"Refractory" eosinophilic airway inflammation in severe asthma: effect of parenteral corticosteroids.
It has been suggested that patients with refractory eosinophilic airway inflammation represent a separate "eosinophilic" asthma phenotype associated with increased morbidity and a poor prognosis. To investigate whether persistent eosinophilia in these patients is a fixed feature or can still be modified by treatment, we investigated the effect of high-dose intramuscular corticosteroids on eosinophils in induced sputum. Twenty-two patients with stable severe asthma (15 women, aged 21-73 years) participated in this double-blind, placebo-controlled study. All were using inhaled corticosteroids (> or = 1,600 microg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (> or = 2%). Two weeks after treatment with triamcinolone, but not placebo, sputum eosinophils almost completely disappeared from a median of 12.6-0.2% (p < 0.001). In 82% of patients, no eosinophils could be observed at all. In addition, the rescue medication score decreased from 1.4 to 0.8 (p = 0.01), and FEV1 improved from a median of 73.8-88.3% predicted (p = 0.001). We conclude that persistent sputum eosinophilia despite extensive antiasthma treatment is not a refractory phenomenon but is still sensitive to high-dose systemic corticosteroids. This implies that these patients with severe asthma need additional or alternative antiinflammatory treatment to combat the eosinophilia and associated poor prognosis.
ten Brinke
Anneke
A
Department of Pulmonary Diseases, Leeuwarden Medical Center, The Netherlands.
Zwinderman
Aeilko H
AH
Sterk
Peter J
PJ
Rabe
Klaus F
KF
Bel
Elisabeth H
EH
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology; D001944:Breath Tests; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004802:Eosinophilia / Q000276:immunology*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D013183:Sputum / Q000276:immunology; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D009569:Nitric Oxide