title: Effects of low dose fluticasone/salmeterol combination on surrogate inflammatory markers in moderate persistent asthma.
abstract: BACKGROUND
  Noninvasive surrogate markers provide valuable information on the asthmatic inflammatory process. We wished to examine the effects of low dose fluticasone/salmeterol combination on different commonly used inflammatory markers in moderate persistent asthma.
  
  
  METHODS
  Twenty-five moderate persistent atopic asthmatics were enrolled of whom 20 completed an open label study. Following an initial 4 week steroid washout period in which patients took salmeterol 50 microg dry powder inhaler 1 puff BD, they received the addition of fluticasone as fluticasone 100 microg/salmeterol 50 microg combination dry powder inhaler 1 puff BD for the next 2 weeks. Exhaled nitric oxide, spirometry, methacholine PD20, sputum/blood eosinophils and sputum/serum eosinophil cationic protein (ECP) were measured following the salmeterol only and fluticasone/salmeterol combination treatment periods.
  
  
  RESULTS
  Compared to salmeterol alone (i.e. after the steroid washout), the use of fluticasone/salmeterol combination conferred significant improvements (P < 0.05) in all surrogate markers of inflammation apart from serum ECP. Geometric mean fold changes were 4.3-fold/1.3-fold for sputum/blood eosinophils, 2.2-fold/1.2-fold for sputum/serum ECP, 2.3-fold for methacholine PD20 and 1.8-fold for exhaled nitric oxide.
  
  
  CONCLUSIONS
  Surrogate markers apart from serum ECP may be used as a guide to evaluate the anti-inflammatory effects of low dose inhaled corticosteroids. Sputum markers tend to be more sensitive than blood when assessing the anti-inflammatory response.
authors.affiliation: Asthma & Allergy Research Group; Department of Pathology, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, UK.
authors.forename: G P
authors.initials: GP
authors.lastname: Currie
authors.forename: N J
authors.initials: NJ
authors.lastname: Syme-Grant
authors.forename: L C
authors.initials: LC
authors.lastname: McFarlane
authors.forename: F A
authors.initials: FA
authors.lastname: Carey
authors.forename: B J
authors.initials: BJ
authors.lastname: Lipworth
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000378:metabolism; D001507:Beclomethasone / Q000008:administration & dosage; D015415:Biomarkers / Q000032:analysis; D001798:Blood Proteins / Q000187:drug effects / Q000378:metabolism; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage; D017402:Chlorofluorocarbons / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000187:drug effects / Q000378:metabolism; D000068298:Fluticasone; D005540:Forced Expiratory Flow Rates / Q000187:drug effects; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D016210:Methacholine Chloride / Q000008:administration & dosage; D008875:Middle Aged; D011237:Predictive Value of Tests; D012260:Ribonucleases / Q000187:drug effects / Q000378:metabolism; D000068299:Salmeterol Xinafoate; D012720:Severity of Illness Index; D013147:Spirometry; D013183:Sputum / Q000737:chemistry / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D001798:Blood Proteins; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents; D017402:Chlorofluorocarbons; D047091:Eosinophil Granule Proteins; D016210:Methacholine Chloride; D019819:Budesonide; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D012260:Ribonucleases; D001507:Beclomethasone; D000420:Albuterol