change in the Borg/FEV(1) slope did not differ significantly between treatment groups and was not related to changes in baseline FEV(1), airway hyperresponsiveness, blood eosinophils, or serum eosinophil cationic protein (ECP). We conclude that treatment with budesonide enhances the perception of airway narrowing, but the effect is unrelated to budesonide dose, or to changes in circulating eosinophil markers.
authors.affiliation: Institute of Respiratory Medicine, University of Sydney, Sydney, New South Wales, Australia. cms@mail.med.usyd.edu.au
authors.forename: Cheryl M
authors.initials: CM
authors.lastname: Salome
authors.forename: Helen K
authors.initials: HK
authors.lastname: Reddel
authors.forename: Sandra I
authors.initials: SI
authors.lastname: Ware
authors.forename: Alyson M
authors.initials: AM
authors.lastname: Roberts
authors.forename: Christine R
authors.initials: CR
authors.lastname: Jenkins
authors.forename: Guy B
authors.initials: GB
authors.lastname: Marks
authors.forename: Ann J
authors.initials: AJ
authors.lastname: Woolcock
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001249:Asthma / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D001294:Attitude to Health; D001798:Blood Proteins / Q000378:metabolism; D016535:Bronchial Hyperreactivity / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology; D019819:Budesonide / Q000008:administration & dosage* / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007249:Inflammation; D018836:Inflammation Mediators / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012260:Ribonucleases; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001798:Blood Proteins; D001993:Bronchodilator Agents; D047091:Eosinophil Granule Proteins; D018836:Inflammation Mediators; D019819:Budesonide; D012260:Ribonucleases