title: Inhaled corticosteroid effects both eosinophilic and non-eosinophilic inflammation in asthmatic patients.
abstract: OBJECTIVE
  To determine induced sputum cell counts and interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-alpha) and leukotriene B4 (LTB4) levels as markers of neutrophilic inflammation in moderate persistent asthma, and to evaluate the response to inhaled steroid therapy.
  
  
  METHODS
  Forty-five moderate asthmatic patients and 10 non-smoker controls were included in this study. All patients received inhaled corticosteroid (800 microg of budesonide) for 12 weeks. Before and after treatment pulmonary function tests were performed, and symptom scores were determined. Blood was drawn for analysis of serum inflammatory markers, and sputum was induced.
  
  
  RESULTS
  Induced sputum cell counts and inflammatory markers were significantly higher in patients with asthma than in the control group. The induced sputum eosinophil counts of 12 patients (26%) were found to be less than 5%, the non-eosinophilic group, and sputum neutrophil counts, IL-8 and TNF-alpha levels were significantly higher than the eosinophilic group (neutrophil, 50+/-14% versus 19+/-10%, p<0.01). In both groups, there was a significant decrease in sputum total cell counts and serum and sputum IL-8, TNF-alpha and LTB4 levels after the treatment. There was no change in sputum neutrophil counts. Although the sputum eosinophil count decreased only in the eosinophilic subjects, there was no significant difference in inflammatory markers between the groups. The symptom scores were significantly improved after treatment, while the improvement did not reach statistical significance on pulmonary function test parameters.
  
  
  CONCLUSIONS
  Notably, in chronic asthma there is a subgroup of patients whose predominant inflammatory cells are not eosinophils. Sputum neutrophil counts and neutrophilic inflammatory markers are significantly higher in these patients. In the non-eosinophilic group, inhaled steroid caused an important decrease in inflammatory markers; however, there was no change in the sputum eosinophil and neutrophil counts.
authors.affiliation: Chest Disease Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. dr_basyigit@yahoo.com
authors.forename: Ilknur
authors.initials: I
authors.lastname: Basyigit
authors.forename: Fusun
authors.initials: F
authors.lastname: Yildiz
authors.forename: Sevgiye Kacar
authors.initials: SK
authors.lastname: Ozkara
authors.forename: Hasim
authors.initials: H
authors.lastname: Boyaci
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ilgazli
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001991:Bronchitis / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D019819:Budesonide / Q000008:administration & dosage* / Q000627:therapeutic use; D004802:Eosinophilia / Q000209:etiology* / Q000473:pathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D013183:Sputum / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D019819:Budesonide